Digital health readiness, health literacy, and patients' awareness in cardiac (tele)rehabilitation participation
Authors: Kizilkilic S E , Xu L , Van Erum H , Falter M , De Pauw M , Dendale P , Kindermans H 
Published: June 2024

Abstract

Background
Cardiac telerehabilitation is proven to be equally safe and effective as center-based cardiac rehabilitation. Nevertheless, some real-world barriers significantly impact the adoption and successful implementation of cardiac rehabilitation as well as cardiac telerehabilitation.

Purpose
This study assesses willingness and actual participation in cardiac (tele)rehabilitation, examining key influencing factors (i.e. digital health readiness, health literacy, patients’ awareness). It explores the relation between digital health readiness and patients’ awareness concerning their intention to participate in cardiac telerehabilitation. Additionally, it investigates the relation between intention and actual participation in cardiac rehabilitation, considering the impact of health literacy and patients’ awareness.

Methods
In this prospective single-center survey study, patients with cardiovascular disease were asked to fill in questionnaires. Digital health readiness was measured by Digital health readiness questionnaire (DHRQ), and health literacy was assessed with the Health Literacy Scale (HLS-EU). Patients' awareness of their cardiovascular disease was determined by the accuracy of their understanding of their specific cardiovascular condition.

Results
A total of 72 patients (mean age 62.7 ± 13.3; 33.3% is women) were included in this survey. 81.7% and 50% patients have respectively the intention to participate in cardiac rehabilitation and telerehabilitation. Additionally, 50,7% patients actually participated cardiac rehabilitation. There is a negative correlation between age and digital health readiness (r = -0.05, p &lt; 0.001)/learnability ( r= -0.26, P = 0.025). There is no correlation between digital health readiness (r= 0.011, P= 0.931) and patients’ awareness with the intention to participate in cardiac telerehabilitation (r = -0.045, P = 0.733). Furthermore, there is also no correlation between health literacy (r = 0.196, P= 0.123) and patients’ awareness (r = 0.002, P = 0.086) with the intention to participate in cardiac rehabilitation. Lastly, no correlation between health literacy and actual participation in cardiac rehabilitation is detected (r = -0.115, P = 0.375), but it has been established that there is a relationship between patients’ awareness and actual participation in cardiac rehabilitation (r = -0.266, P = 0.033).

Conclusion
Cardiovascular patients express a moderate intention to participate in cardiac terehabilitation, and there is no relation between digital health readiness and this intention, suggesting that digital health readiness is not a barrier to the willingness to participate cardiac telerehabilitation. Additionally, higher levels of patients’ awareness of their cardiovascular disease appears to result in increased engagement in cardiac rehabilitation program. However, further research is necessary to explore the barriers in participation to cardiac (tele)rehabilitation.