A virtual community of practice to empower patients with recent ischemic heart disease: A randomized controlled trial.

Ana Isabel Gonzalez- Gonzalez, Helena Vall, Vanesa Ramos-García, Amado Rivero-Santana, Alezandra Torres, Patricia Cifuentes, Débora Koatz, Javier García-García, Valeria Pacheco-Huergo, Pau Rello, Anthea Santos, Alba Campillejo, Sofía Garrido-Elustondo, Marcelo San Martín, Lilisbeth Perestelo-Pérez, Carola Orrego

Keywords: Virtual Community of Practice, Ischemic Heart Disease, Patient Activation, Self-Management

Background:

Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide. Effective self-management and patient activation are critical for improving health outcomes. Virtual communities of practice (vCoPs) are emerging as promising tools to foster patient empowerment, but their effectiveness in chronic disease management remains under-explored.

Research questions:

1. Can participation in a vCoP improve patient activation levels in individuals with recent IHD?
2. How does the vCoP affect secondary outcomes such as adherence to the Mediterranean diet, physical activity, mental health, and quality of life?
3. What are the mechanisms that drive behavioral change within a vCoP?

Method:

This multicenter, pragmatic randomized controlled trial (RCT) enrolls 282 participants with recent IHD from Madrid, Catalonia, and the Canary Islands. Participants are randomized into two groups: a vCoP intervention group and a control group receiving usual care. The intervention leverages a gamified platform delivering educational content, interactive challenges, and moderated discussions. Outcomes include patient activation (primary) and secondary metrics such as dietary adherence, physical activity, mental health, and quality of life. Data collection spans baseline, 6, 12, and 18 months. Statistical analyses involve multilevel linear regression to assess intervention effects.

Results:

Significant differences in adherence to the Mediterranean diet were observed in favor of the intervention at 6, 12, and 18 months (B = 0.86, 95% CI [0.36, 1.35]). However, no significant changes were found for patient activation or other outcomes.

Conclusions:

The vCoP intervention effectively improved adherence to the Mediterranean diet but did not enhance patient activation or quality of life. High dropout rates introduce uncertainty, highlighting the need for further research to identify mechanisms driving behavioral changes in vCoPs.

Points for discussion:

How can participant engagement in vCoPs be improved to minimize dropout rates and maximize intervention effectiveness?

What factors within the vCoP contributed to improved dietary adherence, and how can these be leveraged to enhance other outcomes like patient activation?

How can vCoPs complement existing healthcare models and be scaled to support chronic disease management in diverse settings?

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