The HEALERS: A Patient, Community, and Stakeholder Advisory Board Focus Group Series to Refine a Novel Virtual World-Based Cardiac Rehabilitation Intervention and Clinical Trial

Helayna Abraham¹Grace Patrice Anyetei-Anum²Ashton Krogman³Donald Clark III⁴Melvin Echols⁵Michael E. Hall⁴Karen Hodgman³Brian Kaihoi⁶Stephen Kopecky³Shawn Leth³Shaista Malik⁷Jill Marsteller⁸Lena Mathews⁹Robert Scales¹⁰Phillip Schulte¹¹Adam Shultz³Julie Becker³Bryan Joseph Taylor¹²Randal Thomas³Nathan D Wong⁷Thomas P Olson³LaPrincess Brewer^13,3*

• ¹Department of Internal Medicine, Division of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX, United States
• ²Alix School of Medicine, College of Medicine and Science, Mayo Clinic, Rochester, Michigan, United States
• ³Department of Cadiovascular Medicine, Mayo Clinic, Rochester, Michigan, United States
• ⁴Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, United States
• ⁵Department of Cardiovascular Medicine, Morehouse School of Medicine, Atlanta, GA, United States
• ⁶Global Products and Services, Mayo Clinic Center for Innovation, Rochester, MN, United States
• ⁷Division of Cardiology, Department of Medicine, School of Medicine, University of California, Irvine, Irvine, United States
• ⁸Center for Health Services and Outcomes Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
• ⁹Division of Cardiology, Johns Hopkins School of Medicine, Baltimore. MD, United States
• ¹⁰Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Phoenix, AZ, United States
• ¹¹Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States
• ¹²Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Jacksonville, FL, United States
• ¹³Center for Clinical and Translational Science, Mayo Clinic, Rochester, Michigan, United States

BackgroundCardiac rehabilitation (CR) is a widely underutilized secondary cardiovascular disease prevention strategy, due to a variety of barriers to participation that disproportionately impact women, minoritized racial and ethnic groups, and patients with low socioeconomic status. Destination Cardiac Rehab, a virtual world-based CR (VWCR) program designed by our team in collaboration with patients and community members to mitigate the barriers to CR participation, has demonstrated feasibility and acceptability. In anticipation of a randomized controlled trial (RCT) to further validate the intervention, this qualitative descriptive analysis provides insights garnered from a patient/community/stakeholder-advisory board (PCS-AB, HEALERS) focus group series, convened to inform iterative refinements to a RCT protocol. Methods and ResultsHEALERS participated in five 90-minute virtual focus group sessions to provide feedback on various aspects of the VWCR intervention and the recruitment/retention strategies. Major themes were identified from participant feedback to inform revisions to the trial protocol. Illustrative quotes were selected to represent each theme. Twenty-two members were recruited with diverse sociodemographic and personal/professional backgrounds (mean age 59.3 ± 13 years, 50% female). Regarding trial recruitment, members recommended effective communication strategies, recruitment video suggestions, and expansion of recruitment settings. HEALERS emphasized the importance of feeling safe during exercise and social support in designing an effective VWCR intervention. Lastly, they identified reminder messages, tangible incentives, and fostering positive relationships with the CR staff as important retention tools. ConclusionsA diverse PCS-AB was convened to better understand community needs to improve the patient-centric nature of Destination Cardiac Rehab in anticipation of an upcoming RCT. The HEALERS offered valuable insights that informed actionable changes to the RCT protocol.