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Engaging older people in an internet platform for cardiovascular risk self-management: a qualitative study among Dutch HATICE participants
  1. Tessa van Middelaar1,2,
  2. Cathrien R L Beishuizen1,
  3. Juliette Guillemont3,
  4. Mariagnese Barbera4,
  5. Edo Richard1,2,
  6. Eric P Moll van Charante5
  7. on behalf of the HATICE consortium
    1. 1 Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
    2. 2 Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
    3. 3 Epidemiology and Public Health, University of Toulouse, Toulouse, France
    4. 4 Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
    5. 5 Department of General Practice, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands
    1. Correspondence to Tessa van Middelaar; t.vanmiddelaar{at}


    Objectives To study older peoples’ experiences with an interactive internet platform for cardiovascular self-management, to assess which factors influence initial and sustained engagement. To assess their views on future use within primary care.

    Design Qualitative semistructured interview study, with thematic analysis.

    Setting Primary care in the Netherlands.

    Participants People ≥65 years with an increased risk of cardiovascular disease who used the ‘Healthy Ageing Through Internet Counselling in the Elderly’ internet platform with remote support of a coach. Participants were selected using a purposive sampling method based on gender, age, level of education, cardiovascular history, diabetes, duration of participation and login frequency.

    Results We performed 17 interviews with 20 participants, including three couples. In the initial phase, platform engagement was influenced by perceived computer literacy of the participants, user-friendliness, acceptability and appropriateness of the intervention and the initial interaction with the coach. Sustained platform use was mainly facilitated by a relationship of trust with the coach. Other facilitating factors were regular automatic and personal reminders, clear expectations of the platform, incorporation into daily routine, social support and a loyal and persistent attitude. Perceived lack of change in content of the platform could work both stimulating and discouraging. Participants supported the idea of embedding the platform into the primary care setting.

    Conclusions Human support is crucial to initial and sustained engagement of older people in using an interactive internet platform for cardiovascular self-management. Regular reminders further facilitate sustained use, and increased tailoring to personal preference is recommended. Embedding the platform in primary healthcare may enhance future adoption.

    Trial registration number ISRCTN48151589; Pre-results.

    • ehealth
    • prevention and control
    • primary healthcare
    • cardiovascular diseases
    • qualitative research
    • implementation

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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    • Contributors TvM and CRLB: study design, data acquisition, data analysis, data interpretation and drafting of the manuscript. JG and MB: data interpretation and critical revision of the manuscript. ER and EPMvC: study design, data interpretation and critical revision of the manuscript.

    • Funding The HATICE trial is funded by the European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement no 305374. TvM was supported by an EU Joint Programme—Neurodegenerative Disease Research (JPND) project. The project is supported through the following funding organisations under the aegis of JPND— Finland, Suomen Akatemia (Academy of Finland, 291803); France, L’Agence Nationale de la Recherche (The French National Research Agency, ANR-14-JPPS-0001-02); Germany, Bundesministerium für Bildung und Forschung (BMBF) (The Federal Ministry of Education and Research, FKZ01ED1509); Sweden, Vetenskapsrådet (VR) (Swedish Research Council, 529-2014-7503); The Netherlands, ZonMw (The Netherlands Organisation for Health Research and Development, 733051041).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Medical Ethics Committee of the Academic Medical Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data will not be made publicly available. For more information, please contact the corresponding author.

    • Collaborators Academic Medical Center (AMC), Amsterdam, The Netherlands: ER, Willem A. van Gool, EPMvC, CRLB, Susan Jongstra, TvM, Lennard van Wanrooij and Marieke Hoevenaar-Blom; University of Eastern Finland (UEF), Kuopio, Finland: Hilkka Soininen, Tiia Ngandu and MB; Karolinska Institutet/Stockholm University, Stockholm, Sweden: Miia Kivipelto and Francesca Mangialasche; INSERM, University of Toulouse, Toulouse, France: Sandrine Andrieu, Nicola Coley and JG; NOVAPTEN, Paris, France: Yannick Meiller; VitalHealth Software, Ede, The Netherlands: Bram van de Groep; Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK: Carol Brayne.

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