# Cardiac Self-Efficacy Improvement in a Digital Heart Health Program: Secondary Analysis From a Feasibility and Acceptability Pilot Study

## TL;DR

A digital heart health program improved participants' confidence in managing their cardiovascular disease risk over two months.

## Contribution

Demonstrated that a digital lifestyle program can significantly boost cardiac self-efficacy in a scalable way.

## Key findings

- Total CSE Scale score increased by 12.9% after two months (P<.001).
- All 9 CSE Scale items showed significant increases in confidence (all P<.001).
- Largest gains were in knowing when to seek medical help and understanding physical activity needs.

## Abstract

Lifestyle modification programs play a critical role in preventing and managing cardiovascular disease (CVD). A key aim of many programs is improving patients’ self-efficacy. In-person lifestyle modification programs can enhance self-efficacy in managing CVD risk, also known as cardiac self-efficacy (CSE). However, such programs are typically staffing and resource intensive. Digital lifestyle modification programs may offer a scalable and accessible way to improve CSE, but this has not been shown in prior research.

This study examined changes in CSE among individuals using a digital lifestyle modification program for cardiovascular health. Evaluation of improvement in CSE was a secondary goal of a feasibility and acceptability pilot study of a digital program for Heart Health.

Participants were individuals with elevated risk for CVD who enrolled in a 90-day pilot study that involved mobile app–based, artificial intelligence–powered health coaching and educational lessons focused on behaviors that promote cardiovascular health. Participants completed the 9-item CSE Scale at baseline and in month 2. Changes in confidence in participants’ ability to manage their cardiovascular health were assessed.

The sample included 273 (n=207, 61.2% female; mean age 59.3, SD 10.1 years) participants who submitted a complete CSE Scale at baseline and in month 2. The total CSE Scale score increased by 12.9% (P<.001) from baseline to month 2. Additionally, there were significant increases in mean score on each of the 9 individual CSE Scale items (all P<.001), with the largest increases in confidence “in knowing when to call or visit the doctor for your heart disease” (17% increase; P<.001), “in knowing how much physical activity is good for you” (16.3% increase; P<.001), and “that you can get regular aerobic exercise” (19% increase; P<.001).

The present analyses indicate that participants in a digital lifestyle modification program for cardiovascular health showed significant improvements in CSE within 2 months. This work adds to the growing literature examining ways to improve health-related self-efficacy and scalable access to programs for prevention and management of CVD.