Background: The importance of patient and public involvement (PPI) in research is increasingly acknowledged. PPI is a collaborative approach in which research is conducted with or by end-users. It can enhance research quality and benefit the involved end-users. However, involving end-users in the non-linear and often interdisciplinary process of eHealth development can be challenging. While many resources on PPI exist, a functional and practical overview tailored to eHealth research is lacking. This paper presents a step-by-step approach to support PPI implementation in eHealth intervention research. Methods: Three (ongoing) eHealth projects, each targeting a different population and applying different forms of PPI, informed the approach development. It was iteratively refined based on insights gained from these projects and feedback from other researchers and end-users involved in one of the projects. Results: A six-step approach was developed, each step accompanied by reflective questions to support preparation and evaluation. The steps are: (1) Where in the eHealth evaluation cycle is your research project positioned?; (2) Why do you want to use PPI?; (3) Who is your target population?; (4) How are you going to achieve your aims?; (5) What considerations and conditions need to be taken into account to facilitate PPI?; (6) How did the PPI process unfold? Each step includes recommendations, lessons learned, case examples, and relevant resources (e.g., literature, websites). Conclusion: The approach integrates literature with practical, field-based insights. We hope that the approach inspires and supports researchers in implementing meaningful PPI in research. ... Read more

Background: Mobile health (mHealth) interventions with virtual coaches offer scalable and potentially cost-effective solutions for health behavior change. However, these interventions commonly present challenges, such as limited personalization and insufficient grounding in evidence-based strategies. Perfect Fit (PF; Perfect Fit consortium), a personalized mHealth intervention with a text-based virtual coach, supports adults in quitting smoking and becoming more physically active. By combining innovative techniques, including sensor technology, end user involvement, and evidence-based strategies, PF aims to address common challenges faced by mHealth interventions, including those with virtual coaches. Objective: The study primarily investigated the feasibility and acceptability of PF. The secondary aim was to explore associations between sociodemographic, smoking-, and physical activity–related characteristics and the feasibility and acceptability outcomes. The third aim was to evaluate the feasibility of conducting the research study. Methods: A single-arm, pre-post, mixed methods study was conducted in the Netherlands with 100 adults who smoked. The intervention lasted approximately 16 weeks. Data were collected at baseline, during the intervention, and postintervention (4 months). Quantitative data included usage data and self-report questionnaires on feasibility, acceptability, and baseline characteristics. Qualitative data were gathered through postintervention semistructured interviews. Analyses included descriptive and inferential analyses, as well as the framework approach for the qualitative data. Results: PF usage varied considerably across participants (n=87). The mean satisfaction rating was 2.79 (SD 0.73; scale range 1‐4), and perceived usability had a median score of 67.50 (range 12.50‐87.50; scoring range 0‐100), indicating OK-to-good usability. The mean virtual coach acceptance rating was –0.27 (SD 1.30; scale range −3 to 3; n=77). Higher PF usage was associated with greater satisfaction, usability, and coach acceptance (all P≤.004). Frequent connection issues with the smartwatch were a disruptive factor. Qualitative findings (n=12) provided in-depth insights into PF’s feasibility and acceptability, encompassing both positive and negative experiences. For instance, some participants valued the virtual coach for its anonymity, low-threshold access, and the sense of control it offered, while others preferred a human coach for greater accountability. Suggested improvements included more varied content and enhanced adaptability of the coach to users’ input and personal situations. Exploratory analyses suggested that high PF users were older than moderate (P=.01) and low PF users (P=.05). Importantly, PF was perceived as similarly feasible and acceptable across socioeconomic groups (P>.05), aligning with one of the project’s goals. Finally, research procedures and recruitment strategies proved feasible. Conclusions: PF shows potential as an accessible and inclusive strategy for multiple health behavior changes, contributing to public health. Findings highlight areas for improvement and can guide the future development of virtual coach interventions. ... Read more

Background
To improve lifestyle guidance within cardiac rehabilitation (CR), a comprehensive understanding of the motivation and lifestyle-supporting needs of patients with cardiovascular disease (CVD) is required.

Objectives
This study's purpose is to evaluate patients’ lifestyle and their motivation, self-efficacy and social support for change when starting CR.

Methods
1782 CVD patients (69 % male, mean age 62 years) from 7 Dutch outpatient CR centers participated between 2020 and 2022. Modifiable risk factors were assessed with a survey and interviews by healthcare professionals during CR intake.

Results
Most patients exhibited an elevated risk in 3–4 domains. Elevated risks were most prominent in domains of (1) waist circumference and BMI (2) physical exercise (3) healthy foods intake and (4) sleep duration. Most patients chose to focus on increasing physical exercise, but about 20 % also wanted to focus on a healthy diet and/or decrease stress levels. Generally, motivation, self-efficacy and social support to reach new lifestyle goals were high. However, patients with an unfavorable risk profile had lower motivation and self-efficacy to work on lifestyle changes, while patients with lower social support had a higher chance to quit the program prematurely.

Conclusions
Our results underscore the need to begin CR with a comprehensive lifestyle assessment and highlight the importance of offering lifestyle interventions tailored to patients’ specific modifiable risk factors and lifestyle-supporting needs, targeting multiple lifestyle domains. Expanding the current scope of CR programs to address diverse patient needs and strengthening support may enhance motivation and adherence and lead to significant long-term benefits for cardiovascular health. ... Read more