The effect of a smartphone-based coronary heart disease prevention (SBCHDP) programme on awareness and knowledge of CHD, stress, and cardiac-related lifestyle behaviours among the working population in Singapore: a pilot randomised controlled trial

Research Open Access The effect of a smartphone-based coronary heart disease prevention (SBCHDP) programme on awareness and knowledge of CHD, stress, and cardiac-related lifestyle behaviours among the working population in Singapore: a pilot randomised controlled trial Hui Zhang1, Ying Jiang1, Hoang D. Nguyen2, Danny Chiang Choon Poo2 and Wenru Wang1Email authorView ORCID ID profile Health and Quality of Life Outcomes201715:49 https://doi.org/10.1186/s12955-017-0623-y ©  The Author(s). 2017 Received: 31 August 2016Accepted: 3 March 2017Published: 14 March 2017 Abstract Background Coronary heart disease (CHD) is the most prevalent type of cardiac disease among adults worldwide, including those in Singapore. Most of its risk factors, such as smoking, physical inactivity and high blood pressure, are preventable. mHealth has improved in the last decade, showing promising results in chronic disease prevention and health promotion worldwide. Our aim was to develop and examine the effect of a 4-week Smartphone-Based Coronary Heart Disease Prevention (SBCHDP) programme in improving awareness and knowledge of CHD, perceived stress as well as cardiac-related lifestyle behaviours in the working population of Singapore. Methods The smartphone app “Care4Heart” was developed as the main component of the programme. App content was reviewed and validated by a panel of experts, including two cardiologists and two experienced cardiology-trained nurses. A pilot randomised controlled trial was conducted. Eighty working people were recruited and randomised to either the intervention group (n = 40) or the control group (n = 40). The intervention group underwent a 4-week SBCHDP programme, whereas the control group were offered health promotion websites only. The participants’ CHD knowledge, perceived stress and behavioural risk factors were measured at baseline and on the 4th week using the Heart Disease Fact Questionnaire-2, Perceived Stress Scale, and Behavioural Risk Factor Surveillance System. Results After the SBCHDP programme, participants in the intervention group had a better awareness of CHD being the second leading cause of death in Singapore (X 2  = 6.486, p = 0.039), a better overall CHD knowledge level (t = 3.171, p = 0.002), and better behaviour concerning blood cholesterol control (X 2  = 4.54, p = 0.033) than participants in the control group. Conclusion This pilot study partially confirmed the positive effects of the SBCHDP programme in improving awareness and knowledge of CHD among the working population. Due to the small sample size and short follow-up period, this study was underpowered to detect significant differences between groups. A full-scale longitudinal study is required in the future to confirm the effectiveness of the SBCHDP programme. Keywords mHealthCoronary heart diseaseHealth promotionPrimary preventionWorking population Background The fact that coronary heart disease (CHD) is the most prevalent type of cardiovascular disease (CVD) among adults has become a major concern for public health [1]. It was estimated that eight million people died worldwide due to CHD in 2013 and this figure will continue to increase to 11.1 million by the year 2020 [2]. CHD is projected to remain the number one global killer in the year 2030 [3]. In Singapore, CHD has been the second leading cause of death since 2007, accounting for 15.5% of the total deaths in 2013 [4]. Work-related stress is often found to be associated with CHD [5–7]. In addition, the detrimental effect of CHD on the working population has caused productivity loss and economic burden [8]. Working adults with CHD exhibit poorer work performance, have lower income, and experience job loss because of disease-related diminished work capacity [9]. Premature death of workers caused by CHD is another dire consequence [10]. In Singapore, CHD places a heavy financial burden on working individuals. The cost of medical treatment for a single heart attack episode ranges from 6,000 to 40,000 Singapore dollars [11]. Although CHD affects many aspects of a person’s life, most of its risk factors, such as high blood pressure, abnormal lipid profile, smoking, and physical inactivity, are preventable [12]. Previous studies have reported that working adults lack adequate knowledge and awareness of CHD, and therefore, they were less able to recognise symptoms or adopt a healthy lifestyle to reduce their risks [13–17]. In Singapore, a national survey revealed that 60% of its adult residents exceeded the recommended daily calorie intake, and more than 54% reported that they have never exercised [18]. This calls for a need to develop innovative methods of primary prevention to help the working population prevent CHD. With the rapid evolution of technology in the past decades, mobile health (mHealth), which includes both web-based and smartphone applications (apps), has been increasingly used in chronic disease management [19–22] and health promotion [23–27]. mHealth represents a convenient and accessible way for the public to improve their health and overall welfare. Several studies conducted in Western countries have demonstrated the effectiveness of mHealth in improving self-management skills for people with diabetes [28] and hypertension [29]. The focus in these studies is the use of smartphone technology for delivering self-management education. A recent systematic literature review conducted by Beatty et al. [30] found that three studies had used mobile phone technology for the delivery of cardiac rehabilitation and evaluated health outcomes in patients with CHD [31–33]. These studies supported the feasibility and acceptability of the use of mobile technology in health promotion and disease management. In Singapore, increased smartphone use and a robust 4G network set the foundation for mHealth development [34, 35]. To the best of our knowledge, research has not yet been conducted in Singapore to evaluate the effectiveness of mHealth in improving awareness and knowledge of CHD among the working population. Therefore, this study was designed to examine the feasibility and efficacy of a newly developed 4-week smartphone-based coronary heart disease prevention (SBCHDP) programme in improving awareness and knowledge of CHD, perceived stress as well as cardiac-related lifestyle behaviours among the working population of Singapore. Methods Study design and participants A pilot randomised controlled trial (RCT) was conducted in Singapore. Ethical approval was sought from the Internal Review Board of the National University of Singapore before the actual launch of the study (NUS-IRB reference code: B-15–059). The participants were recruited from various institutions or companies through a poster advertisement. Working individuals who were English speakers, had a full-time job, were aged 21–65 years old, and used smartphones were recruited. Those who had heart diseases, worked in a hea (...truncated)