Development of an online psychological intervention to prevent depression in patients with atrial fibrillation: lessons learned in a user-centered design study

Charlotte Helmark; Robert Ahm; Axel Brandes; Søren J Skovbakke; Jens Cosedis Nielsen; Lisbeth Frostholm; Rod S Taylor; Susanne S Pedersen

doi:10.1186/s40814-024-01586-1

Development of an online psychological intervention to prevent depression in patients with atrial fibrillation: lessons learned in a user-centered design study

Pilot Feasibility Stud. 2025 Jan 6;11(1):2. doi: 10.1186/s40814-024-01586-1.

Authors

Charlotte Helmark^{1

2}, Robert Ahm³, Axel Brandes⁴, Søren J Skovbakke³, Jens Cosedis Nielsen⁵, Lisbeth Frostholm⁶, Rod S Taylor^{3

7}, Susanne S Pedersen^{3

8}

Affiliations

¹ Department of Cardiology, Zealand University Hospital, Roskilde, Denmark. kche@regionsjaelland.dk.
² Department of Psychology, University of Southern Denmark, Odense, Denmark. kche@regionsjaelland.dk.
³ Department of Psychology, University of Southern Denmark, Odense, Denmark.
⁴ Department of Cardiology, Department of Regional Health Research, University of Southern Denmark, EsbjergHospital-University Hospital of Southern , Denmark.
⁵ Department of Cardiology, Department of Clinical Medicine, Aarhus University Hospitaland, Aarhus University , Aarhus, Denmark.
⁶ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁷ School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland.
⁸ Department of Cardiology, Odense University Hospital, Odense, Denmark.

Abstract

Background: Approximately 30% of patients with atrial fibrillation suffer from depression. Depression in patients with atrial fibrillation is associated with poor health outcomes, reduced health-related quality of life, and elevated societal costs. Preventing depression in this population may therefore lead to better health outcomes for the individual patient and reduced burden on society. Online psychological interventions are innovative and evidence-based modes of healthcare delivery. The objective was-through a user-centered design-to develop a personalized online psychological intervention aiming at preventing depression in patients with atrial fibrillation.

Methods: Guided by the Intervention Mapping framework for the development of complex interventions, we used a qualitative design and conducted a series of collaborative workshops with patients (n = 8) with atrial fibrillation.

Results: Through intensive collaboration, we developed the HOPE-AF intervention targeting nine risk factors for depression that were meaningful to patients. It contains four basic modules that give effective tools to handle daily psychological struggles. Furthermore, patients will receive personal risk factors modules. The evidence-based psychological methodology was applied to all modules. Primary lessons learned were (1) engaging patients from the start to ensure the intervention becomes meaningful; (2) using positive phrasing in all patient-related materials to promote motivation; (3) incorporating patients' choice of preference where possible to personalize the intervention.

Conclusion: Based on a user-centered design, the HOPE-AF intervention aiming to prevent depression in patients with AF, was developed. It was confirmed that it is crucial to engage end-users in the development of complex interventions to accommodate their needs and preferences. The Hope-AF intervention will now be tested in a feasibility study.

Keywords: Atrial fibrillation; Depression; EHealth; Patient engagement; Prevention; User-centered design.