Heartwired for change Advancing the implementation of complex eHealth interventions and lifestyle change in routine cardiac care

The research presented in this thesis examines how lifestyle change and complex eHealth interventions can be implemented in routine cardiac care. Cardiovascular diseases are often associated with lifestyle factors such as smoking, physical inactivity, and an unhealthy diet. However, initiating and maintaining lifestyle change is complex, with psychological, social, and organisational factors playing a role. This thesis therefore focuses on supporting patients in lifestyle change, implementing digital health innovations, and integrating psychosocial care.
The first part examines how brief lifestyle advice and linking personal life goals to health goals may influence cardiac patients’ intention-to-change-lifestyle. The second part focuses on the implementation of the BENEFIT programme, a complex eHealth intervention developed within a public-private partnership. Using implementation science frameworks, strategies are developed and evaluated to identify and address barriers, including role ambiguity, stakeholder alignment, and integration into existing workflows. The third part examines, from the perspective of psychologists working in medical settings, factors influencing the acceptance and implementation of internet-based cognitive behavioural therapy as psychosocial support for chronic conditions.
Taken together, the findings indicate that sustainable change in cardiac care depends not only on individual motivation or the quality of digital health innovations. Communication, stakeholder involvement, feasible implementation strategies, attention to psychosocial needs, digital inclusion, and alignment with clinical practice are also important. Moreover, the findings underscore that lifestyle change should not be approached solely as an individual responsibility, but requires attention to the social, organisational, and societal context in which patients live and receive care. As such, this thesis provides directions for sustainable implementation of lifestyle-oriented and digital care.