A qualitative exploratory study of user experience with a peer-support based,self-management website for people with a cardiovascular condition and diabetes

Abstract

Background

Cardiovascular disease and Type 2 diabetes are two serious chronic health conditions that impact patients, families, and health services. Patients who experience both conditions can struggle to access relevant programmes to guide and educate them on successful self-management. Peer support has been proven to assist patients in managing these dual conditions, but the experience of using an online platform has not been previously explored.

Aim

To understand the experience of using a theory-based, peer-support, self-management website for people with cardiovascular and diabetes conditions in an Australian regional health service.

Design

An exploratory qualitative study was undertaken. Our study is reported according to COREQ guidelines.

Methods

Data were collected via online, semi-structured interviews approximately one week after participants were asked to engage with the website. Interviews were conducted to focus on the user experience, feasibility and usefulness of accessing the website, and how it helped support development of self-management skills. Interview data were transcribed from audio recordings into text files, thematic analysis was conducted for evolving themes.

Results

Fifteen participants agreed to be interviewed for the study. Findings revealed that participants found the website useful for providing relevant, comprehensive, and reliable online health information to help them manage their comorbidities. Participants appreciated the opportunity to share their experiences with others, and some expressed their interest in becoming peer supporters, to help others who might be trying to manage similar comorbidities.

Conclusion

Users’ experience of the peer-support, web-based programme was positive overall and supported the physical and emotional well-being of the participants, who were trying to manage two complex chronic health conditions. Considerations for further development are reported on.

Keywords

Peer support website cardiac diabetes qualitative

Introduction

Cardiovascular disease (CVD) and diabetes are prevalent among Australians, with 1.3 million of approximately 6.7% of Australians aged 18 and over reported to have CVD and an estimated 5.1% of 1.3 million Australians are affected by diabetes.¹ Additionally, the number of cases of type 2 diabetes (T2D) mellitus has been growing steadily over time.² Management of both medical conditions puts increased pressure on healthcare expenditure in Australia, and an estimated 9.5% of total allocated expenditure in the Australian health system ($14.3 billion) was attributed to CVD in 2020–2021, and 2.3% ($3.4 billion) was attributed to diabetes.³

Evidence reveals that cardiac rehabilitation⁴ and diabetes self-management programmes⁵ are effective in decreasing hospital re-admission rates, promoting positive lifestyle change and improving health-related quality of life. Self-management interventions equip individuals with health-related knowledge and skills to actively manage their symptoms and treatment^6,7 and have demonstrated positive impacts on health outcomes for patients with cardiac and diabetes conditions.^6,8 Successful self-management can minimise the risk of developing potentially devastating complications, and have positive effects on physical well-being, such as controlled blood glucose levels and blood pressure, and increased exercise capacity.^9–11

Engaging and empowering people diagnosed with cardiac and diabetes comorbidities in self-management interventions remains a major challenge.^12,13 Some patients report difficulties in accessing centre-based rehabilitation programmes due to geographical distance and location, transportation challenges and other logistical costs and limitations.^12,13 A more feasible and flexible delivery model is therefore needed. Web-based programmes, as part of a flexible delivery model, enable extended reach and options to people who cannot attend traditional, in-person rehabilitation programmes. As demonstrated during the COVID-19 pandemic, internet access reduces the barrier of physical distance in healthcare provision, and it was recognised in 2021 data that 99% of Australian adults had access to the internet.¹⁴ Currently there are digital cardiac rehabilitation and diabetes management programmes available in Australia for separate conditions. A systematic review and meta-analysis¹⁵ shows such programmes can reduce re-hospitalisations in patients with coronary artery disease, and the diabetes programmes have been shown to improve health outcomes for patients with diabetes.¹⁶ Evidence indicates that online interventions are effective in supporting behaviour change, reducing risk factors, and helping people to better manage their health conditions at home.¹⁷ This, therefore, provides an impetus to leverage online platforms.

Self-management interventions incorporating peer support are recognised as an important strategy to promote positive health outcomes and reduce the impact of chronic disease.¹⁸ Peer support is about sharing experiences and feelings with others, especially during one's difficult times. Peer supporters are individuals who share similar experiences and knowledge of a health condition and are trained to not only assist patients with knowledge and skill acquisition, but also provide social support, and encourage patients to take active responsibility for their own disease management.¹¹ They also help establish connections for patients based on seeking, receiving and providing practical, emotional and social assistance in better coping with the health condition.¹⁰ Through the emotional, social, and informational support from the peer, patients with chronic medical conditions can feel less alone psychologically and obtain more knowledge and skills to manage the challenges caused by their medical condition. As a result, outcomes such as improved knowledge, and increased self-efficacy and resilience can be achieved.¹⁹ Unlike the support from family members who may not have the full understanding and health professionals who may not have time to provide a full explanation about living with a chronic medical condition, peer support allows people to share experiences, concerns, feelings, insights and tips for facing challenges, and developing skills, with each other. Subsequently, patients and peer-supporters can learn from each other in order to make living with their chronic medical conditions easier, better, and more comfortable. Peer supporters are typically a low-cost component of disease management.²⁰

The majority of peer support programmes target people with a single medical condition, such as diabetes, cancer or heart disease only.¹¹ However, it is common for people to have more than one chronic medical condition, especially people with diabetes, who have a higher risk of other health complications. Despite the growing number of people who have one or more chronic medical conditions, peer support amongst populations with comorbidities has received less attention to date. With CVD and diabetes, one condition can be associated with, or exacerbate, the presence of the other. Since people with diabetes have higher blood pressure and cholesterol levels, there is a higher chance for people with diabetes to also have CVD. The support from peers with a single medical condition may not be the right fit for those with more than one medical condition, as no medicine can cure all illnesses. Hence, for patients with comorbidities, it is important to have support from peers with comorbidities. Therefore, there is a need to provide programmes that cater to patients with comorbidities. Additionally, web-based peer-support programmes have been gaining popularity among people with chronic conditions. While the potential of peer-to-peer support is evident, to our knowledge, peer support via an online platform has not been explored in populations with cardiovascular and diabetes comorbidities.

Aim

This study aimed to understand the experience of using a theory-based, peer-support, self-management website for people with cardiovascular and diabetes conditions in an Australian regional health service.

Methods

Design and settings

An exploratory qualitative study design was undertaken using semi-structured interviews.²¹ This research design and methods enabled participants to express their perspectives on using the peer-support website called ‘Peer2Support Health’, and comment on the layout, evidence-based content, usability, and accessibility of the site. Data were collected at a regional tertiary hospital and health service in Australia. Our study is guided by following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.²²

Website development

How: The website was developed by a multidisciplinary team consisting of professional web application developer, cardiologist, endocrinologist, allied health professionals (physiologist, cardiac rehabilitation coordinator, Diabetes Educator), and a professional graphic designer. The prototype included contents, layout, colour, font, images were appraised by the experts.

Format and access: The format comprised case studies, video clips and quizzes at the end of the website for participants to reflect on their experiences. The website was developed to ensure users can work through different parts of the website at their own pace. A regular tracking feature was applied so that the developers could identify how frequently participants accessed the site as well as the time spent engaged with the site. The website was accessible to participants by QR code, or URL (website link) using a smart phone, tablet or computer, but these devices were only available to participants and researchers, specifically for the purpose of the study.

Content: The content of the website was refined from our previous peer support manual²³ based on Bandura's Self-Efficacy model,²⁴ for patients with cardiac and diabetes self-management programmes. The content comprised information about the purpose of the ‘Peer2Support Health’ website, the role of being a peer supporter, information about heart disease and diabetes including education and management advice for both conditions, as well as skills for being an effective peer supporter with activities to master skills, using role-play techniques. We also included a section about key features of peer support, as well as the essential requirements of ensuring confidentiality for peer supporters.

Ethical considerations

Full ethical approvals and research agreements for this study were obtained from the Metro North Health and the University of the Sunshine Coast Human Research Ethics Committees (LNR/2020/QRBW/65608 and A201440). This study was conducted in compliance with the World Medical Association Declaration of Helsinki. Written informed consent from individual participant was obtained prior to data collection. Interview data were stored on a secure university server with strict access to authorised research personnel only. Data were non-identifiable, and pseudonyms were assigned.

Recruitment and data collection

Following all ethical and hospital governance approvals, participants were selected using purposive sampling methods.²⁵ Inclusion criteria were people with a cardiac condition and T2D, who had access to a device with internet, such as a smartphone, tablet or computer. Exclusion criteria included patients who are critically ill, did not have access to internet. The potential participants were identified by a member of the clinical team who had access to clinical notes when the patients visited for their hospital outpatient appointment. Our trained research assistant contacted the clinical team member for any potential participants. The research staff then confirmed the eligibility prior to approaching patients and asking if they wished to participate in the study. Patients were approached after seeing their doctor. Our trained research staff then confirmed the eligibility prior approaching the patients. After written informed consent was obtained, participants were provided with instructions for accessing the website. Access to the website was through a password-protected link provided directly to participants.

Participants who had used the website for a week, and we used our tracking features to see if patients had used the website before inviting them to take part in semi-structured interviews. Due to the broad geographic area where the participants lived, the interviews were conducted online. An interview guide was developed and reviewed by our experienced qualitative researcher C-JW and MR. The interviews were conducted by the doctoral qualified principal researcher who has a nursing background, experience in undertaking qualitative research, as well as extensive clinical experience in caring for patients with comorbidities of cardiac and diabetes conditions. The interviewer was not involved in the participant's care. Each interview lasted between 30–40 minutes and was digitally audio recorded. Interviews were focused on to the users’ confidence in using the website, how the information provided influenced their self-management of their conditions, the overall feasibility of online access, and the usefulness of the peer support information toward improving their self-efficacy for managing their conditions. Saturation of data was ‘Saturation of data was determined when no new content was discussed by participants in the final two interviews’.²⁶ A systematic review shows sample size for similar qualitative studies can range from 5 to 24.²⁶

Data analysis

Interview data were audiotaped and transcribed in full and NVivo V14 Qualitative software was used to support the analysis, storage and coding of transcripts. Thematic analysis²⁷ was conducted and guided by Bandura's Self-Efficacy theory.²⁴ The theory suggests that performance accomplishments, vicarious experience, verbal persuasion and emotional arousal are sources which can improve an individual's self-efficacy for a specific task. Additionally, people who believe themselves as able to succeed in a particular task, are more likely to be motivated to change their behaviour to accomplish the task.²⁴ The theory has been used to support our previous studies on of self-management programmes.^23,28

The interview data were transcribed by a trained assistant. The primary researcher read the transcripts several times and compared identified categories with the NVivo analysis. Codes were then grouped into conceptual themes with supporting quotes extracted. Another researcher repeated the coding process and once the coding process was agreed upon, categories were developed. These were further discussed with co-authors to reach a consensus. The meanings were validated with participants to ensure their meanings were appropriately presented. Trustworthiness²⁹ was ensured during the study through strategies such as two experienced researchers undertaking coding, analysis and interpretation of themes, with consensus approach used to finalise these. Reflexivity was supported through use of individual diaries to reflect our own values and preconceptions and how these might have influenced our decisions.

Findings

Participants

A total of 15 participants were interviewed, aged from 35 to over 85 years. A majority of participants were males (n = 10, 76.9%). See Table 1: Characteristics of the participants.

Table 1.

Characteristics of the participants.

Participant ID	Age	Sex (self-reported)	Years of being diagnosed with CVD-T2D
01	37	Male	3
02	41	Male	8
03	53	Male	4
04	54	Male	5
05	46	Male	7
06	72	Male	12
07	85	Female	11
08	77	Female	13
09	63	Male	9
10	56	Male	14
11	63	Female	5
12	74	Female	7
13	76	Male	12
14	59	Male	8
15	63	Female	3

Developed themes

Participants shared their perceptions of managing their own health, along with their experiences of utilising the peer-support website. Guided by Bandura's Self-Efficacy model,²⁴ the main themes from the interview data were identified and are presented according to four sources of self-efficacy development.

Performance accomplishment

Bandura suggests individuals’ positive and negative experience can influence their abilities to perform a task.²⁴

Supportive content during a stressful time

For some participants, it was a shock to receive their dual diagnoses, particularly for those who had no family history of cardiac issues or type 2 diabetes. Depending on their individual situation, patients suffered from a range of psychological stress that required extra medical attention and time to eventually subside. All participants stated that the content of the peer support website was informative: ‘pretty real explanatory’, ‘… diabetes contributes to heart disease, which I didn’t know before’. The findings indicated that reliable health information was provided, which helped some participants to gain a clear understanding of their health conditions. The website was also reported to assist patients in reinforcing content that they may have received from health professionals and for some it presented new information that was helpful to identify what activities and strategies they could attempt to help manage their dual diagnoses.

Well, I guess all the stuff was fairly new because this is all new to me, having heart problems. But also with the diabetes thing, well I haven't seen anything, even though it's a heart disease and type two diabetes program, I guess. I hadn't seen before. (P15, female, 63 years)

You tend to forget something and you go through the website, and oh, that's right, I forgot about that. So I think it would be good for anyone who's been diagnosed. It gives them something to follow through and the option and to go back and have another look later. (P3, male, 53 years)

I thought, even though they had separate pages for heart disease and separate things for diabetes, there was certainly a link on how to manage that, with how you should eat and your lifestyle being active and certainly, medications that you should be, well, not that you can decide what medications you could take. (P5, male, 46 years)

I think the website's good. And as I said, it was like doing a refresher course, so to speak, which I think is very handy. (P14, male, 59 years)

Integrated cardiovascular and diabetes online information

After discharge from hospital, patients diagnosed with both comorbidities were frequently provided with written pamphlets or information about resources and workshops that they could follow up with. The website provided a central repository for information which patients could access at their convenience. Patients reported feeling well-informed from the website, with more confidence to manage their conditions from home. The information about the connections between cardiac disease and diabetes was perceived as valuable, as participants reported that not many health information websites focused on the topic of comorbidities.

I've never seen anything where which has heart and diabetes together. You know, this is the first website I've seen that runs to both of them, there are complications with diabetes and your heart and stuff, it's a good learning curve for me. I found a lot of useful information here for me. (P3, male, 53 years)

I think the whole thing seemed to be linking the two conditions. (P14, male, 59 years)

I didn't know that, and I didn't know what the symptoms were. I just thought that diabetes was because my body wasn't producing insulin. That's all, and I didn't think it had anything to do with the heart. (P3, male, 53 years)

Vicarious experience

Vicarious experience refers to a person can watch another performance and compare their own competence with other individual's competence.²⁴

Being able to relate

Participants discussed their experiences of exploring the website and commented on the content, usefulness, and accessibility of the site as it presented stories from real people, not paid actors, in relation to managing their comorbidities. Participant reported a level of comfort knowing that the case studies on the site and the peer-supporters had similar experiences.

You do feel anxious about, you know, like the doctors saying oh you have this condition, you have that condition, you are thinking, oh my God, what's just happened to me? What do I have to do now?… After seeing the website, I started to feel that I am not alone. (P14, male, 59 years)

I’d prefer to believe someone that's been through it themselves rather than someone who maybe have read it in a book. The information is often better from those people who’ve experienced it personally, because they are actually being though it, they have more relevance than the doctors in some cases. (P11, female, 63 years)

As you say on your website the people that are advising other people, are not giving medical advice because the people generally don't have a medical background. But at least they have experience. (P11, female, 63 years)

Experiences shared and positive role models

Participants expressed that the content was beneficial to share experiences. They perceived that those living with the comorbidities were well positioned to support others due to their deep understanding of the impact of living with both conditions, both physically and psychologically. Participants also believed peer support was meaningful and beneficial, with some participants reporting that when they started learning about their health conditions, they felt they were left alone to ‘figure things out by yourself’ (P1). Having peer support available via the website allowed them to engage with others and feel that they were supported. Participants also stated their willingness to help others but were not sure how to do this. For example, participant 7 stated ‘I am willing to help whoever, … I’d like to share experience with them…’.

I can see the benefit of it [peer support], because for myself, I haven’t had anyone that could mentor me in any sort of way you know, I was sort of sent on my way…I could tell them my story and then if they got any help from that and would be really good for them. (P1, male, 37 years)

I prefer to believe someone that's been through it themselves rather than that someone who maybe have read it in a book. The information is often better from those people who've experienced it personally, rather than someone who's read all of the symptoms and all of the information. (P11, female, 63 years)

Some participants preferred receiving information from their other sites or from their health professionals rather than peers, but still acknowledged the potential benefit of the site for others.

I don’t try to go for opinions, I try to reach from actual medical websites or even you know, I don’t know the names of them of the top of my head, but maybe like, you know, the American Diabetes Association or the Australian – I just try to look for one for that. (P6, male, 72 years)

… I mean, as you say on your website the people that are advising other people, you're not giving medical advice because the people generally don't have a medical background. But at least they have experience and you gotta judge it in that way that's written all the way through that website. (P11, female, 63 years)

Verbal persuasion

Verbal persuasion refers to self-efficacy can be influenced by encouragements or not.²⁴

Reinforcing performance

Participants expressed the website information reinforced what they had been provided by their doctors as well as an avenue for them to refer to if they forgot something or needed a reminder on how to manage their activities.

I listened to the lectures [video clips], …, I didn’t know what foods to avoid, that caused the plaque to build up and block your arteries, so that information was good. (P14, male, 59 years)

You tend to forget something, and you go through the website, and oh, that's right, I forgot about that. So, I think it would be good for anyone who's been diagnosed. It gives them something to follow through and the option and to go back and have another look later. (P12, female, 74 years)

Feeling of being in control

Some participants felt that using the website to source information and learn the necessary skills, enabled them to ‘take control’ of the condition and not let their illness ‘take the wheel’. (P7, female, 85 years). Other participants stated:

I do have an understanding that everyone, I know people respond to situations differently. It can be very intuitive for people, …I know what other people in the same situation may be experiencing. … (P9, male, 63 years)

And there are certain things you can try and control as much as you can. It would be the exercise you do and your weight and what you eat and things that. I think, how it came across to me was that majority of the website was designed for people who have both conditions. (P15, female, 63 years)

Emotional arousal

Bandura suggests that being aware of emotions and their perception of these emotions can influence their self-efficacy beliefs.²⁴ Finding from the interviews identified that some participants felt anxious about managing their health condition on a daily basis once discharged from hospital, where less support would be available initially. After participating in the study, and reflecting on their experiences they were able to recognise their emotional and physical states, as indicated in the following quotes:

I was in hospital for three days, they put me on this education session, telling me things about how to manage it [diabetes], it just seems to be such a big lot of information you’ve go tto take in. Then you’re sort of sent on your way, and yeah, you’re sort of left to figure things out yourself…. I got quite angry at times, … after seeing a number of doctors, nurses, physios, … [allied health professionals], I kind of appreciate they positive feedback and I realise my life is back to manageable ….for now at least. (P5, male, 46 years)

Well, you do. You do feel anxious about, you know, and you're thinking, Oh my God, what's just happened to me? And then you start wondering, like right, how far can I push myself [physically] now? Can I run, can I- You know, what can I do? And there's not a lot of information out there about how far you can actually push… This website let me recognise they are someone like me around…and I don’t feel too upset. (P3, male, 53 years)

Figure 1 summarises the main themes and sub themes from the findings, according to the underpinning theory.²⁴

Figure 1.

Application of self-efficacy information sources.

Findings relating to usefulness and accessibility of the site

Findings were also analysed to identify how participants felt about the accessibility and useability of the website. Participants were appreciative that the information on the website was accessible 24 hours a day, seven days a week. Attending an appointment with a health professional could be time-consuming for some patients, depending on the location and service available, and so the online health information platform offered convenience, especially for patients who lived in regional or remote areas. Besides supplying online health information, the peer support aspect was also received favourably.

It's unusual to have a summary of what you're actually going to be going through. Typically, with a website you get a home page, and you have to sort of click on things and explore it yourself, but this actually gave you sort of a fairly good outline of what the website was about and what they were trying to portray. (P11, female, 63 years)

…just to inspire somebody you know like there could be some- like everybody probably handles things differently. And, like somebody could be quite depressed or something and then they see something about or hear something about somebody who has actually grasped the idea and ran with it, and now feeling a lot better, and since it might inspire them to do something better. (P3, male, 53 years)

All participants reported being able to navigate the website with ease on a computer. Most preferred to use a computer over a phone for better readability on bigger screens. Additionally, most participants indicated that they found the website easy to access and use.

Well, it leads on. You got the buttons there to press to follow it up on type two or work out to go to the next step, health management. You just hover the top, the peer support schools, find out all the information and ring up. (P1, male, 37 years)

I check it (the website) about once a week, or whenever if something comes up that I’m purely interested in I’ll go check it out too. (P8, female, 77 years)

Comments were also received regarding potential improvements. Some participants suggested additional content about their conditions while others suggested specific details on strategies for self-management or in relation to working through the content.

…Yeah, maybe a few more ideas. Yeah, like to say things that you could implement, you know, take tips and techniques maybe… Yeah, maybe a few more ideas. Yeah, like to say things that you could implement, you know, take tips and techniques maybe. (P1, male, 37 years)

…the one thing, and this is what I'm always looking for, the one thing that this website didn't have when it comes to healthy eating, I want to see, okay, here's some recipes or here are a list of different things that you can eat. I'm always looking for that and unless I buy diabetic magazine, which I do from time to time, it really doesn't tell me. It says eat healthy foods, such as nuts and vegetables and lean meats and stuff that. I guess that's good, but some simple recipes. (P15, female, 63 years)

I'm pretty sure I covered everything, but there's nothing to say that I did achieve it all. Even, I suppose, just some interaction to say yes, you've done this module, you've done this one, good one, thumbs up, go do the next one. Okay, you've done that one, great, now thumbs up, go to the next one. (P9, male, 63 years)

Discussion

This study explored users’ experience of engaging with an online platform to help participants who have dual cardiac-diabetes conditions. Grounded in self-efficacy theory,²⁴ the platform was found to be positively received, providing participants with feelings of self-confidence in managing their health. Interestingly, our findings also revealed that several participants were willing to share their experiences and become peer supporters for others.

Peer support is to make patients feel less alone. Chronic diseases are long-lasting medical conditions with continuing effects not only on physical health but also on emotional well-being and social life.³⁰ Online peer support can improve social well-being but does not need to only be a one-to-one or one-way interaction.³¹ The online platform has potential for patients to develop their peer support network, which may subsequently improve adherence with self-management activities.³¹ Furthermore, patients using the online platform can be trained to become peer supporters for others. The programme also offers a choice for the users and recipients to be anonymous if they would prefer to receive and/or provide confidential support. Our website provided users with greater accessibility to information and was found to be useful and convenient. However, there is scope to expand the peer support content for future platforms. For example, the online coaching system could be enhanced through incorporating Generative AI, which could enable users to set up tailored goals, further enhancing their wellbeing.³² Further research incorporating this technology is suggested.

Our interview data indicated that being diagnosed with both cardiovascular disease and type 2 diabetes can be daunting initially, however, participants reported that self-efficacy for managing their conditions increased after accessing appropriate online information. This is consistent with the literature demonstrating that patients often do not understand which symptoms to prioritise, and they experience difficulty integrating the treatment regimens of comorbidities,⁸ but that access to self-management information incorporating peer support mechanisms can lead to an improved understanding of helpful behaviours and lower levels of stress and anxiety associated with their care.^7,13 It also appears important to consider the timing of when information is introduced in a patient journey. Research suggests that patients have greatest positive impact on self-management of their conditions if they are familiarised with such information and resources at the beginning of their rehabilitation journey.⁹

Our findings regarding website accessibility indicated that the peer-support website was easy to navigate, but that users’ preference was to access the website via a computer rather than a mobile phone. The rationale for this was that a larger screen could display information better. The reported ease of navigating the website was promising given the high proportion of older Australians being diagnosed with CVD and T2D² and who have not grown up as digital natives.²⁶ It is acknowledged that fundamental to website accessibility is access to the internet and that whilst this is high in developed countries such as Australia, it may be a limiting factor in regional and remote areas.³³ Whilst not explored in their study, online resources can be adapted to provide information to different patient groups easily and effectively. For example, graphics and audio files can help convey information to individuals with low reading literacy.¹⁰ Again, integrating AI technology could greatly enhance the user experience across diverse population groups.

Regarding website content, participants indicated that the website information increased their awareness of the relationship between CVD and T2D, something that multiple participants acknowledged they were not aware of previously. This is consistent with prior research, which demonstrates that individuals do not always understand the inter-related risks of these two chronic conditions, such as a diabetes diagnosis increasing the risk of CVD twofold.^8,11 It is important to acknowledge that there are complex behaviours involved in chronic disease management and that effectively managing the comorbidities can lead to improved quality of life over the medium to longer term.^6,17 A potential strength of the peer-support website is that it presents information about CVD and T2D in an integrated fashion, in contrast to the majority of other health-related peer support programmes which focus on a single chronic condition.^11,23 Interestingly, a comment which was captured during the interviews suggested that the information was quite general and thus may be more useful for newly diagnosed patients. This suggestion may warrant further exploration.

Furthermore, our interview data indicated that the peer-support website appealed to most participants because they could access the online information from any location, which reduced the amount of time required to travel to medical appointments, and they could seek information at a time that suited them, for example, to follow up on an appointment discussion. These findings are consistent with previous research demonstrating that geographical location can be a barrier to accessing chronic condition support^7,33 and that patients typically prefer to access information whenever and wherever they want to.¹⁰ That said, the literature suggests that programme developers be mindful of introducing online peer-support resources to complement and not replace face-to-face interventions.¹⁹ The benefit of online peer-support for CVD and T2D websites, however, may provide individuals with greater autonomy with how they access information.

Participants shared that they valued information being provided by someone who has first-hand experience of the conditions, and whilst they acknowledged that peer support should not be medical advice, they emphasised that gaining different perspectives helped to provide a more rounded picture of disease management. Previous research demonstrates that patients prefer to receive health-related information from people they can relate to, in order to enact behavioural change.¹⁹ Furthermore, Kwan and colleagues (2017) found that barriers to the effective self-management of chronic disease included social support and trust in the information provided.³⁴ A well-constructed peer-support website may, therefore, help address these challenges. Our interview data supports previous research reporting that websites with peer-support components, encourage small changes in referral management amongst individuals with CVD and T2D,³⁵ positively influence smoking cessation, which is a risk factor for CVD¹¹ are more effective in dietary change amongst individuals with CVD risk, compared to websites consisting of medical-related information-only.³¹ It appears there may be a role for peer-support components of websites to help individuals learn more about managing their comorbidities.

Strengths and limitations

This study provided a better understanding of patients with comorbidities using evidence-based online information to support their management of multiple conditions at home, and the feasibility of using the webpage as a supporting approach for patients who are willing to do so. However, limitations are acknowledged. Participants were recruited after visiting doctors in the hospital, when they would generally be motivated, but the long-term effect of using the webpage may be limited. Furthermore, although open-ended interview questions were used, because participants may be at different stages of their conditions, their perspectives may be broader than direct use of the website.

We have acknowledged the limitation of interviewing people after a week of using the website, future longitudinal follow-up would be fruitful to explore in the future. Another limitation of this study is that participation was restricted to individuals accessing healthcare in one regional area. Given that internet access is not limited by geographical location, it may be beneficial to expand the study to a wider community. By including participants from different regions and cultural backgrounds, and at different points of the patient journey, the study would be able to capture a more comprehensive understanding of the website's impact and effectiveness across various populations. Additionally, although the website was developed by professional web developer, with feedback from the multidisciplinary healthcare team, it was not formally evaluated by an independent reviewer. This may potentially have impact on users’ experiences. Addressing these limitations in future website developments would provide a more robust and generalisable assessment of the peer-support cardiac-diabetes website. Furthermore, this study focused on the perceptions of website users only. It does not explore any clinical outcomes associated with website access. This may be helpful to have a more comprehensive understanding of the impact of an integrated CVD and T2D peer-support website.

Future research

Implications for future studies include undertaking a similar study in using peer support websites in wider and varying contexts, for example, refining contents for different cultural contexts, so that more people may be engaged in their journey with people with similar conditions. A future study could evaluate the impact of the peer-support website on the participants’ health outcomes, self-management behaviours, and overall quality of life. Online healthcare delivery systems could be AI-based, featuring positive CVD-T2D stories, supporting patients to work towards their own achievable goals.

The flexibility associated with an online resource, the tailoring of the content to two frequently comorbid conditions, along with the perceived value of the peer-support component, suggest that it may be worthwhile to incorporate an online peer support website into future self-management interventions. As such, it would be important to investigate the scalability and sustainability of the peer-supported website. This could also involve examining factors such as resource requirements, technological infrastructure, and user engagement over an extended period.

Conclusions

This study explored the perspectives of people with cardiac and diabetes conditions following interaction with a peer support website. Our findings capture the benefits of a peer-support website to individuals managing these comorbidities once diagnosed from the hospital. Having flexible and easy access to online resources integrating CVD and T2D information and incorporating lived experiences through peer-support components demonstrates a promising way forward for more effectively supporting individuals to self-manage their cardiovascular and diabetes conditions.

Supplemental Material

sj-pdf-1-dhj-10.1177_20552076251350927 - Supplemental material for A qualitative exploratory study of user experience with a peer-support based, self-management website for people with a cardiovascular condition and diabetes

Supplemental material, sj-pdf-1-dhj-10.1177_20552076251350927 for A qualitative exploratory study of user experience with a peer-support based, self-management website for people with a cardiovascular condition and diabetes by Chiung-Jung (Jo) Wu, Rohan Poulter, John J. Atherton, Richard J. MacIsaac, Tak Yan Leung, Patrick C. K. Hung and Mary-Anne Ramis in DIGITAL HEALTH

Footnotes

Acknowledgements

The authors would like to acknowledge Professor Karen Willis (Professor of Public Health, Victoria University, Australia) for providing expert methodological guidance.

ORCID iD

Chiung-Jung (Jo) Wu

John J. Atherton

Richard J. MacIsaac

Tak Yan Leung

Patrick C. K. Hung

Mary-Anne Ramis

Ethical considerations and Informed consent

This study was approved by the Metro North Health and University of the Sunshine Coast Human Research Ethics Committees (LNR/2020/QRBW/65608 and A201440). Informed consent was obtained from all participants involved in the study.

Author contributions

Study design: C-JW, RP, JJA, RJM, MR; Data analysis: C-JW, RP, JJA, RJM, MR; Manuscript drafts: C-JW, RP, JJA, RJM, MR, PH, TYL; Appraisal and editing of all revisions: C-JW, RP, JJA, RJM, MR, PH. TYL; Final approval: C-JW, RP, JJA, RJM, MR, PH, TYL.

Funding

This project was supported by a start-up grant, from the University of the Sunshine Coast, Australia, awarded to Associate Professor Chiung-Jung Wu.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Data sharing is not applicable to this article as no datasets were generated or analysed in the current study.

Supplemental material

Supplemental material for this article is available online.

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