Co-design of an eHealth intervention to reduce cardiovascular disease risk in male taxi drivers

: ManGuard

Abstract

Introduction:

CVD remains the leading cause of mortality and morbidity worldwide, with men at a higher risk of developing the disease than their female counterparts. This increased risk is partly due to men engaging in higher levels of modifiable CVD risk behaviours, such as poor nutritional choices and the over consumption of alcohol, as well as presenting with poor health seeking behaviours. Taxi driving is a male dominated profession, with taxi drivers identified as being at an increased risk of developing CVD due to a high prevalence of modifiable CVD risk factors, including overweight/obesity, lacking fruit and vegetables, smoking, excessive alcohol consumption and physical inactivity. As such, behaviour change interventions targeting this population may prove advantageous, yet research in this area is limited. eHealth is revolutionizing healthcare, being easily accessible from any location, easy to use, and providing the opportunity for an intervention to be tailored towards populations or risk behaviours. The aim of this PhD study was to co-design a ‘proof-of-concept’ (PoC) of an eHealth intervention, ‘ManGuard’, for reducing CVD risk in male taxi drivers.

Methods:

The development of the ManGuard PoC was guided by the IDEAS framework, an iterative guide for the development of more effective eHealth interventions. Utilising a co-design approach throughout, engaging with an interdisciplinary team of experts and end-users, and incorporating the Behaviour Change Wheel (BCW) throughout to ensure that the ManGuard program was underpinned by behaviour change theory, an eHealth intervention that would be accepted by the target population could be developed. Guided by input from the interdisciplinary team, an online survey, a systematic review and meta-analysis, and focus groups (n = 3) with end-users, a PoC of ManGuard was developed and refined.

Results:

The systematic review and meta-analysis revealed that eHealth interventions are effective in improving CVD-related risk factors in men. However, poor rates of engagement and attrition were reported, highlighting the importance of co-design in eHealth interventions with men for improve their acceptability. The online survey and meetings with the interdisciplinary team identified high levels of psychological stress to be associated with taxi driving, and directly impacting the lifestyle choices they make. Throughout the co-design process, male taxi driver preferences for ManGuard were for the program to be delivered via mobile phone (mHealth), utilising a simple and straightforward design, with concise, clear, consistent, realistic, and relatable content.

Conclusion:

The work undertaken in this PhD study has made several contributions to knowledge. First, it has provided a summary of evidence world-wide on the effectiveness of eHealth interventions for improving CVD-related risk factors among men. Second, it uncovered the lived experience of taxi drivers in Northern Ireland (NI), knowledge that was previously unknown. Third, to my knowledge this is the first study to co-design an eHealth intervention for taxi drivers. As a result, the findings, and methodological considerations, can be utilised by future researchers wishing to engage with this “hard to reach” population. Lastly, this study resulted in the development of the ManGuard PoC, anticipated to progress onwards to undergo feasibility testing to assess the acceptability of this novel intervention.

Date of Award	Jul 2023
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Northern Ireland Department for the Economy
Supervisor	David Thompson (Supervisor), Chantal Ski (Supervisor) & Kevin Brazil (Supervisor)