Introduction
Cardiovascular disease (CVD) remains the leading cause of death globally, with substantial readmission rates after acute events. Secondary prevention strategies—lifestyle modification, risk factor reduction, medication adherence, and regular exercise—are essential to reduce morbidity and mortality. Cardiac rehabilitation has traditionally been delivered in-person, offering education, counseling, and peer interactions that can improve outcomes. Yet attendance and completion rates remain low. The shift to virtual, home-based models during the COVID-19 era highlighted both the potential and the challenges of digital delivery, including variable uptake and the loss of peer interaction found in groups. In this context, peer support—grounded in lived experience—emerges as a potentially valuable complement or alternative to standard rehabilitation, capable of enhancing motivation, self-efficacy, and social connectedness.
Rationale for Peer Support in CVD
Peer support differentiates itself by incorporating experiential knowledge and shared understanding. Peers who have lived with CVD can provide credibility, practical coping strategies, and a sense of hope. The bidirectional benefits extend to those offering support as well as those receiving it. Across various chronic conditions, peer support has shown improvements in quality of life, self-management, and adherence to care plans. For CHD and other cardiac conditions, evidence suggests that peer-led formats—whether in-person or through remote channels—can boost self-efficacy and exercise participation, while also reducing readmissions. However, randomized trials evaluating exclusively digital peer support for CVD are sparse, underscoring the need to identify components that work best in digital formats and to understand feasibility and acceptability among patients and clinicians.
Study-Based Framework for Digital Peer Support
The qualitative study underpins a practical framework for development and delivery of digital peer support programs for people with CVD. It synthesizes voices from two components: (1) in-person peer support attendees, and (2) consumers and clinicians testing a digital app prototype. The resulting framework centers on six core domains—uptake, flexibility, resources, autonomy, safeguarding, and interface design—to guide future program creation and evaluation.
Uptake and Engagement
Awareness and recruitment are prerequisites for success. Participants emphasized the need to raise public and clinical awareness about peer support so that a critical mass of participants can sustain meaningful interactions. In both in-person and digital formats, referrals, outreach campaigns, and clinician endorsement were seen as pivotal for improving uptake.
Flexibility and Integration
Flexibility in delivery and timing, including options to involve family members, was repeatedly highlighted. Digital programs should be adaptable to complement routine cardiac care and rehabilitation, and should allow seamless hybrid use with in-person services when possible. Participants also valued the option to participate passively (lurking) as a legitimate form of engagement, especially in digital settings where first-time users may be overwhelmed.
Autonomy and Non-Hierarchical Language
Autonomy emerged as a central theme for digital peer support. Users should control privacy levels, naming choices, and whether to engage publicly or privately. Importantly, a non-hierarchical, inclusive vocabulary (e.g., “mate,” “buddy,” “supporter”) should replace terms that imply hierarchy, to foster equal, respectful relationships within groups.
Safeguarding and Moderation
Both patients and clinicians stressed the importance of clear rules, moderation, and safeguarding. A credentialed clinician should provide moderation in a largely passive role, intervening when necessary to prevent harm or the spread of misinformation. Clear disclaimers and moderation hours were seen as essential safeguards in digital environments.
User-Friendly Interfaces
Digital platforms should be simple to navigate, with intuitive visuals, concise messaging, and easy setup. Personalization should be possible while maintaining a group-centric format that supports authentic peer connections. The design should enable both active discussions and constructive, low-barrier observation in group forums rather than one-to-one matching alone.
Recommendations: A 6-Element Framework
Integrated from in-person experiences and digital testing, the framework comprises six focus areas: uptake, flexibility, resources, autonomy, safeguarding, and interface. Key recommendations include: broad peer support awareness campaigns, flexible scheduling including family involvement, provision of clinician input and educational materials, user-controlled privacy and interaction levels, credentialed moderation, and simple, visually intuitive interfaces that support group interaction and shared learning.
Implications for Future Research and Practice
Digital peer support is not a universal remedy; some patients may prefer or require in-person interaction. A blended approach—combining digital and in-person elements—may maximize reach and effectiveness for diverse CVD populations. Future research should test the framework in diverse settings, assess outcomes on self-management and readmissions, and evaluate cost, clinician training, and integration with existing cardiac rehabilitation programs.
Conclusion
People living with CVD report substantial benefits from peer support, especially when experiences are shared within a supportive, nonjudgmental community. A framework centered on uptake, flexibility, resources, autonomy, safeguarding, and user-friendly interfaces provides a practical path forward for designing digital peer support programs. Co-design with patients and clinicians will be essential to ensure relevance, feasibility, and real-world impact.
