Introduction
Cardiovascular disease (CVD) remains a leading cause of death worldwide, with secondary prevention playing a crucial role in reducing readmissions and improving quality of life. Traditional cardiac rehabilitation has emphasized in-person, group-based formats, but challenges such as low attendance persist. This qualitative study investigates how peer support—grounded in lived experience—can be delivered in both in-person and digital formats to support people with CVD and their caregivers, and it synthesizes findings into a practical framework for future programs.
What the study examined
The research comprised two complementary components. Component 1 explored in-person peer support benefits and preferences through focus groups with attendees of two established heart disease peer groups in Australia. Component 2 tested a digital peer support app prototype with consumer workshops and healthcare professionals to gather feedback on usability, safeguarding, and potential role in self-management. Together, the components informed a framework that covers uptake, flexibility, resources, autonomy, safeguarding, and interface design.
Key themes from in-person peer support (Component 1)
Participants described several benefits of peer support, including:
- Coping and emotional support: Shared experiences helped participants feel less isolated and offered coping strategies.
- Learning from peers: Attendees gained practical information about recovery, post-hospital care, and condition-specific concerns.
- Mutual understanding: A nonjudgmental space where members could ask questions that they might avoid with family or clinicians.
- Mood uplift and confidence: The group environment fostered hope and social accountability, strengthening self-efficacy.
- Engagement factors: Awareness, flexible scheduling, and involvement of healthcare professionals enhanced participation.
Digital peer support: insights from Component 2
Feedback from consumer workshops and clinician interviews highlighted three core themes for a digital format:
- User autonomy: Participants stressed the value of choosing privacy levels, naming identities, and deciding when to engage. They preferred non-hierarchical language and group-based interactions over one-to-one matching.
- Safeguarding: clear moderation guidelines, rules, and the involvement of credentialed clinicians were deemed essential to prevent misinformation and harm.
- Simple, intuitive interfaces: An easy setup, clear visuals, concise messaging, and personalized experiences were prioritized to encourage ongoing use.
A framework for digital peer support development
The synthesis of components yielded a six-domain framework to guide future programs:
- Uptake: Increase peer support awareness to achieve a critical mass of participants, facilitating ongoing engagement.
- Flexibility: Offer options for timing, delivery mode (in-person, digital, hybrid), and family involvement to fit diverse recovery trajectories.
- Resources: Incorporate healthcare professional input and supplemental materials to strengthen content and legitimacy.
- Autonomy: Enable user-driven privacy settings, nonhierarchical relationships, and optional participation in discussions.
- Safeguarding: Implement clear moderation, disclaimers, and clinician credentials to ensure safety and trust.
- Interface: Prioritize simple, visually intuitive designs, with group-based formats that foster authentic peer connections.
The framework emphasizes co-design or at least stakeholder consultation, ensuring that future digital peer support tools align with the needs and preferences of people living with CVD and their clinicians.
Implications for practice
For real-world adoption, programs should consider integrating peer support with existing cardiac rehabilitation, ensuring flexibility to accommodate different recovery stages and preferences. Moderation by credentialed clinicians is recommended for digital formats to safeguard users and enhance trust. In-person groups will benefit from ongoing facilitator training to sustain supportive, nonjudgmental environments. Ultimately, the most impactful digital interventions will blend autonomy with structured safeguards and streamlined interfaces that support group-based engagement rather than isolated, one-to-one matching.
Limitations and future research
The study’s qualitative design and limited sample restrict generalizability. Attendees of in-person groups may overrepresent positive views, and the digital prototype tested in Component 2 was exploratory. Future research should test scalable digital peer support interventions across diverse populations, assess cost and implementation in health systems, and evaluate clinical outcomes such as self-management, quality of life, and readmission rates.
Conclusion
People with CVD value peer support that is grounded in shared experience and delivered through flexible, user-centered formats. The proposed framework highlights key priorities—uptake, flexibility, resources, autonomy, safeguarding, and interface design—that can guide the development of robust in-person and digital peer support programs. Engaging patients and clinicians in co-design will enhance adoption and ensure that digital peer support advances secondary prevention in cardiovascular disease.
