Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service.
Methods
Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data.
Results
In total, 19 liver transplant recipients participated in the study (25–68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) ‘broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face care; (b) ‘impact of employment' which identified employment as a competing priority and appeared to effect involvement with the programme; (c) ‘adapting Mediterranean eating pattern to meet individual needs' which identified the adaptability of the Mediterranean diet supported by sessions with the dietitian; (d) ‘increasing exercise confidence' which recognised that a tailored approach facilitated confidence and acceptability of the exercise component of the programme.
Discussion
A telehealth lifestyle programme delivered by dietitians and exercise physiologists is an acceptable alternative to face-to-face care that can meet the needs of liver transplant recipients. There is a need to further innovate and broaden the scope of routine service delivery beyond face-to-face consultations.
De LucaLKalafateliMBianchiSet al.
Cardiovascular morbidity and mortality is increased post-liver transplantation even in recipients with no pre-existing risk factors. Liver Int2019;
39: 1557–1565.
2.
LaryeaMWattKDMolinariMet al.
Metabolic syndrome in liver transplant recipients: Prevalence and association with major vascular events. Liver Transpl2007;
13: 1109–1114.
3.
Moya-NajeraDMoya-HerraizACompte-TorreroLet al.
Combined resistance and endurance training at a moderate-to-high intensity improves physical condition and quality of life in liver transplant patients. Liver Transpl2017;
23: 1273–1281.
4.
LaishIBraunMMorEet al.
Metabolic syndrome in liver transplant recipients: Prevalence, risk factors, and association with cardiovascular events. Liver Transpl2011;
17: 15–22.
5.
MadhwalSAtrejaAAlbeldawdiMet al.
Is liver transplantation a risk factor for cardiovascular disease? A meta-analysis of observational studies. Liver Transpl2012;
18: 1140–1146.
6.
LvCZhangYChenXet al.
New-onset diabetes after liver transplantation and its impact on complications and patient survival. J Diabetes2015;
7: 881–890.
7.
VallinMGuillaudOBoillotOet al.
Recurrent or de novo nonalcoholic fatty liver disease after liver transplantation: Natural history based on liver biopsy analysis. Liver Transpl2014;
20: 1064–1071.
8.
McCoySMCampbellKLLassemillanteA-CMet al.
Changes in dietary patterns and body composition within 12 months of liver transplantation. Hepatobil Surg Nutr2017;
6: 317–326.
9.
DharancySLemyzeMBoleslawskiEet al.
Impact of impaired aerobic capacity on liver transplant candidates. Transplantation2008;
86: 1077–1083.
10.
DinuMPagliaiGCasiniAet al.
Mediterranean diet and multiple health outcomes: An umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr2018;
72: 30–43.
11.
RyanMCItsiopoulosCThodisTet al.
The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol2013;
59: 138–143.
12.
OldenburgBTaylorCBO'NeilAet al.
Using new technologies to improve the prevention and management of chronic conditions in populations. Annu Rev Public Health2015;
36: 483–505.
LancasterKAbuzourAKhairaMet al.
The use and effects of electronic health tools for patient self-monitoring and reporting of outcomes following medication use: Systematic review. J Med Internet Res2018;
20: e294.
15.
GranjaCJanssenWJohansenMA.Factors determining the success and failure of ehealth interventions: Systematic review of the literature. J Med Internet Res2018;
20: e10235.
16.
HickmanIJCoranDWallenMPet al. ‘
Back to Life': Using knowledge exchange processes to enhance lifestyle interventions for liver transplant recipients: A qualitative study. Nutr Diet2019;
6: 317–326.
17.
SalisburyCO'CathainAThomasCet al.
Telehealth for patients at high risk of cardiovascular disease: Pragmatic randomised controlled trial. BMJ2016;
353: i2647.
18.
BrownWJBaumanAEBullFCet al.Development of evidence-based physical activity recommendations for adults (18–64 years). Report prepared for the Australian Government Department of Health, 2012, Commonwealth of Australia, Canberra.
19.
TongASainsburyPCraigJ.Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health C2007;
19: 349–357.
20.
CaneJO’ConnorDMichieS.Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci2012;
7: 37.
21.
GuestGMacQueenKMNameyEE.Applied thematic analysis.
Los Angeles:
Sage Publications, 2012.
22.
HwangRMandrusiakAMorrisNRet al.
Exploring patient experiences and perspectives of a heart failure telerehabilitation program: A mixed methods approach. Heart Lung2017;
46: 320–327.
23.
HwangRBruningJMorrisNRet al.
Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: A randomised trial. J Physiother2017;
63: 101–107.
24.
VarnfieldMKarunanithiMLeeCKet al.
Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: Results from a randomised controlled trial. Heart2014;
100: 1770–1779.
25.
O'BrienCMCrampCDoddJM.Delivery of dietary and lifestyle interventions in pregnancy: Is it time to promote the use of electronic and mobile health technologies?Semin Reprod Med2016;
34: e22–e27.
26.
LobeloFKelliHMTejedorSCet al.
The wild wild West: A framework to integrate mhealth software applications and wearables to support physical activity assessment, counseling and interventions for cardiovascular disease risk reduction. Prog Cardiovasc Dis2016;
58: 584–594.
27.
BeratarrecheaADiez-CansecoFIrazolaVet al.
Use of m-health technology for preventive interventions to tackle cardiometabolic conditions and other non-communicable diseases in Latin America – challenges and opportunities. Prog Cardiovasc Dis2016;
58: 661–673.
28.
RolloMEBurrowsTVinczeLJet al.
Cost evaluation of providing evidence-based dietetic services for weight management in adults: In-person versus eHealth delivery. Nutr Diet2018;
75: 35–43.
29.
MillerKEMartzDCStonerCet al.
Efficacy of a telephone-based medical nutrition program on blood lipid and lipoprotein metabolism: Results of Our Healthy Heart. Nutr Diet2018;
75: 73–78.
30.
LaitinenJKorkiakangasEAlahuhtaMet al.
Feasibility of videoconferencing in lifestyle group counselling. Int J Circumpolar Health2010;
69: 500–511.
31.
CookEJRandhawaGSharpCet al.
Exploring the factors that influence the decision to adopt and engage with an integrated assistive telehealth and telecare service in Cambridgeshire, UK: A nested qualitative study of patient ‘users' and ‘non-users'. BMC Health Serv Res2016;
16: 137.
32.
MayrHLTierneyACKucianskiTet al.
Australian patients with coronary heart disease achieve high adherence to 6-month Mediterranean diet intervention: Preliminary results of the AUSMED heart trial. Nutrition2018;
61: 21–31.
33.
OpieRSO'NeilAJackaFNet al.
A modified Mediterranean dietary intervention for adults with major depression: Dietary protocol and feasibility data from the SMILES trial. Nutr Neurosci2018;
21: 487–501.
34.
DavisCHodgsonJBryanJet al.
Older Australians can achieve high adherence to the Mediterranean diet during a 6 month randomised intervention; Results from the Medley Study. Nutrients2017;
9: 534.
35.
SchumacherTLBurrowsTLThompsonDIet al.
The role of family in a dietary risk reduction intervention for cardiovascular disease. Healthcare2016;
4: 74.
36.
HaighLBremnerSHoughtonDet al.
Barriers and facilitators to Mediterranean diet adoption by patients with nonalcoholic fatty liver disease in northern Europe. Clin Gastroenterol Hepatol2019;
17: 1364–1371.
37.
MiddletonGKeeganRSmithMFet al.
Brief report: Implementing a Mediterranean diet intervention into a RCT: Lessons learned from a non-Mediterranean based country. J Nutr Health Aging2015;
19: 1019–1022.
38.
FrithJDayCPRobinsonLet al.
Potential strategies to improve uptake of exercise interventions in non-alcoholic fatty liver disease. J Hepatol2010;
52: 112–116.
39.
BurtonNWKhanABrownWJ.How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity. Br J Sports Med2012;
46: 1125–1131.
40.
SalisburyCThomasCO‘CathainAet al.
Telehealth in chronic disease: Mixed-methods study to develop the TECH conceptual model for intervention design and evaluation. BMJ Open2015;
5: e006448.
