Background: Dealing with cardiovascular disease is challenging, and people often struggle to follow rehabilitation and self-management programs. Several systematic reviews have explored quantitative evidence on the potential of digital interventions to support cardiac rehabilitation (CR) and self-management. However, although promising, evidence regarding the effectiveness and uptake of existing interventions is mixed. This paper takes a different but complementary approach, focusing on qualitative data related to people’s experiences of technology in this space. Objective: Through a qualitative approach, this review aims to engage more directly with people’s experiences of technology that supports CR and self-management. The primary objective of this paper is to provide answers to the following research question: What are the primary barriers to and facilitators and trends of digital interventions to support CR and self-management? This question is addressed by synthesizing evidence from both medical and computer science literature. Given the strong evidence from the field of human-computer interaction that user-centered and iterative design methods increase the success of digital health interventions, we also assess the degree to which user-centered and iterative methods have been applied in previous work. Methods: A grounded theory literature review of articles from the following major electronic databases was conducted: ACM Digital Library, PsycINFO, Scopus, and PubMed. Papers published in the last 10 years, 2009 to 2019, were considered, and a systematic search with predefined keywords was conducted. Papers were screened against predefined inclusion and exclusion criteria. Comparative and in-depth analysis of the extracted qualitative data was carried out through 3 levels of iterative coding and concept development. Results: A total of 4282 articles were identified in the initial search. After screening, 61 articles remained, which were both qualitative and quantitative studies and met our inclusion criteria for technology use and health condition. Of the 61 articles, 16 qualitative articles were included in the final analysis. Key factors that acted as barriers and facilitators were background knowledge and in-the-moment understanding, personal responsibility and social connectedness, and the need to support engagement while avoiding overburdening people. Although some studies applied user-centered methods, only 6 involved users throughout the design process. There was limited evidence of studies applying iterative approaches. Conclusions: The use of technology is acceptable to many people undergoing CR and self-management. Although background knowledge is an important facilitator, technology should also support greater ongoing and in-the-moment understanding. Connectedness is valuable, but to avoid becoming a barrier, technology must also respect and enable individual responsibility. Personalization and gamification can also act as facilitators of engagement, but care must be taken to avoid overburdening people. Further application of user-centered and iterative methods represents a significant opportunity in this space.

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中文翻译：

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心脏康复和自我管理中技术的障碍和促进者：系统的定性扎根理论综述

背景：应对心血管疾病具有挑战性，人们经常难以遵循康复和自我管理计划。几项系统的综述已经探索了有关数字干预对支持心脏康复（CR）和自我管理的潜力的定量证据。然而，尽管有希望，但有关现有干预措施的有效性和采用率的证据参差不齐。本文采用一种不同但互补的方法，重点研究与该领域人们技术经验相关的定性数据。目的：通过定性的方法，本次审查旨在使人们更直接地接触支持CR和自我管理的技术经验。本文的主要目的是为以下研究问题提供答案：支持CR和自我管理的数字干预的主要障碍和促进者是什么？趋势如何？通过综合医学和计算机科学文献的证据来解决这个问题。鉴于人机交互领域的有力证据表明，以用户为中心的迭代设计方法可提高数字医疗干预的成功率，因此，我们还评估了以用户为中心的迭代方法在先前工作中的应用程度。方法：对来自以下主要电子数据库的文章进行了扎实的理论文献综述：ACM数字图书馆，PsycINFO，Scopus和PubMed。考虑了过去10年（2009年至2019年）发表的论文，并使用预定义的关键字进行了系统的搜索。根据预定义的纳入和排除标准筛选论文。通过3个级别的迭代编码和概念开发，对提取的定性数据进行了比较和深入的分析。结果：初步搜索共找到4282条文章。筛选后，剩下61篇文章进行了定性和定量研究，符合我们对技术使用和健康状况的纳入标准。在这61篇文章中，有16篇定性文章被纳入最终分析。成为障碍和促进者的关键因素是背景知识和即时理解，个人责任感和社会联系以及支持参与同时避免给人造成负担的需求。尽管一些研究采用了以用户为中心的方法，在整个设计过程中，只有6位用户参与其中。很少有证据表明采用迭代方法的研究。结论：技术的使用对于接受CR和自我管理的许多人是可以接受的。尽管背景知识是一个重要的推动者，但技术还应支持更大程度的持续和即时了解。连通性很有价值，但是为了避免成为障碍，技术也必须尊重并实现个人责任。个性化和游戏化也可以促进交往，但是必须注意避免给人们造成负担。以用户为中心的迭代方法的进一步应用在这个领域代表了巨大的机会。许多接受CR和自我管理的人都可以接受技术的使用。尽管背景知识是一个重要的推动者，但技术还应支持更大程度的持续和即时了解。连通性很有价值，但是为了避免成为障碍，技术也必须尊重并实现个人责任。个性化和游戏化也可以促进交往，但是必须注意避免给人们造成负担。以用户为中心的迭代方法的进一步应用在这个领域代表了巨大的机会。许多接受CR和自我管理的人都可以接受技术的使用。尽管背景知识是一个重要的推动者，但技术还应支持更大程度的持续和即时了解。连通性很有价值，但是为了避免成为障碍，技术也必须尊重并实现个人责任。个性化和游戏化也可以促进交往，但是必须注意避免给人们造成负担。以用户为中心的迭代方法的进一步应用在这个领域代表了巨大的机会。技术还必须尊重并实现个人责任。个性化和游戏化也可以促进交往，但是必须注意避免给人们造成负担。以用户为中心的迭代方法的进一步应用在这个领域代表了巨大的机会。技术还必须尊重并实现个人责任。个性化和游戏化也可以促进交往，但是必须注意避免给人们造成负担。以用户为中心的迭代方法的进一步应用在这个领域代表了巨大的机会。

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