Table 3.

Intervention modifications and adaptations according to qualitative patient-reported themes

Qualitative theme	Intervention component
AF symptoms are manageable	• Interventionists receive training in AF pathophysiology and symptom profiles, and concurrent treatments (medications) to facilitate group discussions regarding overcoming AF-related barriers to behavior change • Interventionists support patient self-efficacy in managing AF symptoms while adhering to CR program and setting weekly, “SMALL” behavioral health goals
Frustration with Prior Weight Loss Attempts and “Diet” Programs	• Removed pre-existing material on calorie math and calorie counting from the ASPIRE manual • Facilitators and handouts emphasize differences between the Small Changes approach and “diets” • Facilitators and intervention materials repeatedly emphasize the importance of making changes relative to patient’s unique baseline behaviors (i.e., this is not a one-size-fits-all approach) • Instruct patients on the difference between setting behavioral goals (e.g., “I will add 500 daily steps to my total steps next week”) vs. having a “goal weight” (e.g., “I want to be XX pounds). The latter is discouraged throughout the program • Ongoing psychoeducation re: benefits of WL for AF vs. WL for body image or societal reasons
Information Needs: Patients Want More Information about Atrial Fibrillation	• AF psychoeducation incorporated throughout modules with a specific focus in Module 1 • AF-specific handouts (e.g., exercising with AF)
Flexibility	• Virtual delivery model allows patient to participate from work or home • Daytime and evening sessions available