Table 3.

EmpowerMyCH Design Objectives and Intervention Features Unique to CHD

Key Findings	Design Objectives	Key Intervention Features
Perspectives: CHD patients might not understand the need to establish or maintain care with an ACHD specialist especially when they are otherwise feeling well. At times, they may prefer to avoid thinking about their heart to prevent their health condition from interfering with their life	An approach which promotes well-being, rather than illness management	• Empowering tone—Focus on the patient as the hero of their journey, avoiding language that centers on illness or portrays them as passive recipients of care • Building motivation for changes from first user contacts and in recruitment materials • Begin with simple, concise interventions, such as clarifying basic terms like the distinction between defect and disease, while offering the option for users to explore more detailed resources • Allowing users to engage with intervention elements and information which are most relevant to them
Loneliness: CHD patients often feel lonely in their health journey and don’t know how their condition is similar or different compared to others	Build a community	• Patient’s narratives shared as “Peer Empowerment” quotes to provide practical guidance • Engage the EmpowerMyCH users in sharing their experiences • Linking resources, including, community events, community building opportunities, or peer-to-peer connections
Feasibility: Given the intervention’s goal to target multiple barriers to the behaviors, there was a risk for the intervention to be too large and complex for the project team to satisfactorily develop it for the many unique needs that CHD patients have, especially within the resources available	Efficient and multiphase design	• Phased-development of interventions with the initial phase targeting barriers determined by CBPR participants as key drivers for gaps in ACHD care (e.g., knowledge about CHD care, symptom management, etc.) • Targeting behaviors that can achieve multiple outcomes (e.g., patient activation and engagement which can improve timely ACHD visits, mood, and general illness perception) • Strike balance between making intervention broadly applicable to CHD patients, while ensuring it is relevant and has impactful information for users; while being cost-effective • Continuous Development—Regularly adapt and improve intervention components based on user needs and feedback with the opportunity to modify existing content or create new content or features
Accessibility: Most CHD patients are young and have other priorities	Enabling easy, timely, non-intrusive access to concise information, which can be read and acted on quickly when needed	• Short, succinct, actionable information that users can benefit from in just a few minutes • Mobile friendly—easy to read information that fits on a phone screen • Content delivered to patients using nudge approaches through email, SMS, or app notifications that act as gentle reminders • Contents delivered as small bursts of information over time • Automated delivery of the content, independent of whether users are seeking the information
Credibility: There is an abundance of information, but it isn’t reaching the CHD patients, it often seems overwhelming, and it’s unclear which one is reliable	Use credible sources for content creation rather than re-inventing content that already exist.	• Partnering with community organizations to curate exiting information • Formatting and delivering content in an easy to understand and readable way • Tailoring content based on repeated feedback from participants about their needs and priorities
Scalability: There could be variations in terms of age, health literacy, prior engagement in care and research, making it difficult to tailor interventions to meet these diverse needs	Design and content tailored to diverse needs	• Use web and mobile based tools, that are cross-platform including Android and iOS • Content formatted for readability irrespective of the quality of device used • Minimize use of formats (e.g., videos, complicated graphics) that have higher broadband needs • All material formatted for 5th grade reading level • Include questions to facilitate anonymous sharing of knowledge and personal stories and experience between the highly engaged and less engaged CHD patients • Build community that supports each other and future generations of patients