Unsurprisingly the National Health Service (NHS) has harnessed the prolific growth in Internet access to alleviate the increasing burden incurred due to rising healthcare costs. Healthcare interventions focus on the promotion of good behaviours; prevention of bad behaviours; provision of support for shared decision making; increasing knowledge and improving monitoring. Healthcare researchers typically rely on professional software developers in the creation of Internet interventions. Although varying in nomenclature Internet interventions typically consist of the same underlying components, such as navigation, logic and response capture. The LifeGuide Authoring Tool provides a potential solution to reduce this reliance of researchers on software developers in the creation of interventions. However the logic creation command line interface provided by LifeGuide is identified as a potential barrier for adoption, by nonprogrammers, due to their lack of experience with the strict programming style syntax it requires. Through the adoption of user-centred design techniques; early and continuous user involvement; rapid prototyping and interface design principles, a Graphical User Interface (GUI) was developed, with the potential to lower this barrier for researchers with no previous programming experience. A jigsaw metaphor was adopted in the design of the interface, utilising templates and pre-populated fields, with the aim of reducing errors and lowering the cognitive load experienced by users. A task-based evaluation compared the existing LifeGuide interface, with the new GUI, in the creation of commonly used logic. Higher results were reported over the five main usability measures: effectiveness; engagement; efficiency; ease of learning and error tolerability in favour of the GUI, in the creation of intervention logic. Continuing requests to the author to develop healthcare Internet Interventions supports the research, that there is still a heavy reliance of researchers on software developers. A further application for this approach was identified in the development of a tool to support healthcare researchers in the creation of mobile phone messaging interventions.

<p dir="ltr">Background. Although depression is a risk factor for cardiovascular disease (CVD), few clinical trials in people without CVD have examined the effect of depression treatment on CVD-related outcomes. It’s unknown if successful depression treatment improves indicators of CVD risk, such as CVD-relevant health behaviors, traditional CVD risk factors, and CVD events. </p><p dir="ltr">Methods. We examined data from eIMPACT trial, a phase II randomized controlled trial conducted from 2015-2020. Depressive symptoms, CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed. Incident CVD events over four years were identified using a statewide health information exchange. </p><p dir="ltr">Results. The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). CVD-relevant health behaviors did not mediate any intervention effects on traditional CVD risk factors. Twenty-two participants (10%) experienced an incident CVD event. The likelihood of an CVD event did not differ between the intervention group (12.1%) and the usual care group (8.3%; HR = 1.45, 95% CI: 0.62-3.40, p = 0.39). </p><p dir="ltr">Conclusions. Successful depression treatment alone improves self-reported sleep quality but is not sufficient to lower CVD risk of people with depression. Alternative approaches may be needed reduce CVD risk in depression. </p><p dir="ltr">Trial Registration: ClinicalTrials.gov Identifier: NCT02458690 </p><p dir="ltr">Keywords: depression, cardiovascular disease, blood pressure, lipids, medication adherence, sedentary behavior, sleep quality, collaborative care, internet interventions, clinical trial</p>