How and Why Telehealth Interventions Improve Self-Care Among Vulnerable Groups of Patients With Heart Failure: Scoping Review and Rapid Realist Synthesis.

Background: Heart failure (HF) is a prevalent condition among older adults in Canada, often leading to reduced quality of life and frequent hospitalizations. HF disease management interventions, particularly those delivered through telehealth, aim to improve care by fostering self-care and reducing readmissions. However, disparities in access to and use of HF telehealth services persist among vulnerable populations. Objective: This study aimed to present the findings of a scoping review and a rapid realist synthesis of HF telehealth interventions for vulnerable groups of patients with HF. This review is underpinned by the metatheory of critical realism and intersectionality theory. Methods: A rapid realist synthesis of the retrieved literature was undertaken to explore the underlying mechanisms and contexts that make HF telehealth interventions work or not work for marginalized groups of patients with HF. Results: The realist review findings indicated that vulnerable patients require simple interventions. The findings also suggested that for effective use of telehealth and remote monitoring services, these patients require simplified training that could increase their confidence. The review findings further demonstrated that involving patients' family members in the delivery of telehealth interventions ensures success. Conclusions: Future research with vulnerable populations should be underpinned by the critical realism and intersectionality theory and should apply the principles of intersectionality at all stages of the research process, including evaluation and analysis. This review also urges HF practitioners to apply the principles of intersectionality and health equity in clinical practice, such that interventions are simple and personalized, involve family members, include an in-person component, provide training for patients and health professionals, and integrate telemonitoring data.