A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study

Smartphone Use by Caregivers for Patients With Heart Failure During Hospitalization: An Investigation

This study investigated the use of smartphones by family caregivers for hospitalized patients with chronic heart failure (CHF). In total, 120 patients and their unpaid family caregivers participated in this study. The caregivers were divided into two groups based on the perceived importance of smartphones in patient care. Both groups completed the General Demographic Information Survey, Problematic Mobile Phone Use Questionnaire, Barthel Index Scale, Modified Early Warning Score (MEWS), Johns Hopkins Fall Risk Assessment Tool (JH-FRAT), and Family Burden Scale of Diseases Survey. Moreover, left ventricular ejection fraction (LVEF) and stroke volume (SV) were measured in all participants. The age of hospitalized patients with CHF was correlated with the Barthel Index Scale, MEWS, and JH-FRAT, whereas LVEF and SV were correlated with MEWS. The important group had a much higher financial burden than the nonimportant group. Linear regression analysis revealed that financial burden and mental health had a remarkable impact on the content of mobile calls about treatment. Furthermore, the economic status of family caregivers determined the importance of smartphone calls in the care of patients with CHF during hospitalization.

Strategies to promote patient-centeredness within the healthcare industry: A grey-based multicriteria decision making methods

RATIONALE

The international policy agenda has recently advocated for the development of patient-centeredness in healthcare service delivery. Consequently, various stakeholders in the healthcare systems have expressed a vital need for identifying strategies and tools that can enhance patient-centeredness.

AIMS AND OBJECTIVES

The objective of this paper was to prioritise and benchmark the strategies that can improve patient-centeredness in healthcare service delivery.

METHOD

We employed a multi-stage research scenario that consisted of two phases: a phase including of a scoping review to identify the current strategies to improve patient-centeredness (PC); And, a phase including of a multicriteria best-worst method to assign weights to PC principles, and a questionnaire administered to a sample of experts for benchmarking the strategies derived from the literature using the Grey Multi-Attributive Border Approximation Area Comparison (MABAC-G) method.

RESULTS

The most important principle of patient-centeredness was deemed to be access to care, while telehealth tools and Electronic Health Information Systems were respectively suggested as the most efficacious platforms for promoting patient-centeredness.

CONCLUSION

We recommend that administrators and policy makers in the healthcare industry prioritise the implementation and research of strategies such as telehealth tools and electronic health information systems to enhance access and patient-centeredness in the healthcare systems.

The role of patient-oriented mHealth interventions in improving heart failure outcomes: A systematic review of the literature

Heart failure (HF) is a debilitating disease with 26 million patients worldwide. Consistent and complex self-care is required on the part of patients to adequately adhere to medication and to the lifestyle changes that the disease necessitates. Mobile health (mHealth) is being increasingly incorporated in patient interventions in HF, as smartphones prove to be ideal platforms for patient education and self-help assistance. This systematic review aims to summarize and report on all studies that have tested the effect of mHealth on HF patient outcomes. Our search yielded 17 studies, namely 11 randomized controlled trials and six non-randomized prospective studies. In these, patients with the assistance of an mHealth intervention regularly measured their blood pressure and/or body weight and assessed their symptoms. The outcomes were mostly related to hospitalizations, clinical biomarkers, patients' knowledge about HF, quality of life (QoL) and quality of self-care. QoL consistently increased in patients who received mHealth interventions, while study results on all other outcomes were not as ubiquitously positive. The first mHealth interventions in HF were not universally successful in improving patient outcomes but provided valuable insights for patient-oriented application development. Future trials are expected to build on these insights and deploy applications that measurably assist HF patients.

Design and evaluation of child abuse web-based application for parent education & strengthen

BACKGROUND

Child abuse is one of the major health and social problems in the world and has severe short-term and long-term consequences on children's psychological, social and physical functioning. One of the effective strategies to control and prevent child abuse is training parent through web-based applications. The aim of this study is to design and evaluation of child abuse web-based application for parent education and strengthen.

METHODS

This study is an applied-developmental study that performed in Razi Educational and Therapeutic Center in Tabriz. The study consisted of three main phases. The requirements assessment and design phases were completed between November 2022 and February 2023. The research community was parents referring to Razi Center and convenience sampling was used to select the samples. In firststage, a questionnaire was designed by searching in library sources and consulting with specialists for needs assessment and application design. The questionnaire was completed by psychiatric specialists, health information management and health information technology.Finally, the usability of designed application was evaluated with the participation of 30 parents and specialists.

RESULTS

Based on the identified information elements and capabilities, a child abuse web-based application was designed. Application capabilities were such as concepts of child abuse, prevention and treatment strategies, parenting skills, childrens behavioral disorders, child abuse laws and interaction with clinical specialists. Finally, the result of the web-based application usability evaluation was evaluated at a good level equal to an average of 7.6 out of a total of 9 points.

CONCLUSIONS

The possibility of expressing experiences, exchanging message, attractiveness, ease of use, and accessibility of parents, they were designed as application features. The usability of the web-based application was satisfactory to users in various of overall functionality, display, terminology, learning ability and overall application capability.

Characterising consumer engagement in virtual models of care: A systematic review and narrative synthesis

BACKGROUND

Widespread adoption of digital tools and technologies now support the delivery of virtual healthcare. Although, consumer engagement is central to care processes in virtual care models, there is paucity of evidence regarding the nature and outcomes of consumer engagement. This study aimed to determine the nature of consumer engagement used in virtual models of care, and its impact on quality and safety of care.

METHODS

A systematic review was undertaken with a narrative synthesis, with a search strategy applied to five electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Web of Science) RESULTS: Fifty-eight studies were included in the review that utilised a variety of virtual models of care across care services. Consumer engagement, such as patients' active involvement in monitoring, capturing and reporting their health data, was a common feature of the identified virtual models.

CONCLUSION

Increasing use of virtual models of care requires consideration of the role of patients and their support persons in the use of technology and in wider care processes that occur at a distance from health professionals. Ensuring consumers are equipped with necessary support to effectively engage in virtual care is important to ensure equity in access to, and outcomes of, virtual care models.

The effects of a 24-week interactive text message-based mobile health intervention for enhancing self-care behaviours of patients with heart failure: A quasi-experimental study

AIMS

The aim of this study was to identify the effects of a 24-week interactive text message-based mobile health intervention (called) on enhancing the self-care behaviours of patients with heart failure.

BACKGROUND

Whether text message-based mobile health intervention can be used to improve long-term adherence to self-care behaviours among heart failure patients remains unclear.

DESIGN

A quasi-experimental study with a pretest-post-test design and repeated measures.

METHODS

Data from 100 patients (mean age, 58.78 years; 83.0% men) were analysed. The intervention group (n = 50) used the program over 24 weeks, which consisted of weekly goal setting and interactive text messaging, while the control group (n = 50) received usual care. Trained research assistants collected data using self-reported Likert questionnaires. Primary (self-care behaviours) and secondary (health literacy, eHealth literacy, and disease knowledge) outcome variables were measured at baseline and at 1, 3 and 6 months after intervention for follow-up.

RESULTS

The findings showed that the intervention group demonstrated significantly better self-care behaviours than the control group during the 6 months. Notably, the trajectory of self-care behaviours of the patients in the intervention group showed a steep rise between the first- and third-month follow-up, followed by high stability between the third- and sixth-month follow-up. In addition, the intervention group had significantly higher disease knowledge than the control group at the first- and sixth-month follow-up.

CONCLUSIONS

We found that the program, as an interactive text messaging service, may be an optimal strategy for improving long-term adherence to self-care behaviours through motivating and providing social support.

RELEVANCE TO THE NURSING PRACTICE

The WithUs program can help nurses and other healthcare professionals to track patients' health indicators such as symptom severity, diet and physical activity. In addition, nurses can take an important role in evaluating the efficacy of the app in relation to patients' health outcome.

PATIENT OR PUBLIC CONTRIBUTION

Patients have completed a self-reported questionnaire after providing informed consent.

Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post-hospital discharge period

BACKGROUND

People living with heart failure (HF) are particularly vulnerable after hospital discharge. An alliance between patient authors, clinicians, industry, and co-developers of HF programs can represent an effective way to address the unique concerns and obstacles people living with HF face during this period. The aim of this narrative review article is to discuss challenges and opportunities of this approach, with the goal of improving participation and clinical outcomes of people living with HF.

METHODS

This article was co-authored by people living with HF, heart transplant recipients, patient advocacy representatives, cardiologists with expertise in HF care, and industry representatives specializing in patient engagement and cardiovascular medicine, and reviews opportunities and challenges for people living with HF in the post-hospital discharge period to be more integrally involved in their care. A literature search was conducted, and the authors collaborated through two virtual roundtables and via email to develop the content for this review article.

RESULTS

Numerous transitional-care programs exist to ease the transition from the hospital to the home and to provide needed education and support for people living with HF, to avoid rehospitalizations and other adverse outcomes. However, many programs have limitations and do not integrally involve patients in the design and co-development of the intervention. There are thus opportunities for improvement. This can enable patients to better care for themselves with less of the worry and fear that typically accompany the transition from the hospital. We discuss the importance of including people living with HF in the development of such programs and offer suggestions for strategies that can help achieve these goals. An underlying theme of the literature reviewed is that education and engagement of people living with HF after hospitalization are critical. However, while clinical trial evidence on existing approaches to transitions in HF care indicates numerous benefits, such approaches also have limitations.

CONCLUSION

Numerous challenges continue to affect people living with HF in the post-hospital discharge period. Strategies that involve patients are needed, and should be encouraged, to optimally address these challenges.

Self-management in heart failure using mHealth: A content validation

AIM

To describe the development of a mobile health application -mICardiApp- designed by a multidisciplinary professional team and patients with heart failure and to evaluate its content validity.

METHODS

Critical reviews of the literature, semi-structured interviews with patients, and user stories guided the development of the content of the mobile application. These contents were refined and validated through a modified Delphi process. An expert panel of healthcare and social care professionals together with patients and academics evaluated the content through two content validity indicators, relevance, and adequacy, and provided narrative feedback. The content validity of the app and each screen was determined by calculating the Content Validity Index (CVI). Similarly, the Adequacy Index (AI) was analyzed.

RESULTS

The developed app is composed by 8 topics: (1) available resources, (2) cardiac rehabilitation, (3) control of signs and symptoms, (4) emotional support, (5) learning and having fun, (6) medication, (7) nutrition, and (8) physical activity. The results demonstrated high CVI of the screens and the full app. 57 of the 59 screens in the app reached an excellent CVI ≥ 0.70 for both relevance and adequacy, except for 2 screens. The CVI Average Method of the app was 0.851.

CONCLUSIONS

mICardiApp is presented as an application to improve health literacy and self-management of patients with multimorbidity and heart failure, with proven validation.

Development and usage of a health recommendation web tool (HeaRT) designed to inform women of personalized preventive health recommendations

BACKGROUND

Implementation of guidelines for evidence-based screening and disease prevention remains a core challenge in health care. The lack of access to accurate and personalized health recommendations may contribute to sub-optimal performance of medical screening, and ultimately increased risk for communicable and non-communicable disease. Many women do not monitor their cardiovascular disease (CVD) risk or receive regular medical screenings. A health recommendation tool (HeaRT) that provides women with profiled, individually tailored information about recommended tests and screening was designed to improve women's engagement in preventive health. This study characterized utilization of the tool in a real world setting.

OBJECTIVE

To describe the development and usage patterns of HeaRT, a novel health web-tool that provides personalized health recommendations for women.

METHODS

Extracted web-tool data including user input (age, BMI, smoking status and family history of CVD) and time spent in the results screen were analysed. Engagement was assessed by time spent in each results category, number of clicks and whether the user emailed/printed the recommendations. Usage patterns were analysed using multivariate analyses, logistic regression and cluster analyses.

RESULTS

HeaRT was used 13,749 times in the years between its launch and data extraction three years later. Web-tool analysis found that 68.6 % of users accessed results and approximately 15 % printed or emailed the list of recommendations. Further analysis found that almost all the users entered the nutrition category (78 %), followed by the risk-factor category (69.5 %) and Physical activity category (61.9 %). Three usage patterns were identified by cluster analysis, including a nutrition/physical activity cluster, a risk-factor cluster and an all-categories cluster. Cluster affiliation analysis found BMI and smoking status were not predictors of cluster affiliation, whereas users over the age of 65 were more likely to solely enter the risk-factor tab (P < .001) and users with family history of CVD were more likely to either enter only the risk-factor tab or to enter all tabs (P < .01).

CONCLUSIONS

HeaRT users looked at health recommendations on a variety of health topics, and 15 % printed or emailed the recommendations. A tailored health recommendation web-tool may empower women to seek preventive-care and health maintenance, and help them interact with health care providers from a position of shared responsibility. This tool and similar programs may enable health care consumers to actively participate in directing their own health maintenance by providing consumers with personalized health recommendations. Additionally, user characteristics may inform future web-tool designers on target population profile and usage patterns.

A smartphone app to improve the safety of patients undergoing treatment with oral antineoplastic agents: 4 years of experience in a university hospital

Objective

This study aims to analyze the impact of the eOncosalud app on the management and follow-up of adverse effects (AE) in patients receiving oral antineoplastic agents.

Material and methods

We performed an observational, prospective study of cancer outpatients treated with oral antineoplastic agents (OAA), monitored by the eOncosalud app between August 2017 and October 2021. Safety variables were collected from eOncosalud: the number of AE; severity of the AE according to CTCAE, version 4.03; timelapse from app installation to first recorded AE; automatic recommendations issued; and the patient's acceptance of the recommendations made. To assess the impact of the recommendations generated by the algorithm, we calculated the positive predictive value (PPV) as the number of recommendations accepted out of the total number of recommendations generated. Safety-related patient messages were also analyzed (AE, drug-drug interactions, drug administration).

Result

The app was downloaded and used by 186 patients (58.0% women), with a mean age of 59.0 years. A total of 1,368 AE were recorded, the most frequent being fatigue (19.37%), diarrhea (18.20%), and skin changes (9.21%). Regarding the recommendations issued by the app algorithm, 102 patients received 344 information brochures, 39 patients received 51 recommendations for supportive care to control AE, 60 patients received 240 recommendations to visit their primary care doctor, 14 patients received 16 recommendations to contact their specialist pharmacist or oncologist-hematologist, and 34 patients received 73 recommendations to go to the emergency room. The suggestion to go to the emergency room and contact the specialist pharmacist or oncologist-hematologist had a PPV of 0.51 and 0.35, respectively. Half of the patients (50.4%) used the messaging module. A total of 1,668 messages were sent. Of these, 47.8% were related to treatment safety: AE, 22.7%; drug-drug interactions, 20.6%; drug administration, 3.6%; and missing a dose, 1.0%.

Conclusions

The eOncosalud app enables close, real-time monitoring of patients treated with OAA. The automatic recommendations through the app's algorithm have optimized available healthcare resources. The app facilitated early detection of AE, thus enabling patients themselves to improve the safety of their treatment.

The effectiveness and usability of a novel mobile phone-based self-care intervention for patients with heart failure: A mixed-methods pilot study

AIM

To evaluate the preliminary effectiveness and usability of a novel mobile phone-based self-care intervention (named WithUs) for patients with heart failure (HF).

METHODS AND RESULTS

We conducted a mixed-methods pilot study with group pretest-posttest design and usability testing. Participants were 26 Korean HF patients (20 men; median age 62 years) who took part in this study after hospital discharge. Data were collected at baseline and after the 24-week intervention, using questionnaires and interviews. The outcome variables were eHealth literacy, disease knowledge, and self-care behaviours. The Wilcoxon signed-rank test was used to compare the pre- and post-intervention results. Thematic analysis was used for analysing qualitative data. The WithUs programme improved the eHealth literacy (p = .005), disease knowledge (p < .001), and self-care behaviours (p < .001) of patients with HF. The median score of total app usability was 4.1 out of 5 (interquartile range = 4.0-5.0). Four themes were identified which complemented the quantitative results. These were increased awareness of the importance of routine self-care behaviours, enhanced motivation toward self-care behaviours, challenges adapting to the new app, and suggestions for improving app adoption.

CONCLUSION

The app was effective in improving adherence to self-care behaviours, eHealth literacy, and disease knowledge in patients with HF. The usability evaluation results showed that the app is usable and has the potential to support HF patients in self-care. However, the app needs to be modified to improve its adoption.

Mobile Apps for People With Rare Diseases: Review and Quality Assessment Using Mobile App Rating Scale

BACKGROUND

Mobile apps are becoming increasingly popular, with 5.70 million apps available in early 2021. Smartphones can provide portable and convenient access to health apps. Here, we consider apps for people with one of the estimated 7000 rare conditions, which are defined as having an incidence of <1 in 2000. The needs of people with rare conditions are known to be different from those of people with more common conditions. The former may be socially isolated (not knowing anyone else who has the condition) and may not be able to find reliable information about the disorder.

OBJECTIVE

The aim of this review is to search for apps developed specifically for people diagnosed with a rare disease and to assess them for quality using the Mobile App Rating Scale (MARS). We examine features that address 6 identified needs of people with a rare disorder and make recommendations for future developers.

METHODS

Google Play Store (Android) and Apple App Store (iOS) were searched for relevant health-related apps specifically for rare diseases. The search included the names of 10 rare disease groups. App quality was determined using MARS, assessing app engagement, functionality, aesthetics, and information.

RESULTS

We found 29 relevant apps (from a total of 2272) addressing 14 rare diseases or disease groups. The most common rare conditions addressed were cystic fibrosis (n=6), hemophilia (n=5), and thalassemia (n=5). The most common app features were web-based information and symptom trackers. The mean MARS score was 3.44 (SD 0.84). Lowest scores were for engagement.

CONCLUSIONS

Most apps provided factual and visual information, providing tools for self-monitoring and resources to help improve interactions during health consultations. App origin and quality varied greatly. Developers are recommended to consider ways to make appropriate apps more easily identifiable to consumers, to always include high-quality information, improve engagement, provide qualitative evaluations of the app, and include consumers and clinicians in the design.

The most used questionnaires for evaluating satisfaction, usability, acceptance, and quality outcomes of mobile health

Background

Various questionnaires are used for evaluating satisfaction, usability, acceptance, and quality outcomes of mobile health (mHealth) services. Using the best one to meet the needs of an mHealth study is a challenge for researchers. Therefore, this study aimed to review and determine the frequently used questionnaires for evaluating the mentioned outcomes of mHealth services.

Methods

The PubMed database was searched for conducting this review in April 2021. Papers that used a referenced questionnaire to evaluate the satisfaction, usability, acceptance, or quality outcomes of mHealth were included. The first author’s name, year of publication, evaluation outcome, and evaluation questionnaire were extracted from relevant papers. Data were analyzed using descriptive statistics.

Results

In total, 247 papers were included in the study. Questionnaires were used for usability (40%), quality (34.5%), acceptance (8.5%), and satisfaction (4%) outcomes, respectively. System usability scale (36.5%), mobile application rating scale (35.5%), post study system usability questionnaire (6%), user mobile application rating scale (5%), technology acceptance model (4.5%), computer system usability questionnaire (2.5%), net promoter score (2%), health information technology usability evaluation scale (2%), the usefulness, satisfaction, and ease of use (1.5%), client satisfaction questionnaire (1.5%), unified theory of acceptance and use of technology (1.5%), questionnaire for user interaction satisfaction (1%), user experience questionnaire (1%), and after-scenario questionnaire (1%) were the most used questionnaires, respectively.

Conclusion

Despite the existence of special questionnaires for evaluating several outcomes of mHealth, general questionnaires with fewer items and higher reliability have been used more frequently. Researchers should pay more attention to questionnaires with a goal-based design.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01764-2.

CODESING DE APLICATIVO CUIDATIVO-EDUCACIONAL PARA PESSOAS COM INSUFICIÊNCIA CARDÍACA: IDEAÇÃO, PROTOTIPAGEM E CO-IMPLANTAÇÃO

RESUMO Objetivo descrever o processo de ideação, prototipagem e co-implantação do protótipo de aplicativo cuidativo-educacional à pessoa com insuficiência cardíaca em vulnerabilidade, seus familiares/cuidadores e equipe de saúde. Método estudo metodológico, com cinco fases: Constructo; Ideação; Prototipagem; Co-implantação e Adequação, realizadas de setembro de 2020 a julho de 2021. A equipe do Codesign envolveu 72 atores (15 pacientes com IC, 19 familiares/cuidadores, 35 profissionais da saúde, dois pesquisadores e um designer e desenvolvedor), que contribuíram com dados linguísticos e visuais. Resultados foi produzido o protótipo InCare®, representado pelo fluxograma de interação do usuário e esboços estruturais. Foram definidas cores para composição das telas e escolhidos recursos do protótipo, com delineamento da descrição, proposta e requisitos funcionais. O aplicativo envolveu temáticas relevantes (definição da doença e vulnerabilidade, etiologia, classificação, sinais e sintomas, cuidados diários e abordagens paliativistas, tratamentos, alimentação, atividade física e redes de suporte, benefícios) e aglutinou funcionalidades conforme necessidades e preferências da equipe, sendo considerado inovador e um incentivo ao autocuidado. Conclusão O Codesign permitiu a ideação de recursos, conteúdos, esboços das telas, fluxo do usuário, prototipagem e nome do protótipo, em processo criativo e participativo, para promoção da saúde da pessoa com insuficiência cardíaca em situação de vulnerabilidade em saúde.

CODESIGN OF A CARE-EDUCATIONAL APP FOR PEOPLE WITH HEART FAILURE: DESIGN, PROTOTYPING AND CO-IMPLEMENTATION

ABSTRACT Objective to describe the process corresponding to the design, prototyping and co-implementation of a care-educational app prototype for vulnerable people with heart failure, their family members/caregivers and the health team. Method a methodological study with five phases: Construct, Design, Prototyping, Co-implementation and Adaptation, all performed from September 2020 to July 2021. The Codesign team involved 72 actors (15 patients with HF, 19 family members/caregivers, 35 health professionals, two researchers and a designer and developer), who contributed with linguistic and visual data. Results the InCare® prototype was produced, represented by the flowchart corresponding to the user's interaction and structural sketches. Colors were defined to compose the screens and the prototype resources were chosen, outlining the description, proposal and functional requirements. The app involved relevant themes (definition of the disease and vulnerability, etiology, classification, signs and symptoms, daily care measures and palliative approaches, treatments, diet, physical activity and support networks, benefits) and gathered functionalities according to the team's needs and preferences, being considered innovative and encouraging for self-care. Conclusion codesign allowed designing resources, contents, screen sketches, user flow, prototyping and prototype name, in a creative and participatory process to promote the health of people with heart failure in vulnerable health situations.

Spanish adaptation and validation of the User Version of the Mobile Application Rating Scale (uMARS)

OBJECTIVE

While the professional version of the Mobile App Rating Scale (MARS) has already been translated, and validated into the Spanish language, its user-centered counterpart has not yet been adapted. Furthermore, no other similar tools exist in the Spanish language. The aim of this paper is to adapt and validate User Version of the MARS (uMARS) into the Spanish language.

MATERIALS AND METHODS

Cross-cultural adaptation, translation, and metric evaluation. The internal consistency and test-retest reliability of the Spanish version of the uMARS were evaluated using the RadarCovid app. Two hundred and sixteen participants rated the app using the translated scale. The app was then rated again 2 weeks later by 21 of these participants to measure test-retest reliability.

RESULTS

No major differences were observed between the uMARS original and the Spanish version. Discrimination indices (item-scale correlation) obtained appropriate results for both raters. The Spanish uMARS presented with excellent internal consistency, α = .89 and .67 for objective and subjective quality, respectively, and temporal stability (r > 0.82 for all items and subscales).

DISCUSSION

The Spanish uMARS is a useful tool for health professionals to recommend high-quality mobile apps to their patients based on the user's perspective and for researchers and app developers to use end-user feedback and evaluation, to help them identify highly appraised and valued components, as well as areas for further development, to continue ensuring the increasing quality and prominence of the area of mHealth.

CONCLUSION

uMARS Spanish version is an instrument with adequate metric properties to assess the quality of health apps from the user perspective.

Investigating the effect of multimedia education in combination with teach-back method on quality of life and cardiac anxiety in patients with heart failure: a randomized clinical trial

BACKGROUND

Education can contribute to promotion of the quality of life and reduction of heart anxiety in patients with heart failure, so it is important to find a suitable educational method for these patients. Therefore, the present study was an attempt to determine the effect of multimedia education using teach-back method on the life quality and cardiac anxiety in patients with heart failure.

METHODS

The present study was a randomized clinical trial. 120 patients with heart failure class I to III and aged less than 60 years old were selected using sequential sampling; then, they were assigned randomly into two intervention groups and one control group. Group A (multimedia education), group B (education using multimedia together with teach-back method), and group C (control). The quality of life and cardiac anxiety were evaluated in the participants of the three groups before, after, 1 month, and 3 months after the intervention. Data were analyzed using descriptive tests, Pearson correlation, Kolmogorov-Smirnov, chi square and ANOVA test in SPSS 22. The significance level was set at P < 0.05.

RESULTS

No significant differences were found in the mean scores of the quality of life and cardiac anxiety in the control and two intervention groups before the educational intervention. However, immediately after, 1 month and 3 months after the educational intervention, a significant difference was observed between the mean scores of the quality of life and cardiac anxiety in the intervention groups (P < 0.05).

CONCLUSION

Multimedia education together with Teach-Back method is effective in promoting the quality of life and reducing cardiac anxiety in patients with heart failure. Therefore, it is recommended that health policymakers should use this educational method in providing treatment programs.

IRANIAN REGISTRY OF CLINICAL TRIALS

20190917044802N1. Registration date: 5/2/2020.

Mobile health applications for older adults: a systematic review of interface and persuasive feature design

OBJECTIVE

Mobile-based interventions have the potential to promote healthy aging among older adults. However, the adoption and use of mobile health applications are often low due to inappropriate designs. The aim of this systematic review is to identify, synthesize, and report interface and persuasive feature design recommendations of mobile health applications for elderly users to facilitate adoption and improve health-related outcomes.

MATERIALS AND METHODS

We searched PubMed, Embase, PsycINFO, CINAHL, and Scopus databases to identify studies that discussed and evaluated elderly-friendly interface and persuasive feature designs of mobile health applications using an elderly cohort.

RESULTS

We included 74 studies in our analysis. Our analysis revealed a total of 9 elderly-friendly interface design recommendations: 3 recommendations were targeted at perceptual capabilities of elderly users, 2 at motor coordination problems, and 4 at cognitive and memory deterioration. We also compiled and reported 5 categories of persuasive features: reminders, social features, game elements, personalized interventions, and health education.

DISCUSSION

Only 5 studies included design elements that were based on theories. Moreover, the majority of the included studies evaluated the application as a whole without examining end-user perceptions and the effectiveness of each single design feature. Finally, most studies had methodological limitations, and better research designs are needed to quantify the effectiveness of the application designs rigorously.

CONCLUSIONS

This review synthesizes elderly-friendly interface and persuasive feature design recommendations for mobile health applications from the existing literature and provides recommendations for future research in this area and guidelines for designers.

Estimating Patient Empowerment and Nurses' Use of Digital Strategies: eSurvey Study

Patient empowerment is seen as the capability to understand health information and make decisions based on it. It is a competence that can improve self-care, adherence and overall health. The COVID-19 pandemic has increased the need for information and has also reduced the number of visits to health centers. Nurses have had to adapt in order to continue offering quality care in different environments such as the digital world, but this entails assessing the level of their patients’ empowerment and adapting material and educational messages to new realities. The aim of this study is, on the one hand, to assess nurses’ use of digital resources to provide reinforcing information to their patients and, on the other hand, to evaluate how they assess the level of empowerment of their patients. To perform the study, 850 nurses answered 21 questions related to their own digital literacy and patients’ empowerment. The ability to make decisions is the characteristic most selected by nurses (70%) as useful in measuring patient empowerment, whereas 9.19% do not measure it in any way. Printed material is most often used by nurses to offer additional information to patients (71.93%), mobile applications are the least used option (21.58%), and elder nurses are those who most recommend digital resources. In this study, younger nurses make little or no use of technology as a resource for training and monitoring patients. In spite of some limitations concerning the study, digital health needs to be promoted as an indisputable tool in the nurse’s briefcase in the future to ensure that older patients can manage electronic resources in different fields.

Developing and Implementing a Mobile Health Heart Failure Self-Care Program to Reduce Readmissions: A Patient-Centered Outcomes Research Randomized Controlled Trial (Preprint)

Background

Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life during the discharge period. Lifestyle behavior modifications that promote the self-management of chronic cardiac diseases have been associated with an improved quality of life. However, whether a mobile health (mHealth) program can assist patients in the self-management of HF during the acute posthospital discharge period is unknown.

Objective

We aimed to develop an mHealth program designed to enhance patients’ self-management of HF by increasing knowledge, self-efficacy, and symptom detection. We hypothesized that patients hospitalized with HF would be willing to use a feasibly deployed mHealth program after their hospital discharge.

Methods

We employed a patient-centered outcomes research methodology to design a stakeholder-informed mHealth program. Adult patients with HF admitted to a large academic hospital were enrolled and randomized to receive the mHealth intervention versus usual care. Our feasibility outcomes included ease of program deployment, use of the clinical escalation process, duration of participant recruitment, and participant attrition. Surveys assessing the demographics and clinical characteristics of HF were measured at baseline and at 30 and 90 days after discharge.

Results

The study period was between July 1, 2019, and April 7, 2020. The mean cohort (N=31) age was 60.4 (range 22-85) years. Over half of the participants were men (n=18, 58%) and 77% (n=24) were White. There were no significant differences in baseline measures. We determined that an educational mHealth program tailored for patients with HF is feasibly deployed and acceptable by patients. Though not significant, we found notable trends including a higher mean quality of life at 30 days posthospitalization among program users and a longer duration before rehospitalization, which are suggestive of better HF prognosis.

Conclusions

Our mHealth tool should be further assessed in a larger comparative effectiveness trial. Our pilot intervention offers promise as an innovative means to help HF patients lead healthy, independent lives. These preliminary data suggest that patient-centered mHealth tools can enable high-risk patients to play a role in the management of their HF after discharge.

Trial Registration

ClinicalTrials.gov NCT03982017; https://clinicaltrials.gov/ct2/show/NCT03982017