Use of mobile applications in heart failure self-management: a qualitative study of patients’ and primary care clinicians’ perspectives (Preprint)

BACKGROUND Heart failure is one of the leading causes of hospitalisation, morbidity, and mortality in the world. Heart failure self-management is challenging and involves a set of self-care behaviours required to reduce the risk of deterioration, identify signs and symptoms of exacerbation, and avoid hospitalisation. Mobile applications (apps) have the potential to facilitate heart failure self-management tasks. OBJECTIVE This study aimed to explore patients’ and clinicians’ perspectives on the facilitators and barriers to using mobile applications, as well as desired features, to support heart failure self-management. METHODS Face-to-face semi-structured interviews were conducted in a general practice clinic in Sydney. Eligible participants were adult heart failure patients and health care professionals who provided care to these patients at the clinic. The interviews were audio-recorded, transcribed, and analyzed using thematic data analysis in NVivo 12. RESULTS Twelve participants were interviewed: six patients (mean age 69±7.9 years) and six clinicians. The main facilitators to the use of apps to support heart failure self-management included the ability for communication between clinicians and patients, personalized feedback and education, and automated self-monitoring. Other desired features included facilitated monitoring of patient-reported measures and mental health tools. Main barriers were related to patients’ digital literacy. CONCLUSIONS The use of mobile apps to support heart failure self-management can be facilitated by several features identified in this study. Future research should consider these features in the co-design and testing of heart failure mobile apps with patients and clinicians.

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Patients’ Needs Regarding Anxiety Management in Palliative Cancer Care: A Qualitative Study in a Hospice Setting

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119846844 ◽

2019 ◽

Vol 36 (11) ◽

pp. 947-954 ◽

Cited By ~ 2

Author(s):

Danielle Zweers ◽

Alexander de Graeff ◽

Jette Duijn ◽

Everlien de Graaf ◽

Petronella O. Witteveen ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Symptom Management ◽

World Health ◽

Future Research ◽

Common Symptom ◽

Structured Interviews ◽

Open Communication ◽

Hospice Patients ◽

Health Organization

Introduction: Anxiety is a common symptom in the palliative phase, and symptom management depends on the competencies of individual professionals. This study aims to get insight into the needs of anxious hospice patients with advanced cancer regarding support. Method: Semi-structured interviews were performed in admitted hospice patients with cancer. Patients admitted from May 2017 till May 2018 were eligible whether or not they were anxious. Interviews were analyzed and coded within predefined topics. Results: Fourteen patients were included: 10 females, median age 71, and median World Health Organization performance score 3. Most patients were highly educated. Thirteen patients were interviewed within 6 months before death. Information, open communication, sense of control, safety, adequate symptom management, and respect for patients’ coping strategy were the 6 main expressed needs. Conclusion: Assessing patients’ needs regarding anxiety provided important angles where health-care professionals can make a difference in order to support anxious patients in their final stage of life to realize tailored palliative care. Future research should focus on the development of a systematic approach for health-care professionals to manage anxiety in daily care of terminal patients.

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Factors inhibiting the internet adoption by base of the pyramid in India

Digital Policy Regulation and Governance ◽

10.1108/dprg-01-2018-0001 ◽

2018 ◽

Vol 20 (4) ◽

pp. 323-336 ◽

Cited By ~ 4

Author(s):

Sumedha Chauhan ◽

Parul Gupta ◽

Mahadeo Jaiswal

Keyword(s):

Digital Literacy ◽

Perceived Risk ◽

Future Research ◽

The Internet ◽

Intention To Use ◽

Digital Information ◽

Structured Interviews ◽

Internet Adoption ◽

Content Type ◽

Use Of The Internet

Purpose This paper aims to explore the factors inhibiting the internet adoption among base of pyramid (BoP) and to develop further insights of such factors. Design/methodology/approach Researchers used a mixed-method study with QUAL/QUAN sequence in this research. Given the dearth of research on the internet usage by the BoP segment in India, the authors began with the exploratory qualitative study. Semi-structured interviews in local language were carried out with the people belonging to the BoP segment in India using common interview protocol. Face-to-face interviews were conducted for 20-30 min with ten people. Thematic analysis (Braun and Clarke, 2006) was conducted on the interview transcripts which lead to five themes. These themes were identified as the potential inhibitors to the internet adoption by the BoP segment in India. This step was further followed by a confirmatory quantitative study. Findings The results confirm that the factors such as lack of digital literacy, complexity and language barrier play a significant role in inhibiting the internet adoption by the BoP segment. However, there is no impact of perceived risk and cost on the internet adoption. The significant relationship between lack of digital literacy and intention to use implies that if the BoP segment is capable to locate, evaluate and use digital information, it is more likely to use the internet. Similarly, the relationship between complexity and the intention to use suggests that if the BoP segment finds it easy to use and understand the internet, it is more likely to use it. Practical implications This research has the implications for government departments and policymakers that are responsible for promoting use of the internet. Therefore, such departments and policymakers are advised to channelize their effort on resting the digital literacy, especially in terms of internet adoption. Findings of this study show that digital literacy, complexity and language barriers are major inhabitants in the internet adoption. Directed and focused government policies and initiatives such as subsidized seminars and training programmes specially designed for the BoP segment can help in increasing internet adoption. Social implications The adoption and use of the internet services by BoP have major implications for digital equality. Therefore, it would be important to explore the factors inhibiting the internet adoption among BoP. Originality/value This paper not only explores the factors inhibiting internet adoption among BoP in developing countries such as India but also provides deeper insights to these factors by collecting first-hand information from target segment. The finding of this research provides meaningful inputs to policymakers and also to industry to remove digital divide in the target population. This is how this research adds value to the existing knowledge available in this domain and it also provides agenda for future research.

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Factors Affecting Consumer Adoption of Mobile Apps in NCR: A Qualitative Study

Global Business Review ◽

10.1177/0972150919876748 ◽

2019 ◽

Vol 21 (1) ◽

pp. 176-196 ◽

Cited By ~ 3

Author(s):

Neerja Arora ◽

Garima Malik ◽

Deepak Chawla

Keyword(s):

Qualitative Study ◽

Diffusion Of Innovation ◽

Mobile Applications ◽

Mobile Apps ◽

Technological Advancement ◽

National Capital Region ◽

Structured Interviews ◽

User Friendliness ◽

Gen Y ◽

Gen X

The recent years have seen an exponential rise in the mobile application space. Organizations strive to be present in this space for interacting with the customer. In this light, it is important to study the current usage of mobile applications and factors which affect their adoption across age groups. This research is a qualitative study, which investigates the pattern of usage, the user friendliness, the liked and disliked features of mobile apps and the beliefs associated with them. Mobile applications being a fairly recent technological advancement, it has been important to study their adoption in the light of the diffusion of innovation and investigate the effect of social influence on decisions to use mobile apps. The findings of this study are based on a total of 29 responses (19 through semi-structured interviews and 10 through focus group discussion) in National Capital Region of India (NCR). The responses were analyzed using content analysis. This study reveals differences in patterns of usage and beliefs among Gen X and Gen Y users. It was found that Gen Y users used mobile apps much more extensively than Gen X users. Though both categories of users believed that usage of mobile apps made life easier, Gen X users had negative beliefs about mobile apps. The findings also reveal the presence of the trait of innovativeness and uniqueness among Gen Y users, which leads to adoption of mobile applications.

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Assessment of chronic disease self-management in patients with chronic heart failure based on the MCID of patient-reported outcomes by the multilevel model

10.21203/rs.3.rs-40363/v3 ◽

2020 ◽

Author(s):

Jing Tian ◽

Jinghua Zhao ◽

Qing Zhang ◽

Jia Ren ◽

Linai Han ◽

...

Keyword(s):

Heart Failure ◽

Chronic Disease ◽

Chronic Heart Failure ◽

Clinical Significance ◽

Multilevel Models ◽

Threshold Value ◽

Patient Reported Outcome ◽

Self Management ◽

Low Sodium Diet ◽

Patient Reported

Abstract Purpose: The minimal clinically important difference (MCID) of a patient-reported outcome (PRO) represents the threshold value of the change in the score for that PRO. It is deemed to have an important implication in clinical management. This study was performed to evaluate the clinical significance of chronic disease self-management (CDSM) for patients with chronic heart failure based on the MCID of the chronic heart failure - PRO measure (CHF-PROM).Methods: A multicenter, prospective cohort study of 555 patients with heart failure were enrolled from July 2018. Advice of CDSM was provided in written form at discharge to all patients. Information regarding CHF-PROM and CDSM were collected during follow-up. Multilevel models were applied to dynamically evaluate the effects of CDSM for CHF-PROM scores, as well as its physical and psychological domains. MCID changes of the PRO were introduced and compared with β values of CDSM obtained from the multi-level models to further evaluate the clinical significance.Results: Scores for CHF-PROM improved significantly after discharge. The multilevel models showed that a regular schedule, avoidance of over-eating, a low-sodium diet and exercise increased scores on CHF-PROM. Compared with the MCID, avoidance of over-eating (12.39 vs. 9.75) and maintenance of a regular schedule often (10.98 vs. 9.75), and exercise almost every day (11.36 vs. 9.75) reached clinical significance for the overall summary. Avoidance of over-eating (5.88 vs. 4.79) and a regular schedule almost every day (4.96 vs. 4.79) reached clinical significance for the physical scores. Avoidance of over-eating half of the time (5.26 vs. 4.87) and a regular schedule almost every day (5.84 vs. 4.87) demonstrated clinical significance for the psychological scores.Conclusions: This study observed an association of avoidance of over-eating and maintenance of a regular schedule with the improvement of CHF-PROM. It provides further evidence for management of heart failure.

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Usability Testing of a Sensor-Controlled Digital Game to Engage Older Adults with Heart Failure in Physical Activity and Weight Monitoring

Applied Clinical Informatics ◽

10.1055/s-0040-1721399 ◽

2020 ◽

Vol 11 (05) ◽

pp. 873-881

Author(s):

Kavita Radhakrishnan ◽

Christine Julien ◽

Matthew O'Hair ◽

Thomas Baranowski ◽

Grace Lee ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Qualitative Analysis ◽

Self Management ◽

Future Research ◽

Game Playing ◽

Semistructured Interview ◽

Digital Game ◽

Weight Monitoring ◽

Behavior Tracking

Abstract Background Poor self-management of heart failure (HF) has contributed to poor health outcomes. Sensor-controlled digital games (SCDGs) integrates data from behavior-tracking sensors to trigger progress, rewards, content, and positive feedback in a digital game to motivate real-time behaviors. Objectives To assess the usability of an SCDG prototype over a week of game-playing among 10 older adults with HF in their homes. Methods During initial play, participants' SCDG experiences were observed in their homes using a checklist based on the seven-item Serious Game User Evaluator (SeGUE) instrument. After a week of game-playing, participants completed a survey guided by the Intrinsic Motivation Inventory, to provide their perceptions of the SCDG's usability. Qualitative analysis via semistructured interview-derived themes on experiences playing the SCDG, perceptions regarding engaging with the SCDG, and any usability issues encountered. Results Ten HF participants (50% women and 50% White) played the SCDG for an average of 6 out of 7 days. Nine found the SCDG to be interesting, satisfying, and easy to play. The average step count over a week was 4,117 steps (range: 967–9,892). Average adherence with weight monitoring was 5.9 days in a week. Qualitative analysis yielded outcomes regarding attitudes toward SCDG, and barriers and facilitators that influenced participants' engagement with the SCDG. Conclusion To the best of the authors' knowledge, this usability and feasibility study is the first to report an SCDG designed to improve HF self-management behaviors of older adults in their homes. Future research should consider several issues, such as user profiles, prior game-playing experiences, and network conditions most suitable for connected health interventions for older adults living in the community.

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Influence of self-management on patient-reported outcomes for individuals with chronic heart failure: a multilevel model approach from a longitudinal study

10.21203/rs.3.rs-22271/v1 ◽

2020 ◽

Author(s):

Jing Tian ◽

Jinghua Zhao ◽

Qing Zhang ◽

Jia Ren ◽

Linai Han ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Patient Reported Outcomes ◽

Multilevel Models ◽

Management Strategies ◽

Angiotensin Converting Enzyme Inhibitors ◽

Self Management ◽

Converting Enzyme Inhibitors ◽

Patient Reported ◽

Improve Patient

Abstract Purpose: Self-management is highly heterogenous in patient-reported outcomes in individuals with chronic heart failure and lacks a clinical definition. The aim of this study was to identify clinically meaningful strategies that improve patient-reported outcomes in those with chronic heart failure.Methods: A multicenter, prospective cohort study of 555 patients with heart failure were enrolled from May 2017 to May 2019. Self-management advice was provided in written form at discharge. Information regarding chronic heart failure in patient-reported outcomes and self-management was collected during follow-up. Multilevel models were applied to dynamically evaluate the effects of self-management strategies for patient-reported outcome of chronic heart failure (CHF-PRO) scores, as well as its physical and psychological domains. Minimal clinically important difference was introduced to further evaluate clinical significance.Results: Scores for CHF-PRO improved significantly after discharge. A regular schedule, avoidance of over-eating, and a low-sodium diet increased scores on patient-reported outcomes, including overall scores and physical and psychological scores. In addition, exercise improved patient-reported outcomes and its physical domain. The use of angiotensin-converting enzyme inhibitors also increased physical scores. Among these variables, a regular daily schedule and avoidance of over-eating almost every day reached clinical significance for CHF-PRO scores, as well as its physical and psychological domains.Conclusions: Self-management, especially the avoidance of over-eating and maintenance of a regular schedule, should be implemented to improve patient-reported outcomes in those with chronic heart failure.Trial registration: 2018LL128, January 2, 2018.

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Influence of self-management on patient-reported outcomes for individuals with chronic heart failure: a multilevel model approach from a longitudinal study

10.21203/rs.3.rs-16907/v1 ◽

2020 ◽

Author(s):

Jing Tian ◽

Jinghua Zhao ◽

Qing Zhang ◽

Jia Ren ◽

Linai Han ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Clinical Significance ◽

Patient Reported Outcomes ◽

Multilevel Models ◽

Management Strategies ◽

Self Management ◽

Converting Enzyme Inhibitors ◽

Patient Reported ◽

Improve Patient

Abstract Purpose: Self-management is highly heterogenous in patient-reported outcomes in individuals with chronic heart failure and lacks a clinical definition. The aim of this study was to identify clinically meaningful strategies that improve patient-reported outcomes in those with chronic heart failure. Methods: A total of 555 patients with heart failure were enrolled. Self-management advice was provided in written form at discharge. Information regarding chronic heart failure in patient-reported outcomes and self-management was collected during follow-up. Multilevel models were applied to evaluate the effects of self-management strategies for patient-reported outcome of chronic heart failure (CHF-PRO) scores, as well as its physical and psychological domains. Minimal clinically important difference was introduced to further evaluate clinical significance. Results: Scores for CHF-PRO improved significantly after discharge. A regular schedule, avoidance of over-eating, and a low-sodium diet increased scores on patient-reported outcomes, including overall scores and physical and psychological scores. In addition, exercise improved patient-reported outcomes and its physical domain. The use of angiotensin-converting enzyme inhibitors also increased physical scores. Among these variables, a regular daily schedule and avoidance of over-eating almost every day reached clinical significance for CHF-PRO scores, as well as its physical and psychological domains. Conclusions: Self-management, especially the avoidance of over-eating and maintenance of a regular schedule, should be implemented to improve patient-reported outcomes in those with chronic heart failure.

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A Systematic Literature Review of the Design Approach and Usability Evaluation of the Pain Management Mobile Applications

Symmetry ◽

10.3390/sym11030400 ◽

2019 ◽

Vol 11 (3) ◽

pp. 400 ◽

Cited By ~ 8

Author(s):

Umm Shah ◽

Thiam Chiew

Keyword(s):

Pain Management ◽

Literature Review ◽

Systematic Literature Review ◽

Mobile Applications ◽

Mobile Apps ◽

Empirical Evaluation ◽

The Elderly ◽

Design Approach ◽

Self Management ◽

Usability Assessment

The increasing popularity of mHealth is a promising opportunity for pain self-management. Mobile apps can be easily developed, but understanding the design and usability will result in apps that can retain more users. This research aims at identifying, analyzing, and synthesizing the current state-of-the-art of: (a) the design approach and (b) usability assessment of pain management mobile applications. A systematic literature review was conducted on 27 studies retrieved from Medline, PubMed, EMBASE, Web of Science, and Scopus. The review revealed that most of the apps were for chronic pain. No app was specifically for men or for the elderly. None of the studies involved expert-based system inspection methods. Only one study used two different approaches of automated and empirical evaluation. We mapped the identified usability issues to ISO 9241-11 and ISO/IEC 25010, and aggregated the recommendations for improvement. Moreover, we also identified certain issues that are solely concerned with the patient’s behavior. We organized the issues into taxonomies of design considerations for building usable pain self-management mobile applications. As pain is prevalent among the elderly, pain management will be much needed while moving toward an aging society. However, we found that the involvement of the elderly in the development of pain management mobile apps is very minimal, which may affect the utility and usability of the apps.

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Self-Management of Hypertension in Hispanic Adults

Clinical Nursing Research ◽

10.1177/1054773811411582 ◽

2011 ◽

Vol 20 (4) ◽

pp. 347-365 ◽

Cited By ~ 5

Author(s):

Amelia Perez

Keyword(s):

Health Care Professionals ◽

Intervention Studies ◽

Self Management ◽

Future Research ◽

Management Interventions ◽

Quantitative Studies ◽

Hispanic Adults ◽

Hispanic Patients ◽

Hypertension Awareness ◽

And Control

Almost one third of the U.S. population has hypertension. Compared to non-Hispanic Whites, Hispanic individuals have significantly lower levels of hypertension awareness, treatment, and control. This article provides an integrative review of factors that may influence self-management of hypertension among Hispanic adults. A detailed literature search of articles published between 1985 and 2010 was performed. Twelve articles based on quantitative studies ( n = 9) and qualitative studies ( n = 3) were reviewed. Barriers and facilitators to self-management of hypertension were identified. The findings in this review may help health care professionals in recognizing factors that need to be considered in the development of self-management interventions for Hispanic patients with hypertension. Future research is needed to further explore facilitators to self-management, and to implement and evaluate intervention studies aimed at blood pressure management in Hispanics with hypertension.

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Health care professionals’ views towards self-management and self-management education for people with type 2 diabetes

BMJ Open ◽

10.1136/bmjopen-2019-029961 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029961 ◽

Cited By ~ 3

Author(s):

Jamie Ross ◽

Fiona A Stevenson ◽

Charlotte Dack ◽

Kingshuk Pal ◽

Carl R May ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Care Professionals ◽

Management Education ◽

Information Provision ◽

Self Management ◽

Normalisation Process Theory ◽

Management Approach ◽

Structured Interviews ◽

Diverse Range

ObjectivesSignificant problems with patients engaging with diabetes self-management education (DSME) exist. The role of healthcare professionals (HCPs) has been highlighted, with a lack of enthusiasm, inadequate information provision and poor promotion of available programmes all cited as affecting patients’ decisions to attend. However, little is known about HCPs’ views towards DSME. This study investigates the views of HCPs towards self-management generally and self-management in the context of DSME more specifically.DesignA qualitative study using semi-structured interviews to investigate HCPs views of type 2 diabetes self-management and DSME. Data were analysed thematically and emergent themes were mapped on to the constructs of Normalisation Process Theory (NPT).SettingTwo boroughs in London, UK.ParticipantsSampling was purposive to recruit a diverse range of professional roles including GPs, practice nurses, diabetes specialist nurses, healthcare assistants (HCAs), receptionists and commissioners of care.ResultsInterviews were conducted with 22 participants. The NPT analysis demonstrated that while a self-management approach to diabetes care was viewed by HCPs as necessary and, in principle, valuable, the reality is much more complex. HCPs expressed ambivalence about pushing certain patients into self-managing, preferring to retain responsibility. There was a lack of awareness among HCPs about the content of DSME and benefits to patients. Commitment to and engagement with DSME was tempered by concerns about suitability for some patients. There was little evidence of communication between providers of group-based DSME and HCPs or of HCPs engaging in work to follow-up non-attenders.ConclusionsHCPs have concerns about the appropriateness of DSME for all patients and discussed challenges to engaging with and performing the tasks required to embed the approach within practice. DSME, as a means of supporting self-management, was considered important in theory, but there was little evidence of HCPs seeing their role as extending beyond providing referrals.

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