Measures of Engagement with mHealth Interventions in Patients with Heart Failure: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Ifeanyi Madujibeya ◽  
Terry Lennie ◽  
Adaeze Aroh ◽  
Misook L Chung ◽  
Debra Moser
Keyword(s):  
Heart Failure ◽  
Patient Engagement ◽  
English Language ◽  
Exercise Adherence ◽  
Qualitative Studies ◽  
Current Evidence ◽  
Structured Interviews ◽  
System Usage ◽  
Patients With Heart Failure ◽  
Usage Data

BACKGROUND The computing and communication features of mobile devices are increasingly leveraged in mHealth interventions to provide comprehensive and tailored support that may have positive outcomes in patients with heart failure (HF). However, examination of mHealth intervention effectiveness has provided mixed findings. Considering that patient engagement is a prerequisite for the effectiveness of interventions, understanding how patients engage with mHealth interventions, and the effects of patient engagement on HF outcomes may explain the mixed findings. OBJECTIVE Our aim was to synthesize current evidence on measures of patient engagement with mHealth interventions, and the effects of engagement on HF outcomes METHODS A comprehensive search of the literature was conducted in 7 databases for relevant studies published in the English Language from 2009 to September 2021. Descriptive characteristics of studies were reported. Content analysis was conducted to identify themes that described patient engagement with mHealth in the qualitative studies included in the review. RESULTS We synthesized 32 studies that operationalized engagement with mHealth interventions in 4771 patients with HF (67.9% male), ranging from a sample of 7 to 1571, with a median of 53.3 patients. Patient engagement with mHealth interventions was measured only quantitatively based on system usage data (71.8%, 23/32), only qualitatively based on data from semi-structured interviews and focus groups (6.3%, 2/32), and by a combination of both quantitative and qualitative data (21.9%, 7/32). System usage data were evaluated using 6 metrics of engagement: (1) number of physiological parameters transmitted (63.3%, 19/30); (2) number of HF questionnaires completed (6.7%, 2/30); (3) numbers of logins (13.3%, 4/30); (4) number of short message service (SMS) responses (3.3%, 1/30); (5) time spent (16.7%, 5/30); (6) number of features accessed/screen viewed (9.5%, 4/30). There was a lack of consistency in how system usage metrics were reported across the studies. Eighty percent of the studies reported only the descriptive characteristics of the system usage data. Emotional, cognitive, and behavioral domains of patient engagement were identified in qualitative studies. Patient engagement levels ranged from 45% to 100% and decreased over time. The effects of engagement on HF knowledge, self-care, exercise adherence, and HF hospitalizations were inconclusive. CONCLUSIONS The operational definitions of patient engagement with mHealth interventions are underreported and lack consistency. The application of inferential analytical methods to engagement data is extremely limited. More research focused on developing optimal and standardized measures of patient engagement that may be applied across different study designs is warranted.

scholarly journals Operationalization of heart failure patients engagement with mHealth

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
I Madujibeya ◽  
A Aroh
Keyword(s):  
Heart Failure ◽  
English Language ◽  
Current Evidence ◽  
Structured Interviews ◽  
System Usage ◽  
Funding Sources ◽  
Comprehensive Search ◽  
Qualitative Measure ◽  
Study Designs ◽  
Usage Data

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The computing and communication features of mobile devices have been leveraged in mobile Health (mHealth) interventions to provide comprehensive and tailored support that may have positive outcomes in patients with heart failure (HF.  However, the effects of the interventions have shown mixed evidence. Considering that patients’ engagement is a prerequisite for the effectiveness of the interventions, understanding how patients engage with the interventions, and the effects of patients’ engagement on HF outcomes may explain the mixed findings. Objective This study aimed to synthesize current evidence on measures of HF patients’ engagement with mHealth interventions, and the effects of the interventions on HF outcomes. Method In accordance with the Arksey and O’Malley framework for scoping review, a comprehensive search of the literature was conducted in 7 databases for relevant studies published in the English language from 2009 to Feb. 2021. The descriptive characteristics of the studies were reported. Thematic analysis was conducted to identify themes that described patients’ engagement in the qualitative studies included in the review. Results The review synthesized 29 studies that operationalized engagement with mHealth interventions in 3665 patients with HF, ranging from a sample of 7 to 1571, with a median of 80 patients. Patients’ engagement with mHealth interventions was measured quantitively based on system usage data (82.7%, 24/29), qualitatively by semi-structured interviews and focus groups (10.3%, 3/29), and by mixed methods or combination of qualitative and system usage data (17.2%, 5/29). System usage data were evaluated using 7 metrics: (1) number of physiological parameters measured (88.5%, 3/26); (2) duration of use or time spent (3.8%, 6/26);  (3) features accessed/screen viewed (11.5%, 3/26); (4) number of HF educational videos viewed (7.7%, 2/26); (5) number of SMS response (3.8%, 1/26); (6) number of HF questionnaire completed (3.8%,  1/26; (7)numbers of logins (5%, 1/19).  There is a lack of consistency in how system usage metrics were reported across the studies; 73.7 % of the studies reported only the descriptive statistics of the System usage data. Intervention usage was the most identified subtheme in the qualitative measure. The effect of patients’ engagement with mHealth interventions on HF-related outcomes was inconclusive. Conclusion The operational definitions of patients’ engagement with mHealth interventions are underreported and lack consistency. The application of inferential analytical methods to the engagement data is extremely limited, which indicates a gap in mHealth research in patients with HF. More research focusing on developing optimal and standardized measures of patients’ engagement that may be applied across different study designs is warranted

Caring experiences of family caregivers of patients with heart failure: A meta-ethnographic review of the past 10 years

2020 ◽  
Vol 19 (6) ◽  
pp. 473-485 ◽  
Author(s):  
Eun Young Kim ◽  
Seieun Oh ◽  
Youn-Jung Son
Keyword(s):  
Heart Failure ◽  
Family Caregivers ◽  
Healthcare Providers ◽  
Qualitative Studies ◽  
Bibliographic Databases ◽  
Eligibility Criteria ◽  
Essential Information ◽  
Patients With Heart Failure ◽  
Caregiving Roles

Background: Living with heart failure, a debilitating disease with an unpredictable course, requires ongoing adaptation and management not only from patients but also from their families. Family caregivers have been known to be key facilitators of self-management of heart failure. An integrative understanding of the experiences of family caregivers will provide essential information for improving the quality of life of persons with heart failure and their families. Aims: This study aimed to integrate and synthesize the findings of qualitative studies on family members’ experiences of caring for patients with heart failure. Methods: We employed the meta-ethnography methodology. Five electronic bibliographic databases were used to retrieve studies published from April 2009–March 2019 that explored family caregivers’ experiences of caring for patients with heart failure. Twelve qualitative studies were finally included for the synthesis, based on the eligibility criteria. Results: Three themes were identified: “shouldering the entire burden,” “starting a new life,” and “balancing caregiving and everyday life.” These three themes illustrate how family caregivers fulfilled caregiving roles, what helped them juggle their multiple responsibilities, and how they struck a balance between life as caregivers and individuals in their own right. Conclusion: This review provides a deeper understanding of family caregivers’ experiences of caring for patients with heart failure. The findings can help healthcare providers in the development and implementation of tailored interventions for both patients and family caregivers.

scholarly journals Long-term exercise adherence in patients with heart failure: A qualitative study

Heart & Lung ◽  
2020 ◽  
Vol 49 (6) ◽  
pp. 696-701
Author(s):  
Shane Warehime ◽  
Danae Dinkel ◽  
Windy Alonso ◽  
Bunny Pozehl
Keyword(s):  
Heart Failure ◽  
Qualitative Study ◽  
Exercise Adherence ◽  
Patients With Heart Failure

Ramipril for the Prevention and Treatment of Cardiovascular Disease

2003 ◽  
Vol 37 (3) ◽  
pp. 412-419 ◽  
Author(s):  
April D Vuong ◽  
Laura G Annis
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Ace Inhibitors ◽  
English Language ◽  
Ace Inhibitor ◽  
Data Extraction ◽  
Left Ventricular ◽  
Current Evidence ◽  
Pubmed Database ◽  
Prevention And Treatment

OBJECTIVE: To evaluate the effectiveness of ramipril in the prevention and treatment of cardiovascular disease and determine its need for inclusion on a formulary. DATA SOURCES: A MEDLINE and PubMed database search was conducted (1987–May 2002). Only journals written in the English language were selected for review. DATA EXTRACTION AND STUDY SELECTION: Articles reporting the use of ramipril in humans were evaluated. Emphasis was placed on randomized, controlled trials assessing efficacy. DATA SYNTHESIS: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor that exerts its effects through inhibition of the renin–angiotensin–aldosterone system. It exhibits a safety profile that is similar to that of other ACE inhibitors and is comparable in cost to the majority of the available agents. Clinical trials have proven the effectiveness of ACE inhibitors in the treatment of hypertension, heart failure, and nephropathy. Ramipril, however, is the only ACE inhibitor currently approved for the prevention of cardiovascular events in high-risk patients without evidence of left-ventricular dysfunction or heart failure, based on the results of the HOPE (Heart Outcomes Prevention Evaluation) trial. Whether this effect is specific to ramipril has yet to be proven. This article emphasizes the major trials involving ramipril including the AIRE (Acute Infarction Ramipril Efficacy), REIN (Ramipril Efficacy in Nephropathy), and HOPE trials. CONCLUSIONS: Although similar to other ACE inhibitors in many aspects, it cannot be assumed that the benefits shown with ramipril in the HOPE trial are a class effect. Ongoing trials should help to clarify this matter. Until this time, current evidence justifies the inclusion of ramipril on a formulary.

scholarly journals Hospitalist perspectives of available tests to monitor volume status in patients with heart failure: a qualitative study

2020 ◽  
Author(s):  
Anna M Maw ◽  
Carolina Ortiz-lopez ◽  
Megan A Morris ◽  
Christine Jones ◽  
Elaine Gee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Volume Status ◽  
Structured Interviews ◽  
Patients With Heart Failure ◽  
The Us ◽  
Time Required

AbstractAcute decompensated heart failure is the leading admitting diagnosis in patients 65 and older with more than 1 million hospitalizations per year in the US alone. Traditional tools to evaluate for and monitor volume status in patients with heart failure, including symptoms and physical exam findings, are known to have limited accuracy. In contrast, point of care lung ultrasound is a practical and evidenced-based tool for monitoring of volume status in patients with heart failure. However, few inpatient clinicians currently use this tool to monitor diuresis. We performed semi-structured interviews of 23 hospitalists practicing in 5 geographically diverse academic institutions in the US to better understand how hospitalists currently assess and monitor volume status in patients hospitalized with heart failure. We also explored their perceptions and attitudes toward adoption of lung ultrasound. Hospitalist participants reported poor reliability and confidence in the accuracy of traditional tools to monitor diuresis and expressed interest in learning or were already using lung ultrasound for this purpose. The time required for training and access to equipment that does not impede workflow were considered important barriers to its adoption by interviewees.

scholarly journals Barriers to Self-care Among Patients with Heart Failure: A Qualitative Study

2020 ◽  
Author(s):  
Reza Negarandeh ◽  
Ali Aghajanloo ◽  
Khatereh Seylani
Keyword(s):  
Heart Failure ◽  
Content Analysis ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Self Care ◽  
The Body ◽  
Financial Strain ◽  
Personal Factors ◽  
Structured Interviews ◽  
Patients With Heart Failure

Introduction: Heart failure is the most prevalent cardiovascular disease. It is the end stage of most cardiovascular diseases and is characterized by the reduced ability of the heart to pump enough blood to fulfill the metabolic needs of the body. Self-care is the basis of the management of chronic diseases such as heart failure. The aim of this study was to explore the barriers to self-care among patients with heart failure. Methods: This was a qualitative content analysis. Participants were fourteen patients with heart failure and three healthcare providers who were purposively recruited from cardiac care centers in Zanjan, Iran. Data were collected through in-depth semi-structured interviews and were analyzed through the conventional qualitative content analysis approach proposed by Elo and Kyngäs. Results: Self-care barriers -care among patients with HF were categorized into three main categories, namely personal factors, disease burden, and inefficient support system. Each category had three subcategories which were respectively lack of self-care knowledge, heart failure-related negative emotions, the difficulty of changing habits, progressive physical decline, comorbid conditions, financial strain, inadequate social support, healthcare providers’ inattention to self-care, and limited access to healthcare providers. Conclusion: Patients with heart failure face different personal, disease-related, and supportrelated barriers to self-care. Based on these barriers, healthcare providers can develop interventions for promoting self-care among patients with heart failure.

scholarly journals Understanding Barriers to Healthcare Access for Heart Failure Patients during the COVID-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1027-1028
Author(s):  
Hanzhang Xu ◽  
Julie Miller ◽  
Roy Thompson ◽  
Bradi Granger ◽  
Matthew Dupre
Keyword(s):  
Heart Failure ◽  
Access To Care ◽  
Healthcare Access ◽  
Transitions Of Care ◽  
Structured Interviews ◽  
Patient Centered ◽  
Patients With Heart Failure ◽  
Heart Center ◽  
Barriers To Healthcare Access

Abstract Early outpatient follow-up within two weeks after hospital discharge is an effective strategy for improving transitions of care in older patients with heart failure (HF). However, implementing timely follow-up care for HF patients has been challenging, especially during the COVID-19 pandemic. This convergent mixed-methods study identified patients’ barriers to accessing care and ascertained their recommendations for addressing these barriers. We enrolled 264 HF patients admitted to the Duke Heart Center between May 2020 and August 2021. A standardized survey and electronic health records (EHR) were used to collect patients’ sociodemographic, psychosocial, behavioral, and clinical data. For patients who reported some difficulty accessing their healthcare (n=30), semi-structured interviews were conducted to understand these barriers. Data were analyzed using rapid analysis techniques. Barriers to accessing care varied across participants, with scheduling an appointment being the most common barrier (12 of the 30 responses). Participants indicated that job-related conflicts, providers’ availability, or COVID-19 contributed most to the difficulty in scheduling an appointment. Some participants experienced more difficulties during the pandemic due to fewer appointments available for non-acute and non-COVID-19 related needs. Transportation was another critical barrier, which was often associated with the participants’ physical functional status. Participants identified the benefits of using telemedicine to address access to care barriers; however, they shared their concerns that telemedicine visits may not be sufficient to assess their HF conditions. Study findings highlight the need for more continual, tailored, and patient-centered interventions to improve access to care in older HF patients.

Symptom perception management education improves self-care in patients with heart failure

Work ◽  
2021 ◽  
pp. 1-9
Author(s):  
Joana Pereira Sousa ◽  
Cláudia Oliveira ◽  
Miguel Pais-Vieira
Keyword(s):  
Heart Failure ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Complex Intervention ◽  
Care Management ◽  
Self Care ◽  
Symptom Perception ◽  
Structured Interviews ◽  
Symptom Recognition ◽  
Patients With Heart Failure

BACKGROUND: Patients with heart failure often have difficulty recognizing signs and symptoms of the disease, which delays seeking help, and therefore interferes with patient engagement and self-care management. Early detection of these symptoms could lead to care-seeking and avoid hospitalizations. OBJECTIVE: The purpose of this study was to design a complex intervention through a systematic literature review and qualitative study. METHODS: Our design followed the Medical Research Council’s recommendations. To design a complex intervention, we combined a systematic literature review on education, symptom recognition, and self-care management in patients with heart failure, and semi-structured interviews with cardiology healthcare providers and patients with heart failure admitted to a cardiology ward. RESULTS: The systematic literature review identified 582 studies published between 2005 and 2014, of which four were included in the final review. These suggested that patient education focused on symptom recognition, combined with reinforcements, led to better self-care behaviors. Additionally, content analysis of semi-structured interviews revealed three themes: health management, behavior management, and support received. CONCLUSIONS: Combining the findings of the literature review and the themes that emerged from the semi-structured interviews, we proposed the development and implementation of a complex intervention on symptom perception and fluid management.

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