Hirschey Jaclyn, Bane Sunetra, Mansour Moussa, Sperber Jodi, Agboola Stephen, Kvedar Joseph, Jethwani Kamal
Partners Connected Health, Partners Healthcare, Boston, MA, United States.
Heart Center, Massachusetts General Hospital, Boston, MA, United States.
JMIR Hum Factors. 2018 Mar 15;5(1):e13. doi: 10.2196/humanfactors.8004.
Atrial fibrillation (AFib) is the most common form of heart arrhythmia and a potent risk factor for stroke. Nonvitamin K antagonist oral anticoagulants (NOACs) are routinely prescribed to manage AFib stroke risk; however, nonadherence to treatment is a concern. Additional tools that support self-care and medication adherence may benefit patients with AFib.
The aim of this study was to evaluate the perceived usability and usefulness of a mobile app designed to support self-care and treatment adherence for AFib patients who are prescribed NOACs.
A mobile app to support AFib patients was previously developed based on early stage interview and usability test data from clinicians and patients. An exploratory pilot study consisting of naturalistic app use, surveys, and semistructured interviews was then conducted to examine patients' perceptions and everyday use of the app.
A total of 12 individuals with an existing diagnosis of nonvalvular AFib completed the 4-week study. The average age of participants was 59 years. All participants somewhat or strongly agreed that the app was easy to use, and 92% (11/12) reported being satisfied or very satisfied with the app. Participant feedback identified changes that may improve app usability and usefulness for patients with AFib. Areas of usability improvement were organized by three themes: app navigation, clarity of app instructions and design intent, and software bugs. Perceptions of app usefulness were grouped by three key variables: core needs of the patient segment, patient workflow while managing AFib, and the app's ability to support the patient's evolving needs.
The results of this study suggest that mobile tools that target self-care and treatment adherence may be helpful to AFib patients, particularly those who are newly diagnosed. Additionally, participant feedback provided insight into the varied needs and health experiences of AFib patients, which may improve the design and targeting of the intervention. Pilot studies that qualitatively examine patient perceptions of usability and usefulness are a valuable and often underutilized method for assessing the real-world acceptability of an intervention. Additional research evaluating the AFib Connect mobile app over a longer period, and including a larger, more diverse sample of AFib patients, will be helpful for understanding whether the app is perceived more broadly to be useful and effective in supporting patient self-care and medication adherence.
心房颤动（房颤）是最常见的心律失常形式，也是中风的一个重要危险因素。非维生素K拮抗剂口服抗凝药（NOACs）通常用于管理房颤患者的中风风险；然而，治疗依从性不佳是一个问题。支持自我护理和药物依从性的其他工具可能会使房颤患者受益。
本研究的目的是评估一款移动应用程序的感知可用性和有用性，该应用程序旨在支持服用NOACs的房颤患者的自我护理和治疗依从性。
先前基于临床医生和患者的早期访谈及可用性测试数据开发了一款支持房颤患者的移动应用程序。然后进行了一项探索性试点研究，包括自然使用该应用程序、进行调查以及半结构化访谈，以考察患者对该应用程序的看法及其日常使用情况。
共有12名已确诊为非瓣膜性房颤的个体完成了为期4周的研究。参与者的平均年龄为59岁。所有参与者都或多或少或强烈同意该应用程序易于使用，并且92%（11/12）的参与者表示对该应用程序感到满意或非常满意。参与者的反馈指出了一些可能改善该应用程序对房颤患者的可用性和有用性的变化。可用性改进的方面按三个主题进行了整理：应用程序导航、应用程序说明和设计意图的清晰度以及软件漏洞。对应用程序有用性的看法按三个关键变量进行了分类：患者群体的核心需求、管理房颤时的患者工作流程以及该应用程序满足患者不断变化需求的能力。
本研究结果表明，针对自我护理和治疗依从性的移动工具可能对房颤患者有帮助，尤其是那些新确诊的患者。此外，参与者的反馈深入了解了房颤患者的不同需求和健康经历，这可能会改善干预措施的设计和针对性。定性考察患者对可用性和有用性看法的试点研究是评估一项干预措施在现实世界中可接受性的一种有价值且经常未得到充分利用的方法。进一步开展研究，在更长时间内评估房颤连接移动应用程序，并纳入更大、更多样化的房颤患者样本，将有助于了解该应用程序在支持患者自我护理和药物依从性方面是否被更广泛地认为是有用且有效的。
