Wali Sahr, Keshavjee Karim, Nguyen Linda, Mbuagbaw Lawrence, Demers Catherine
Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
JMIR Cardio. 2020 Nov 9;4(1):e15885. doi: 10.2196/15885.
Heart failure (HF) affects many older individuals in North America, with recurrent hospitalizations despite postdischarge strategies to prevent readmission. Proper HF self-care can potentially lead to better clinical outcomes, yet many older patients find self-care challenging. Mobile health (mHealth) apps can provide support to patients with respect to HF self-care. However, many mHealth apps are not designed to consider potential patient barriers, such as literacy, numeracy, and cognitive impairment, leading to challenges for older patients. We previously demonstrated that a paper-based standardized diuretic decision support tool (SDDST) with daily weights and adjustment of diuretic dose led to improved self-care.
The aim of this study is to better understand the self-care challenges that older patients with HF and their informal care providers (CPs) face on a daily basis, leading to the conversion of the SDDST into a user-centered mHealth app.
We recruited 14 patients (male: 8/14, 57%) with a confirmed diagnosis of HF, aged ≥60 years, and 7 CPs from the HF clinic and the cardiology ward at the Hamilton General Hospital. Patients were categorized into 3 groups based on the self-care heart failure index: patients with adequate self-care, patients with inadequate self-care without a CP, or patients with inadequate self-care with a CP. We conducted semistructured interviews with patients and their CPs using persona-scenarios. Interviews were transcribed verbatim and analyzed for emerging themes using an inductive approach.
Six themes were identified: usability of technology, communication, app customization, complexity of self-care, usefulness of HF-related information, and long-term use and cost. Many of the challenges patients and CPs reported involved their unfamiliarity with technology and the lack of incentive for its use. However, participants were supportive and more likely to actively use the HF app when informed of the intervention's inclusion of volunteer and nurse assistance.
Patients with varying self-care adequacy levels were willing to use an mHealth app if it was simple in its functionality and user interface. To promote the adoption and usability of these tools, patients confirmed the need for researchers to engage with end users before developing an app. Findings from this study can be used to help inform the design of an mHealth app to ensure that it is adapted for the needs of older individuals with HF.
心力衰竭（HF）影响着北美许多老年人，尽管采取了出院后预防再入院的策略，但仍有反复住院的情况。适当的心力衰竭自我护理有可能带来更好的临床结果，然而许多老年患者发现自我护理具有挑战性。移动健康（mHealth）应用程序可以为心力衰竭自我护理的患者提供支持。然而，许多mHealth应用程序在设计时并未考虑到潜在的患者障碍，如识字能力、计算能力和认知障碍，这给老年患者带来了挑战。我们之前证明，一种基于纸张的标准化利尿剂决策支持工具（SDDST），结合每日体重监测和利尿剂剂量调整，可改善自我护理。
本研究的目的是更好地了解老年心力衰竭患者及其非正式护理提供者（CPs）日常面临的自我护理挑战，从而将SDDST转换为以用户为中心的mHealth应用程序。
我们从汉密尔顿综合医院的心力衰竭诊所和心脏病病房招募了14名确诊为心力衰竭、年龄≥60岁的患者（男性：8/14，57%）和7名CPs。根据自我护理心力衰竭指数，将患者分为3组：自我护理充分的患者、没有CPs时自我护理不足的患者或有CPs时自我护理不足的患者。我们使用人物角色情景对患者及其CPs进行了半结构化访谈。访谈内容逐字记录，并采用归纳法分析新出现的主题。
确定了六个主题：技术的可用性、沟通、应用程序定制、自我护理的复杂性、心力衰竭相关信息的有用性以及长期使用和成本。患者和CPs报告的许多挑战都涉及他们对技术的不熟悉以及缺乏使用技术的动力。然而，当被告知干预措施包括志愿者和护士协助时，参与者表示支持并更有可能积极使用心力衰竭应用程序。
自我护理水平不同的患者如果应用程序的功能和用户界面简单，愿意使用mHealth应用程序。为了促进这些工具的采用和可用性，患者确认研究人员在开发应用程序之前需要与最终用户进行沟通。本研究的结果可用于为mHealth应用程序的设计提供信息，以确保其适合老年心力衰竭患者的需求。
