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S. Wali



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    OS29 - e-Health Solutions for Patient Self Management (ID 47)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 1
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      OS29.04 - End-User Engagement: Electronic Self-Care Application for Patients with Heart Failure (ID 206)

      S. Wali, Medicine, McMaster University; Hamilton/CA

      • Abstract
      • Slides

      Purpose/Objectives: Heart failure (HF) is a chronic disease that affects over 1% of Canadians and is associated with a significant economic burden (2.8 billion/year). Self-care is key to the management of HF and can potentially lead to better clinical outcomes. Proper HF self-care includes tasks such as daily weight and symptom monitoring, as well as adjusting diuretics based on weight. Nevertheless, patients find HF self-care challenging, with less than 50% of patients regularly weighing themselves. Mobile applications can support self-care but barriers such as literacy, numeracy and mild cognitive impairment can lead to challenges in adopting technology. Our previous work supports the use of a paper-based standardized diuretic decision support tool (SDDST) promoting self-care in older individuals with HF to manage their daily weight and adjust their diuretic dose accordingly. The primary objective of this study was to use participant (HF patients, informal care-providers [CPs]) input to convert our paper-based SDDST into a user-centered electronic mobile application.

      Methodology/Approach: We recruited patients (male and female, age > 60) with a confirmed diagnosis of HF, and their CPs from the Heart Function Clinic at the Hamilton Health Sciences General site. HF patients were categorized into three groups, 1) adequate self-care patients, 2) inadequate self-care patients without a CP or 3) inadequate self-care patients with a CP, based on their self-care abilities measured with the Self-Care Heart Failure Index (SCHFI) where a score of > 70 is considered self-care adequate. We are conducting semi-structured interviews with HF patients and CPs using Persona-Scenarios. Interviews are transcribed verbatim and analyzed using NVivo, version 10, for emerging themes regarding self-care. This study has received ethics approval from the Hamilton Integrated Research Ethics Board.

      Finding/Results: Thus far, we have interviewed 6 patients (4 male, 2 female, mean age: 74) and 3 CPs. We have identified 3 major themes which include 1) Challenges with technology, 2) Communication and assistance with circle of care, and 3) App customization. Many of the challenges patients and CPs mentioned involved their unfamiliarity with technology. However, participants were supportive and more likely to actively use the HFApp when informed of the intervention’s inclusion of volunteer and nurse assistance. Data collection and analysis is still in-progress and will be completed by the end of December.

      Conclusion/Implications/Recommendations: Many mHealth apps fail to maximize their potential due to the lack of end-user engagement. To our knowledge, this is the first the study that includes patient and CP feedback throughout the design process. Our solution focuses on the patient’s needs, where the app must be easy to operate, robust and effective. Today, value-based outcomes and patient engagement are key to managing costs, which self-care can help achieve. We expect that simpler more user-friendly apps will result from our study supported by a patient-centric model of feedback.

      140 Character Summary: Self-care is key for HF management. We have designed a simple, patient-centered mHealth app to improve HF-self-care in the home setting.

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