A Patient-Centered Mobile Phone App (iHeartU) With a Virtual Human Assistant for Self-Management of Heart Failure: Protocol for a Usability Assessment Study

Abstract

Background Heart failure (HF) causes significant economic and humanistic burden for patients and their families, especially those with a low income, partly due to high hospital readmission rates. Optimal self-care is considered an important nonpharmacological aspect of HF management that can improve health outcomes. Emerging evidence suggests that self-management assisted by smartphone apps may reduce rehospitalization rates and improve the quality of life of patients. We developed a virtual human–assisted, patient-centered mobile health app (iHeartU) for patients with HF to enhance their engagement in self-management and improve their communication with health care providers and family caregivers. iHeartU may help patients with HF in self-management to reduce the technical knowledge and usability barrier while maintaining a low cost and natural, effective social interaction with the user. Objective With a standardized systematic usability assessment, this study had two objectives: (1) to determine the obstacles to effective and efficient use of iHeartU in patients with HF and (2) to evaluate of HF patients’ adoption, satisfaction, and engagement with regard to the of iHeartU app. Methods The basic methodology to develop iHeartU systems consists of a user-centric design, development, and mixed methods formative evaluation. The iterative design and evaluation are based on the guidelines of the American College of Cardiology Foundation and American Heart Association for the management of heart failure and the validated “Information, Motivation, and Behavioral skills” behavior change model. Our hypothesis is that this method of a user-centric design will generate a more usable, useful, and easy-to-use mobile health system for patients, caregivers, and practitioners. Results The prototype of iHeartU has been developed. It is currently undergoing usability testing. As of September 2018, the first round of usability testing data have been collected. The final data collection and analysis are expected to be completed by the end of 2019. Conclusions The main contribution of this project is the development of a patient-centered self-management system, which may support HF patients’ self-care at home and aid in the communication between patients and their health care providers in a more effective and efficient way. Widely available mobile phones serve as care coordination and “no-cost” continuum of care. For low-income patients with HF, a mobile self-management tool will expand their accessibility to care and reduce the cost incurred due to emergency visits or readmissions. The user-centered design will improve the level of engagement of patients and ultimately lead to better health outcomes. Developing and testing a novel mobile system for patients with HF that incorporates chronic disease management is critical for advancing research and clinical practice of care for them. This research fil...

Voice Interface Technology Adoption by Patients With Heart Failure: Pilot Comparison Study

“…Furthermore, in a few studies, the technology has been recommended for patients with HF to collect information about symptoms and management of their conditions. In particular, the proposed designs for voice interface technology for patients with HF can be found in the studies by Ferguson et al [ 21 ] and Zhang et al [ 22 ]. However, these studies did not provide results for evaluating the implementation of the proposed technology.…”

Measures of Engagement With mHealth Interventions in Patients With Heart Failure: Scoping Review

“…The key characteristics of the interventions are presented in ( Multimedia Appendix 3 ). In approximately 50% (16/32) of the studies [ 14 , 35 , 38 , 40 , 43 , 45 , 47 - 49 , 52 - 55 , 57 , 58 , 60 ], patients used smartphones, 28% (9/32) [ 36 , 37 , 39 , 42 , 46 , 59 , 61 - 63 ] used tablet computers, 6.25% (2/32) [ 50 , 56 ] used PDAs, and 16% (5/32) used either portable telemonitoring devices [ 34 , 44 ] or a combination of smartphones, smart watches, and tablet computers [ 45 , 51 , 64 ] as integral components of mHealth systems for the management of HF symptoms or for the provision of HF-related self-care education.…”

“…Patient engagement with mHealth interventions was measured solely based on system usage data in 72% (23/32) of the studies. Among the remaining studies, 6% (2/32) used only qualitative methods to determine engagement (focus groups and semistructured interviews) [ 34 , 39 ]; 19% (6/32) [ 14 , 40 , 48 , 54 , 57 , 62 ] used both system usage data and qualitative methods; and 3% (1/32) [ 43 ] planned to use system usage data, qualitative methods (think aloud), and user engagement questionnaires.…”

“…For example, in a mobile phone–based telemonitoring intervention, patients stated that they felt guilty when they missed measuring the required daily physiological parameters [ 14 ]. In 11.1% (1/9) [ 43 ] of the studies that included qualitative measures, investigators planned to use think aloud to capture the patient’s cognitive process while patients were performing tasks on mHealth applications.…”

Deliver Cardiac Virtual Care: A Primer for Cardiovascular Professionals in Canada

“…Patients who have heart failure require particularly close monitoring due to the high risk of re-hospitalization with a significant burden of morbidity, mortality, and health care expenditure. 27 , 28 , 29 , 30 Developing strategies for self-monitoring and regular CVC follow-up (such as virtual wards) may reduce readmissions. 31 The use of wearable activity monitors, blood pressure monitors, Wi-Fi or Bluetooth enabled weight scales, and mobile based apps are important means of acquiring physiological data to assess progress, but patients may face barriers of cost and technological literacy preventing the use of these devices.…”