A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study

Abstract

Background Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce. Objective This study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI). Methods The AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed. Results The focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant. Conclusions We developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research.

Nurses’ Roles in mHealth App Development: Scoping Review

“…The characteristics of the included studies are summarized in Table 1 . Of the 157 included publications, 132 (84.1%) either described usability testing or were original research papers [ 32 - 49 , 51 , 52 , 55 , 56 , 58 - 65 , 67 - 75 , 77 - 81 , 83 , 85 - 87 , 89 - 107 , 110 , 112 - 117 , 119 - 124 , 126 , 129 , 130 , 132 - 134 , 136 , 138 , 140 - 145 , 147 - 160 , 162 - 169 , 171 - 173 , 175 - 187 ].…”

“…The remaining publications (7/157, 4.5%) were protocols or descriptions of theoretical frameworks [ 50 , 53 , 54 , 57 , 109 , 130 , 139 ]. A total of 34 countries were represented in the publications, most frequently Brazil (29/157, 18.5%) [ 36 , 37 , 40 , 45 , 48 , 60 , 61 , 65 , 70 , 83 , 87 , 114 , 115 , 117 , 120 , 134 , 136 , 138 , 142 , 143 , 152 - 154 , 157 , 163 , 165 , 177 , 182 , 183 ], the United States (26/157, 16.6%) [ 33 , 38 , 41 , 42 , 44 , 47 , 54 , 57 , 66 , 68 , 69 , 71 , 76 , 81 , 89 , 97 , 102 , 103 , 107 , 113 , 121 , 132 , 160 , 164 , 170 , 181 ], South Korea (10/157, 6.4%) [ 56 , 58 , 101 , 105 ...…”

“…Nurses played a role in all the stages of development. Nurses were most represented in the design and prototyping phase (112/157, 71.3%) [ 32 - 37 , 39 , 41 - 43 , 45 , 46 , 49 , 51 - 53 , 55 - 58 , 60 , 63 - 65 , 67 - 70 , 73 - 79 , 81 , 84 - 88 , 90 - 93 , 96 , 99 - 102 , 104 , 106 , 107 , 110 - 118 , 121 - 129 , 131 - 136 , 138 , 139 , 141 , 142 , 144 - 146 , 148 , 149 , 151 - 153 , 155 , 157 , 158 , 160 - 165 , 167 , 169 , 171 , 173 - 177 , 180 , 182 , 184 - 186 , 188 ], followed by the requirements gathering phase (98/157, 62.4%) [ 32 - 37 , 39 - 41 , 43 ...…”

Technology-Supported Behavior Change—Applying Design Thinking to mHealth Application Development

“…Although there are studies that mention that they are using stage-of-change-based content for their application users (e.g., [ 86 , 87 , 88 ]), there are, to the best of our knowledge, no studies that have integrated the staging process inside of the application, or focused on the design of a mobile application applying the TTM as a basis for dynamic stage-specific content. The unique feature of our application prototype thus lies in this implementation of a TTM-based algorithm, along with its corresponding interfaces, into a structure that may serve as a basis for the future integration of dynamic change-process-stage-based content.…”

Acceptability, Preferred Medium, and Components of Nurse-Led Cardiac Telerehabilitation: A Cross-Sectional Study

“…In addition, CTR aims to ensure that every patient can actively utilize appropriate resources (López et al, 2020), making patient perception a key factor in its development (Gioia & Salducci, 2019). Several studies have examined patient needs in the context of CTR (Rawstorn et al, 2018), specifically focusing on the development of a Smartphone App that aligns with patient preferences and requirements for delivering CTR (Choi et al, 2021). Consequently, the incorporation of patient preferences into the design and implementation of CTR programs could enhance participation and completion rates (Beleigoli et al, 2021; Rawstorn et al, 2018).…”