A Smartphone App for Self-Management of Heart Failure in Older African Americans: Feasibility and Usability Study

Heiney, Sue P.; Donevant, Sara B; Adams, Swann Arp; Parker, Pearman D; Chen, Hongtu; Levkoff, Sue E.

doi:10.2196/17142

Cited by 41 publications

(84 citation statements)

References 30 publications

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“…On the basis of our analysis, Black patients used the technology 21 fewer times on average during the study period compared with non-Black patients with otherwise similar characteristics. As in our data set, Black race is not highly correlated with other features, this study adds to the evidence that technology design may need to be better tailored for this population [ 14 ]. Although our findings contribute to the emergent and growing literature on racial disparities in technology use, this area is still understudied.…”

Section: Discussionmentioning

confidence: 61%

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

Apergi

Bjarnadóttir

Baras

et al. 2021

JMIR Mhealth Uhealth

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Background Heart failure (HF) is associated with high mortality rates and high costs, and self-care is crucial in the management of the condition. Telehealth can promote patients’ self-care while providing frequent feedback to their health care providers about the patient’s compliance and symptoms. A number of technologies have been considered in the literature to facilitate telehealth in patients with HF. An important factor in the adoption of these technologies is their ease of use. Conversational agent technologies using a voice interface can be a good option because they use speech recognition to communicate with patients. Objective The aim of this paper is to study the engagement of patients with HF with voice interface technology. In particular, we investigate which patient characteristics are linked to increased technology use. Methods We used data from two separate HF patient groups that used different telehealth technologies over a 90-day period. Each group used a different type of voice interface; however, the scripts followed by the two technologies were identical. One technology was based on Amazon’s Alexa (Alexa+), and in the other technology, patients used a tablet to interact with a visually animated and voice-enabled avatar (Avatar). Patient engagement was measured as the number of days on which the patients used the technology during the study period. We used multiple linear regression to model engagement with the technology based on patients’ demographic and clinical characteristics and past technology use. Results In both populations, the patients were predominantly male and Black, had an average age of 55 years, and had HF for an average of 7 years. The only patient characteristic that was statistically different (P=.008) between the two populations was the number of medications they took to manage HF, with a mean of 8.7 (SD 4.0) for Alexa+ and 5.8 (SD 3.4) for Avatar patients. The regression model on the combined population shows that older patients used the technology more frequently (an additional 1.19 days of use for each additional year of age; P=.004). The number of medications to manage HF was negatively associated with use (−5.49; P=.005), and Black patients used the technology less frequently than other patients with similar characteristics (−15.96; P=.08). Conclusions Older patients’ higher engagement with telehealth is consistent with findings from previous studies, confirming the acceptability of technology in this subset of patients with HF. However, we also found that a higher number of HF medications, which may be correlated with a higher disease burden, is negatively associated with telehealth use. Finally, the lower engagement of Black patients highlights the need for further study to identify the reasons behind this lower engagement, including the possible role of social determinants of health, and potentially create technologies that are better tailored for this population.

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Section: Discussionmentioning

confidence: 61%

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

Apergi

Bjarnadóttir

Baras

et al. 2021

JMIR Mhealth Uhealth

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“…While there are several patient-centered heart failure apps available, few have been designed by clinicians who care for patients with heart failure or have been evaluated with a scientific assessment or publication in a medical journal to date [8,9,[15][16][17]. Several well-designed, previously published feasibility studies utilized a more resource-intensive telemonitoring approach (such as a chest strap that monitors physiological data and accelerometer or blood pressure monitoring) in combination with a smartphone app [8,9].…”

Section: Discussionmentioning

confidence: 99%

Habits Heart App for Patient Engagement in Heart Failure Management: Pilot Feasibility Randomized Trial

Wei¹,

Ibrahim²,

Kumar³

et al. 2021

JMIR Mhealth Uhealth

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Background Due to the complexity and chronicity of heart failure, engaging yet simple patient self-management tools are needed. Objective This study aimed to assess the feasibility and patient engagement with a smartphone app designed for heart failure. Methods Patients with heart failure were randomized to intervention (smartphone with the Habits Heart App installed and Bluetooth-linked scale) or control (paper education material) groups. All intervention group patients were interviewed and monitored closely for app feasibility while receiving standard of care heart failure management by cardiologists. The Atlanta Heart Failure Knowledge Test, a quality of life survey (Kansas City Cardiomyopathy Questionnaire), and weight were assessed at baseline and final visits. Results Patients (N=28 patients; intervention: n=15; control: n=13) with heart failure (with reduced ejection fraction: 15/28, 54%; male: 20/28, 71%, female: 8/28, 29%; median age 63 years) were enrolled, and 82% of patients (N=23; intervention: 12/15, 80%; control: 11/13, 85%) completed both baseline and final visits (median follow up 60 days). In the intervention group, 2 out of the 12 patients who completed the study did not use the app after study onboarding due to illnesses and hospitalizations. Of the remaining 10 patients who used the app, 5 patients logged ≥1 interaction with the app per day on average, and 2 patients logged an interaction with the app every other day on average. The intervention group averaged 403 screen views (per patient) in 56 distinct sessions, 5-minute session durations, and 22 weight entries per patient. There was a direct correlation between duration of app use and improvement in heart failure knowledge (Atlanta Heart Failure Knowledge Test score; ρ=0.59, P=.04) and quality of life (Kansas City Cardiomyopathy Questionnaire score; ρ=0.63, P=.03). The correlation between app use and weight change was ρ=–0.40 (P=.19). Only 1 out of 11 patients in the control group retained education material by the follow-up visit. Conclusions The Habits Heart App with a Bluetooth-linked scale is a feasible way to engage patients in heart failure management, and barriers to app engagement were identified. A larger multicenter study may be warranted to evaluate the effectiveness of the app. Trial Registration ClinicalTrials.gov NCT03238729; http://clinicaltrials.gov/ct2/show/NCT03238729

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“…A recent review identified few high-quality commercially available mHealth apps for managing heart failure and a paucity of peer-reviewed literature assessing the experiences, functionality, and efficacy of apps [ 12 ]. However, with more interventions using mHealth as a medium for intervention delivery, its acceptability and usability have been reported [ 16 , 24 , 25 ]. Although many heart failure apps are currently available, a systematic search [ 26 ] found that several apps need further redesign or development to engage users in self-management behaviors.…”

Section: Introductionmentioning

confidence: 99%

Experiences of Using a Self-management Mobile App Among Individuals With Heart Failure: Qualitative Study

Schmaderer¹,

Miller²,

Mollard³

2021

JMIR Nursing

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Background Interventions that focus on the self-management of heart failure are vital to promoting health in patients with heart failure. Mobile health (mHealth) apps are becoming more integrated into practice to promote self-management strategies for chronic diseases, optimize care delivery, and reduce health disparities. Objective The purpose of this study was to explore the experience of using a self-management mHealth intervention in individuals with heart failure to inform a future mHealth intervention study. Methods This study used a qualitative descriptive design. Participants were enrolled in the intervention groups of a larger parent study using a mobile app related to self-management of heart failure. The purposive, convenient, criterion-based sample for this qualitative analysis comprised 10 patients who responded to phone calls and were willing to be interviewed. Inclusion criteria for the parent study were adults who were hospitalized at Nebraska Medical Center with a primary diagnosis and an episode of acute decompensated heart failure; discharged to home without services such as home health care; had access to a mobile phone; and were able to speak, hear, and understand English. Results Study participants were middle-aged (mean age 55.8, SD 12 years; range 36-73 years). They had completed a mean of 13.5 (SD 2.2) years (range 11-17 years) of education. Of the 10 participants, 6 (60%) were male. Half of them (5/10, 50%) were New York Heart Association Classification Class III patients and the other half were Class IV patients. The intervention revealed four self-management themes, including (1) I didn’t realize, and now I know; (2) It feels good to focus on my health; (3) I am the leader of my health care team; and (4) My health is improving. Conclusions Participants who used a self-management mHealth app intervention for heart failure reported an overall positive experience. Their statements were organized into four major themes. The education provided during the study increased self-awareness and promoted self-management of their heart failure. The mHealth app supported patient empowerment, resulting in better heart failure management and improved quality of life. Participants advocated for themselves by becoming the leader of their health, especially when communicating with their health care team. Finally, the mHealth app was used by the participants as a self-management tool to assist in symptom management and improve their overall health. Future research should study symptom evaluation, medication tracking, and possibly serve as a health provider communication platform to empower individuals to be leaders in their chronic disease management.

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A Smartphone App for Self-Management of Heart Failure in Older African Americans: Feasibility and Usability Study

Cited by 41 publications

References 30 publications

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

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

Habits Heart App for Patient Engagement in Heart Failure Management: Pilot Feasibility Randomized Trial

Experiences of Using a Self-management Mobile App Among Individuals With Heart Failure: Qualitative Study

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