An eHealth Diary and Symptom-Tracking Tool Combined With Person-Centered Care for Improving Self-Efficacy After a Diagnosis of Acute Coronary Syndrome: A Substudy of a Randomized Controlled Trial

Abstract

BackgroundPatients with cardiovascular diseases managed by a person-centered care (PCC) approach have been observed to have better treatment outcomes and satisfaction than with traditional care. eHealth may facilitate the often slow transition to more person-centered health care by increasing patients’ beliefs in their own capacities (self-efficacy) to manage their care trajectory. eHealth is being increasingly used, but most studies continue to focus on health care professionals’ logic of care. Knowledge is lacking regarding the effects of an eHealth tool on self-efficacy when combined with PCC for patients with chronic heart diseases.ObjectiveThe objective of our study was to investigate the effect of an eHealth diary and symptom-tracking tool in combination with PCC for patients with acute coronary syndrome (ACS).MethodsThis was a substudy of a randomized controlled trial investigating the effects of PCC in patients hospitalized with ACS. In total, 199 patients with ACS aged <75 years were randomly assigned to a PCC intervention (n=94) or standard treatment (control group, n=105) and were followed up for 6 months. Patients in the intervention arm could choose to use a Web-based or mobile-based eHealth tool, or both, for at least 2 months after hospital discharge. The primary end point was a composite score of changes in general self-efficacy, return to work or prior activity level, and rehospitalization or death 6 months after discharge.ResultsOf the 94 patients in the intervention arm, 37 (39%) used the eHealth tool at least once after the index hospitalization. Most of these (24/37, 65%) used the mobile app and not the Web-based app as the primary source of daily self-rating input. Patients used the eHealth tool a mean of 38 times during the first 8 weeks (range 1–118, SD 33) and 64 times over a 6-month period (range 1–597, SD 104). Patients who used the eHealth tool in combination with the PCC intervention had a 4-fold improvement in the primary end point compared with the control group (odds ratio 4.0, 95% CI 1.5–10.5; P=.005). This improvement was driven by a significant increase in general self-efficacy compared with the control group (P=.011). Patients in the PCC group who did not use the eHealth tool (n=57) showed a nonsignificant composite score improvement compared with those in the control group (n=105) (odds ratio 2.0, 95% CI 0.8–5.2; P=.14).ConclusionsWe found a significant effect on improved general self-efficacy and the composite score for patients using an eHealth diary and symptom-tracking tool in combination with PCC compared with traditional care.Trial RegistrationSwedish registry, Researchweb.org, ID NR 65 791.

The Use of Data Collected From mHealth Apps to Inform Evidence‐Based Quality Improvement: An Integrative Review

“…Studies varied greatly in their aims, methodologies, and sample sizes. A variety of study designs were selected for analysis, including four systematic reviews (Holmen et al., ; Kitsiou, Pare, Jaana, & Gerber, ; Lee et al., ; Peiris, Praveen, Johnson, & Mogulluru, ), four randomized controlled trials (Armstrong, Coyte, Brown, Beber, & Semple, ; Cingi et al., ; Lakshminarayana et al., ; Wolf et al., ), one nonrandomized controlled trial (Sundberg et al., ), three retrospective cohort studies (Dickson, Sumathipala, & Reeves, ; Khanna, Sambandam, Gul, & Mounasamy, ; Twichell et al., ), six pilot studies (Foo et al., ; Gunter et al., ; Jakel et al., ; Macpherson et al., ; Patel, Siegler, Stromberg, Ravitz, & Hanson, ; Semple, Sharpe, Murnaghan, Theodoropoulos, & Metcalfe, ), and one case report (Gernart et al., ).…”

“…Data collected through apps were used both in real time to deliver health care, inform healthcare decision‐making, and create self‐awareness (Armstrong et al., ; Cingi et al., ; Dickson et al., ; Foo et al., ; Gunter et al., ; Jakel et al., ; Khanna et al., ; Macpherson et al., ; Semple et al., ; Sundberg et al., ; Twichell et al., ), and retrospectively to inform healthcare management (Gernart et al., ; Lakshminarayana et al., ; Semple et al., ; Wolf et al., ), communication strategies (Khanna et al., ; Patel et al., ), and healthcare delivery changes (Foo et al., ).…”

“…Although the purpose of the apps was improvement focused, it was the data collected by the mHealth apps that informed these changes. The data from these apps were used for a variety of purposes resulting in quality improvement (e.g., faster identification of changes in patient condition; Semple et al., ; Twichell et al., ), improving communication processes (Foo et al., ; Khanna et al., ; Patel et al., ), enhancing understanding of quality of life (Cingi et al., ; Lakshminarayana et al., ; Sundberg et al., ), increasing patient compliance (Cingi et al., ; Gernart et al., ; Kitsiou et al., ; Wolf et al., ), and improving access to and satisfaction with health care (Dickson et al., ; Lakshminarayana et al., ).…”

“…Using an app to collect data in real time lowers the risk of missing data sets, as it is all stored in a central online, secure space and cannot be misplaced after collection. Collecting and using data from mHealth apps retrospectively also equip clinicians with information on healthcare processes over time, which can be used to inform sustainable healthcare change and provide evidence for both clinicians and patients (e.g., reviewing effectiveness of interventions; Khanna et al., ; Patel et al., ), patient treatment compliance via mHealth app diaries (Gernart et al., ; Wolf et al., ), understanding quality of life (Cingi et al., ; Gernart et al., ; Wolf et al., ), reviewing time to treatment (Dickson et al., ), and using data captured on the app as a memory aid when attending follow‐up appointments (Lakshminarayana et al., ).…”

“…This review highlights that data from mHealth apps are used for the benefit of both patients and clinicians in health care. For patients, this includes recognition of abnormal results (Semple et al., ; Twichell et al., ), improved illness management (Cingi et al., ; Kitsiou et al., ; Lakshminarayana et al., ; Peiris et al., ; Semple et al., ; Wolf et al., ), improved accuracy of electronic health records and health data (Lakshminarayana et al., ; Wolf et al., ), real‐time communication and feedback (Peiris et al., ; Sundberg et al., ), faster treatment time (Armstrong et al., ; Dickson et al., ; Semple et al., ), enhanced patient experience (Armstrong et al., ; Lakshminarayana et al., ; Semple et al., ; Sundberg et al., ), access to health and health system information (Lakshminarayana et al., ; Lee et al., ), and self‐awareness and education (Holmen et al., ; Kitsiou et al., ; Lakshminarayana et al., ). For healthcare providers (predominantly medical), this includes the improvement of communication between healthcare teams (Foo et al., ; Khanna et al., ), improvement of patient management pathways (Dickson et al., ; Foo et al., ; Twichell et al., ), time‐ and cost‐efficient healthcare delivery (Gunter et al., ; Lee et al., ; Semple et al., ), greater understanding of patient compliance (Kitsiou et al., ; Lakshminarayana et al., ; Wolf et al., ), and the impact of work and illness on emotional well‐being and quality of life (Gernart et al., ; Jakel et al., ; Lakshminarayana et al., ; Macpherson et al., ).…”