Atrial fibrillation self-management: a mobile telephone app scoping review and content analysis

Abstract

Atrial fibrillation (AF) affects over 1.4 million people in the UK, resulting in a five-fold increased stroke risk and a three to four times greater risk of severe, disabling stroke. Atrial fibrillation, a chronic disease, requires monitoring, medication, and lifestyle measures. A self-management approach supported by mobile health (mHealth) may empower AF self-care. To assess the need to develop new mHealth self-management interventions for those with AF this review aimed to identify commercially available AF self-management apps, analyse, and synthesize (i) characteristics, (ii) functions, (iii) privacy/security, (iv) incorporated behaviour change techniques (BCTs), and (v) quality and usability. We searched app stores for ‘atrial fibrillation’ and ‘anticoagulation’, and included apps focused on AF self-management in the review. We examined app functions, privacy statements against best practice recommendations, the inclusion of BCTs using the App Behaviour Change Scale, and app quality/usability using the Mobile App Rating Scale. From an initial search of 555 apps, five apps were included in the review. Common functions were educational content, medication trackers, and communication with healthcare professionals. Apps contained limited BCTs, lacked intuitive functions and were difficult to use. Privacy policies were difficult to read. App quality rated from poor to acceptable and no app had been evaluated in a clinical trial. The review reports a lack of commercially available AF self-management apps of sufficient standard for use in healthcare settings. This highlights the need for clinically validated mHealth interventions incorporating evidence-based BCTs to support AF self-management.

A Systematic Review on Mobile Health Applications’ Education Program for Patients Taking Oral Anticoagulants

“…Educational content is an important component of self-management applications. It is commonly reported as the most common self-management feature identified within health applications [17,18,36]. Education tailored to each individual is a key recommendation that significantly promotes self-management in the adult population, particularly in terms of medication adherence.…”

“…Res. Public Health 2021, 18, 8902 2 of 15 changes agrees with a doctor's or other health professional's recommendations [8]. High levels of drug knowledge and self-efficacy increase drug use level and self-care.…”

“…The methodological quality of the 12 studies varied from poor to excellent. The interpretation of the total score is as follows: excellent (26-28), good (20)(21)(22)(23)(24)(25), fair (15)(16)(17)(18)(19), and poor (≤14). Four studies were classified as having a fair methodological quality.…”

“…Moreover, ethical issues must be addressed, and the safety of patients' personal data must be ensured. However, the lack of theoretical underpinning to inform and guide behavioral changes (i.e., increasing medication adherence or physical activity levels) raises questions about the applications' benefits for their users [17,18]. At present, it is very important to understand which mHealth applications' components affect easy adaptation and behavioral change among patients.…”

“…It is likewise vital to improve knowledge and medication adherence to patients taking warfarin. Systematic reviews with content analyses have examined the quality, functionality, and clinical outcomes of mHealth apps used for hypertension, pain, and other chronic diseases [17][18][19]. Therefore, this systematic review aimed to analyze health education's impact on patients on warfarin therapy using mobile health applications.…”