Evaluating the Usability and Usefulness of a Mobile App for Atrial Fibrillation Using Qualitative Methods: Exploratory Pilot Study

Abstract

BackgroundAtrial fibrillation (AFib) is the most common form of heart arrhythmia and a potent risk factor for stroke. Nonvitamin K antagonist oral anticoagulants (NOACs) are routinely prescribed to manage AFib stroke risk; however, nonadherence to treatment is a concern. Additional tools that support self-care and medication adherence may benefit patients with AFib.ObjectiveThe aim of this study was to evaluate the perceived usability and usefulness of a mobile app designed to support self-care and treatment adherence for AFib patients who are prescribed NOACs.MethodsA mobile app to support AFib patients was previously developed based on early stage interview and usability test data from clinicians and patients. An exploratory pilot study consisting of naturalistic app use, surveys, and semistructured interviews was then conducted to examine patients’ perceptions and everyday use of the app.ResultsA total of 12 individuals with an existing diagnosis of nonvalvular AFib completed the 4-week study. The average age of participants was 59 years. All participants somewhat or strongly agreed that the app was easy to use, and 92% (11/12) reported being satisfied or very satisfied with the app. Participant feedback identified changes that may improve app usability and usefulness for patients with AFib. Areas of usability improvement were organized by three themes: app navigation, clarity of app instructions and design intent, and software bugs. Perceptions of app usefulness were grouped by three key variables: core needs of the patient segment, patient workflow while managing AFib, and the app’s ability to support the patient’s evolving needs.ConclusionsThe results of this study suggest that mobile tools that target self-care and treatment adherence may be helpful to AFib patients, particularly those who are newly diagnosed. Additionally, participant feedback provided insight into the varied needs and health experiences of AFib patients, which may improve the design and targeting of the intervention. Pilot studies that qualitatively examine patient perceptions of usability and usefulness are a valuable and often underutilized method for assessing the real-world acceptability of an intervention. Additional research evaluating the AFib Connect mobile app over a longer period, and including a larger, more diverse sample of AFib patients, will be helpful for understanding whether the app is perceived more broadly to be useful and effective in supporting patient self-care and medication adherence.

Patients’ Perceptions of mHealth Apps: Meta-Ethnographic Review of Qualitative Studies

“…Most of the articles reviewed included populations inhabiting developed countries, apart from one that focused on a developing country (South Africa). Most of these qualitative studies focused on the United States [21,23-25,27,31,34,36,41,43,45,47,48,54] and the United Kingdom [30,32,35,42,53,61]. Other countries included were the Netherlands [22,33,44], Denmark [26,55,58], Sweden [38,40,49], Australia [28,29,46], Canada [50,56], South Africa [62], Singapore [59], China [63], Germany [37], Ireland [57], Belgium [60], Spain [39], and Switzerland [52].…”

“…Most of the apps under consideration were tailored to deal with chronic diseases: cancer [22,30,33,38,40,56,63]; HIV [23,24,31,45,48]; diabetes [28,50,55]; hypertension and cardiovascular diseases [43,54,57]; chronic kidney disease [27,42]; cystic fibrosis [21,51]; chronic pain [26,58]; juvenile arthritis [35,61]; brain and spinal cord anomalies [34]; multiple sclerosis [52]; chronic illnesses, in general [25,62]; and mental health disorders [32,36,39,41,46,47,53,60]. Other apps were specific to pregnancy/obstetric care [29,37,44,59], and one was for postoperative care [49].…”

Mobile health applications for managing atrial fibrillation for healthcare professionals and patients: a systematic review

“…No relevant studies were identified via handsearching. As a result, seven studies [4][5][6][12][13][14][15] were included (see Table 1).…”

Understanding the Attitudes of Clinicians and Patients Toward a Self-Management eHealth Tool for Atrial Fibrillation: Qualitative Study

“…Specific to self-monitoring tools for patients with AF, there are other published studies that demonstrated that patients were generally satisfied with a mobile self-care and medication adherence app [ 12 , 13 ]. In the study by Hirschey et al [ 12 ], the majority of the participants reported using the medication reminder feature, despite stating that they would have remembered to take their medication without the app. Participants also liked that they were able to check their heart rates quickly.…”

“…This is in stark contrast to our findings that such features in an e-tool were not seen to be useful and illustrate the importance of understanding the patient population for whom an e-tool is designed. In the study by Hirschey et al [ 12 ], the patients had an average age of 59 years, and the majority had at least some college education. Our participants were older and had much less formal education; more than 63% of Singaporeans aged 65 years or older in 2018 did not attain more than primary school education [ 18 ].…”