Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study

Abstract

Background Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. Objective This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. Methods We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. Results We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with ...

Evaluation of Heart Failure Apps to Promote Self-Care: Systematic App Search

“…App adequacy was determined if the following standard disease management features were included: (1) diagnosis, (2) weight, (3) behavior tracking, (4) self-care, and (5) notifications. These 5 features were chosen based on their ability to capture factors related to HF management protocol, personalized care for older adults, and health promotion [25,26].…”

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

“…The use of mHealth apps has successfully assisted in the self-management of patients with heart failure [9,10]. However, there is limited literature to support the use of mHealth in the African American population [11][12][13][14], with few heart failure mHealth apps designed specifically for this population, who are typically sicker, poorer, less educated, and more affected by comorbid conditions compared to other racial groups in the United States [15].…”

Hurdles to Developing and Scaling Remote Patients’ Health Management Tools & Systems: A Scoping Review

“…Eleven articles did not provide su cient details to determine the extent to which, considered interventions integrated or intended to integrate into traditional healthcare systems. As demonstrated in Figure 6, in 10 of the 30 articles [20], [37], [41], [42], [52], [53], [54], [55], [56] and [57], there was su cient information to establish that integration with traditional healthcare facilities had at least been considered. Again, in most cases above integration was limited to audio or video communication with healthcare providers or some alert mechanisms.…”

“…The picture was quite different with regards to primary articles (See PA in Figure 7). Of the 30 articles reviewed, 22 articles [58], [20], [36], [37], [39], [40], [41], [42], [46], [52], [53], [54], [55], [56], [57], [59], [61], [62], [65], [66], [67] and [68] discussed interventions which targeted one, single disease. Targeted diseases ranged from PTSD, mental health, Parkinson disease, COPD to IBD and malaria.…”