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

Abstract

Background Atrial fibrillation (AF) is the most common heart rhythm disorder and poses a growing disease burden worldwide because of an aging population. A multidisciplinary approach with an emphasis on patient education and self-management has been demonstrated to improve outcomes for AF through the engagement of patients in their own care. Although electronic tools (e-tools) such as apps have been proposed to provide patient education and facilitate self-management, there have been few studies to guide the development of these tools for patients with AF. Objective This study aims to explore the perceptions of patients and health care providers (HCPs) and their attitudes toward the use of e-tools for the self-management of AF. It also seeks to elicit the factors that contribute to these attitudes. Methods Semistructured qualitative interviews with HCPs and patients were conducted to understand the interpretations and expectations of an e-tool that would be used for the self-management of AF. Interview data were analyzed using an exploratory thematic analysis approach to uncover emergent themes and infer ideas of preferred features in a device. A modified technology acceptance model was developed as a framework to help interpret these findings. Data from the HCPs and patients were compared and contrasted. Results Both patients and HCPs thought that an e-tool would be useful in the self-management of AF. Although both groups favored educational content and monitoring of blood pressure, patients expressed more passivity toward self-care and an ambivalence toward the use of technology to monitor their medical condition. This appears to be related to factors such as a patient’s age, social support, and their attitudes toward technology. Instead, they favored using the app to contact their HCPs. Conclusions This study provides insights into significant differences in the attitudes of patients and HCPs toward the use of e-tools for self-care against their priorities. Understanding patients’ motivations and their needs are key to ensuring higher acceptance of such tools.

Patient perspectives of the Self-management and Educational Technology tool for Atrial Fibrillation (SETAF): A mixed-methods study in Singapore

“…One participant even reported not attempting the surveys that were part of the education component of SETAF due to limited comprehension. AF patients in Singapore tend to be older with lower levels of formal education [13]. Given the multiethnic groups in Singapore, the lack of language options was also considered to be a shortcoming.…”

“…During the development phase of SETAF, vital signs monitoring and access to advice from healthcare professionals were identified as desirable features for the mHealth tool [13]. Hence, a paired blood pressure monitor was included in the intervention to allow patients to measure their heart rate and blood pressure.…”

“…In addition, the European Society of Cardiology guideline has underscored the role of psychosocial management in integrated AF care [11]. Current mHealth interventions for AF patients are largely focused on patient education, medication adherence and self-monitoring [13]. To our knowledge, no mHealth interventions have addressed the psychosocial needs of AF patients.…”

“…However, it is important to consider the contextual background of patient preferences, usability and acceptance of such technology in order to overcome barriers to use and promote medium to long term user engagement. In a previous study reporting the development phase of the Self-management and Educational technology support Tool for AF patients (SETAF), Cher et al explored patients' and clinicians' perspectives and attitudes towards the proposed mHealth intervention based on a demonstration prototype [13]. The insights gleaned from this study informed the design of SETAF to better address the needs and preferences of the local population.…”

“…In our preceding developmental study [13], we used a modified Technology Acceptance Model (TAM) for use in a healthcare context, but because there was no actual use of the mHealth tool, an evaluation of user experience was not possible. In the present study, we also drew on the TAM to examine user experience as the participants can now provide insights into the tool's perceived usefulness and perceived ease of use as originally described by Davis et al [14].…”