Using an Electronic App to Promote Home-Based Self-Care in Older Patients With Heart Failure: Qualitative Study on Patient and Informal Caregiver Challenges

Abstract

Background Heart failure (HF) affects many older individuals in North America, with recurrent hospitalizations despite postdischarge strategies to prevent readmission. Proper HF self-care can potentially lead to better clinical outcomes, yet many older patients find self-care challenging. Mobile health (mHealth) apps can provide support to patients with respect to HF self-care. However, many mHealth apps are not designed to consider potential patient barriers, such as literacy, numeracy, and cognitive impairment, leading to challenges for older patients. We previously demonstrated that a paper-based standardized diuretic decision support tool (SDDST) with daily weights and adjustment of diuretic dose led to improved self-care. Objective The aim of this study is to better understand the self-care challenges that older patients with HF and their informal care providers (CPs) face on a daily basis, leading to the conversion of the SDDST into a user-centered mHealth app. Methods We recruited 14 patients (male: 8/14, 57%) with a confirmed diagnosis of HF, aged ≥60 years, and 7 CPs from the HF clinic and the cardiology ward at the Hamilton General Hospital. Patients were categorized into 3 groups based on the self-care heart failure index: patients with adequate self-care, patients with inadequate self-care without a CP, or patients with inadequate self-care with a CP. We conducted semistructured interviews with patients and their CPs using persona-scenarios. Interviews were transcribed verbatim and analyzed for emerging themes using an inductive approach. Results Six themes were identified: usability of technology, communication, app customization, complexity of self-care, usefulness of HF-related information, and long-term use and cost. Many of the challenges patients and CPs reported involved their unfamiliarity with technology and the lack of incentive for its use. However, participants were supportive and more likely to actively use the HF app when informed of the intervention’s inclusion of volunteer and nurse assistance. Conclusions Patients with varying self-care adequacy levels were willing to use an mHealth app if it was simple in its functionality and user interface. To promote the adoption and usability of these tools, patients confirmed the need for researchers to engage with end users before developing an app. Findings from this study can be used to help inform the design of an mHealth app to ensure that it is adapted for the needs of older individuals with HF.

Involving Older People With Frailty or Impairment in the Design Process of Digital Health Technologies to Enable Aging in Place: Scoping Review

“…In 12 (55%) of the 22 studies, recruitment through partners was used to identify relevant and interested older people (for example, through patient associations) [ 26 , 28 , 31 - 33 , 37 , 38 , 41 , 42 , 44 , 45 , 47 ]. In 4 studies, purposeful sampling was used to recruit participants [ 35 , 36 , 40 , 46 ], and in 2 studies, outreach approaches were applied. These included contact made through local support groups for people with age-related macular degeneration (AMD) [ 27 ] and through posters and written materials physically placed in local public areas and sent out electronically (ie, through social media) [ 30 ].…”

A hybrid virtual nurse model

“…In their qualitative study, Wali and colleagues aimed to better understand the self-care challenges older patients with heart failure and their caregivers faced daily 10. Investigators explored the conversion of the paper-based standardized diuretic decision support tool (SDDST) with daily weights into a user-centered mobile health app 10. Patients “highly desired” the use of direct communication, both in-person and virtually (with a nurse), as well as the sharing of and access to information 10.…”

“…10 Patients "highly desired" the use of direct communication, both in-person and virtually (with a nurse), as well as the sharing of and access to information. 10 The addition of an app was noted to improve health outcomes and deemed helpful; patients said they'd previously felt there was a gap in the quality of their care because their healthcare providers didn't understand their health conditions. 10 Martorella and colleagues also investigated the preliminary effects of a virtual nursing intervention to improve pain relief in patients undergoing cardiac surgery through a mixed-methods study.…”

“…10 The addition of an app was noted to improve health outcomes and deemed helpful; patients said they'd previously felt there was a gap in the quality of their care because their healthcare providers didn't understand their health conditions. 10 Martorella and colleagues also investigated the preliminary effects of a virtual nursing intervention to improve pain relief in patients undergoing cardiac surgery through a mixed-methods study. 7 Patients who were scheduled for their first cardiac surgery were randomly assigned to either virtual care or standard/usual care.…”

Designing Disease-Specific mHealth Apps for Clinical Value

“…In contrast, our case study disease, myasthenia gravis is an autoimmune disease that can be triggered or worsened by social, environmental and physiological factors, but is not caused by them. These differences have profound influences on what the most effective mhealth interventions are likely to be [43][44][45][46][47][48].…”