VA FitHeart, a Mobile App for Cardiac Rehabilitation: Usability Study

Abstract

BackgroundCardiac rehabilitation (CR) improves outcomes for patients with ischemic heart disease or heart failure but is underused. New strategies to improve access to and engagement in CR are needed. There is considerable interest in technology-facilitated home CR. However, little is known about patient acceptance and use of mobile technology for CR.ObjectiveThe aim of this study was to develop a mobile app for technology-facilitated home CR and seek to determine its usability.MethodsWe recruited patients eligible for CR who had access to a mobile phone, tablet, or computer with Internet access. The mobile app includes physical activity goal setting, logs for tracking physical activity and health metrics (eg, weight, blood pressure, and mood), health education, reminders, and feedback. Study staff demonstrated the mobile app to participants in person and then observed participants completing prespecified tasks with the mobile app. Participants completed the System Usability Scale (SUS, 0-100), rated likelihood to use the mobile app (0-100), questionnaires on mobile app use, and participated in a semistructured interview. The Unified Theory of Acceptance and Use of Technology and the Theory of Planned Behavior informed the analysis. On the basis of participant feedback, we made iterative revisions to the mobile app between users.ResultsWe conducted usability testing in 13 participants. The first version of the mobile app was used by the first 5 participants, and revised versions were used by the final 8 participants. From the first version to revised versions, task completion success rate improved from 44% (11/25 tasks) to 78% (31/40 tasks; P=.05), SUS improved from 54 to 76 (P=.04; scale 0-100, with 100 being the best usability), and self-reported likelihood of use remained high at 76 and 87 (P=.30; scale 0-100, with 100 being the highest likelihood). In interviews, patients expressed interest in tracking health measures (“I think it’ll be good to track my exercise and to see what I’m doing”), a desire for introductory training (“Initially, training with a technical person, instead of me relying on myself”), and an expectation for sharing data with providers (“It would also be helpful to share with my doctor, it just being a matter of clicking a button and sharing it with my doctor”).ConclusionsWith participant feedback and iterative revisions, we significantly improved the usability of a mobile app for CR. Patient expectations for using a mobile app for CR include tracking health metrics, introductory training, and sharing data with providers. Iterative mixed-method evaluation may be useful for improving the usability of health technology.

The Iterative Convergent Design for Mobile Health Usability Testing: Mixed Methods Approach

“…A recent study by Beatty et al [50] illustrates the mixed methods process as they collected both quantitative and qualitative data to determine the usability of a mobile app for technology-facilitated home cardiac rehabilitation. Quantitative data included the SUS and task completion rate, whereas the qualitative data included questions about the functionality of the mobile app [50].…”

“…The latter 2 columns include the quantitative data, for example, scales or items, and the qualitative data, for example, qualitative questions or observation types. For example, Beatty et al [50,58] used matching by integrating the task completion time (quantitative) with asking “I noticed that the _____ feature took you longer than some of the others. Tell me more about that?” (qualitative).…”

Designing meaningful outcome parameters using mobile technology: a new mobile application for telemonitoring of patients with heart failure

“…10 Mobile health (mHealth) applications proved useful to provide assistance in self-management, 11 symptom monitoring, 12 and home-based cardiac rehabilitation. 13 In addition, smart devices have the potential to generate new patient-reported outcome measures (PROMs) in HF patients. Their integrated sensor technologies allow not only for ambulatory data acquisition but also for more continuous monitoring of physiological data like heart rate or walking activity in the context of everyday life.…”

The effect of mobile applications for improving adherence in cardiac rehabilitation: a systematic review and meta-analysis

“…Third, mobile applications provide opportunities to share the data with the health care providers which has the potential to promote CR through subjective norms and social influence [32]. It has been reported that many patients had expected to share the obtained data with their health care providers and they viewed this as a key benefit of using mobile applications [33]. Another study has reported great promotion of participation in CR through interaction, communication and feedback [34].…”