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

JMIR Cardio ◽  
10.2196/15885 ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. e15885
Author(s):  
Sahr Wali ◽  
Karim Keshavjee ◽  
Linda Nguyen ◽  
Lawrence Mbuagbaw ◽  
Catherine Demers
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Self Care ◽  
Decision Support Tool ◽  
Daily Basis ◽  
The Self ◽  
Older Individuals ◽  
Care Providers ◽  
Support Tool ◽  
Mhealth Apps

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.

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

2019 ◽  
Author(s):  
Sahr Wali ◽  
Karim Keshavjee ◽  
Linda Nguyen ◽  
Lawrence Mbuagbaw ◽  
Catherine Demers
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Self Care ◽  
Decision Support Tool ◽  
Daily Basis ◽  
The Self ◽  
Older Individuals ◽  
Care Providers ◽  
Support Tool ◽  
Mhealth Apps

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.

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

2020 ◽  
Author(s):  
Sahr Wali ◽  
Karim Keshavjee ◽  
Linda Nguyen ◽  
Lawrence Mbuagbaw ◽  
Catherine Demers
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Self Care ◽  
Decision Support Tool ◽  
Daily Basis ◽  
Older Individuals ◽  
Care Providers ◽  
Support Tool ◽  
Home Based ◽  
Mhealth Apps

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.

scholarly journals Voice Interface Technology Adoption by Patients With Heart Failure: Pilot Comparison Study (Preprint)

2020 ◽  
Author(s):  
Lida Anna Apergi ◽  
Margret V Bjarnadottir ◽  
John S Baras ◽  
Bruce L Golden ◽  
Kelley M Anderson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care Providers ◽  
Technology Use ◽  
Older Patients ◽  
Self Care ◽  
Ease Of Use ◽  
Care Providers ◽  
Negatively Associated ◽  
Black Patients ◽  
Voice Interface

BACKGROUND Heart failure (HF) is associated with high mortality rates and high costs, and self-care is crucial in the management of the condition. Telehealth can promote patients’ self-care while providing frequent feedback to their health care providers about the patient’s compliance and symptoms. A number of technologies have been considered in the literature to facilitate telehealth in patients with HF. An important factor in the adoption of these technologies is their ease of use. Conversational agent technologies using a voice interface can be a good option because they use speech recognition to communicate with patients. OBJECTIVE The aim of this paper is to study the engagement of patients with HF with voice interface technology. In particular, we investigate which patient characteristics are linked to increased technology use. METHODS We used data from two separate HF patient groups that used different telehealth technologies over a 90-day period. Each group used a different type of voice interface; however, the scripts followed by the two technologies were identical. One technology was based on Amazon’s Alexa (Alexa+), and in the other technology, patients used a tablet to interact with a visually animated and voice-enabled avatar (Avatar). Patient engagement was measured as the number of days on which the patients used the technology during the study period. We used multiple linear regression to model engagement with the technology based on patients’ demographic and clinical characteristics and past technology use. RESULTS In both populations, the patients were predominantly male and Black, had an average age of 55 years, and had HF for an average of 7 years. The only patient characteristic that was statistically different (<i>P</i>=.008) between the two populations was the number of medications they took to manage HF, with a mean of 8.7 (SD 4.0) for Alexa+ and 5.8 (SD 3.4) for Avatar patients. The regression model on the combined population shows that older patients used the technology more frequently (an additional 1.19 days of use for each additional year of age; <i>P</i>=.004). The number of medications to manage HF was negatively associated with use (−5.49; <i>P</i>=.005), and Black patients used the technology less frequently than other patients with similar characteristics (−15.96; <i>P</i>=.08). CONCLUSIONS Older patients’ higher engagement with telehealth is consistent with findings from previous studies, confirming the acceptability of technology in this subset of patients with HF. However, we also found that a higher number of HF medications, which may be correlated with a higher disease burden, is negatively associated with telehealth use. Finally, the lower engagement of Black patients highlights the need for further study to identify the reasons behind this lower engagement, including the possible role of social determinants of health, and potentially create technologies that are better tailored for this population. CLINICALTRIAL

scholarly journals Self-care in heart failure patients

2015 ◽  
Vol 23 (4) ◽  
pp. 578-586 ◽  
Author(s):  
Ana Paula da Conceição ◽  
Mariana Alvina dos Santos ◽  
Bernardo dos Santos ◽  
Diná de Almeida Lopes Monteiro da Cruz
Keyword(s):  
Heart Failure ◽  
Self Care ◽  
Left Ventricular ◽  
The Self ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Failure Index ◽  
Joint Monitoring ◽  
The Mean ◽  
Care Behavior

AbstractObjective: to describe self-care behavior and its associated factors in a sample of heart failure Brazilian patients.Method: descriptive cross-sectional study with non-probabilistic sample of 116 ambulatory patients undergoing heart failure treatment. Self-care was evaluated using the Self-Care of Heart Failure Index, (scores ≥70 points=appropriate self-care). Association tests were applied, considering a descriptive level of 0.05.Results: the mean age of participants was 57.7 (SD =11.3) years; 54.3% were male; the mean schooling was 5.5 (SD = 4.0) years; and 74.1% had functional class II-III. The mean scores on the subscales of the Self-Care of Heart Failure Index indicated inappropriate self-care (self-care maintenance: 53.2 (SD =14.3), selfcare management: 50.0 (SD = 20.3) and self-care confidence: 52.6 (SD=22.7)) and it was found low frequencies of participants with appropriate self-care (self-care maintenance, 6.9%), self-care management (14.7%) and self-care confidence (19%). Higher scores of the Self-Care of Heart Failure Index were associated with: reduced left ventricular ejection fraction (p=0.001), longer time of experience with the disease (p=0.05) and joint monitoring by physician and nurse (p=0.007).Conclusion: investments are needed to improve the self-care behavior and the nursing can play a relevant role in this improvement.

scholarly journals Transcultural Adaptation and Theoretical Models of Validation of the Spanish Version of the Self-Care of Heart Failure Index Version 6.2 (SCHFI v.6.2)

2021 ◽  
Vol 18 (2) ◽  
pp. 569
Author(s):  
Raúl Juárez-Vela ◽  
Angela Durante ◽  
Rosa Antonio-Oriola ◽  
Vicente Gea-Caballero ◽  
Michał Czapla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Factor Analysis ◽  
Psychometric Properties ◽  
Exploratory Factor Analysis ◽  
Self Care ◽  
Public Health Problem ◽  
The Self ◽  
Spanish Version ◽  
Factorial Validity ◽  
Failure Index

Background: Heart failure (HF) is a major and growing public health problem worldwide. Across the world, heart failure is associated with high mortality, high hospitalization rates, and poor quality of life. Self-care is defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiologic stability, the response to symptoms when they occur, and the ability to follow the treatment regimen and control symptoms. One instrument used to measure self-care is the Self Care of Heart Failure Index. Aim: The purpose of this study was to test the psychometric properties of the Spanish version of the Self Care of Heart Failure Index v.6.2 (SCHFI v.6.2). Methodology: Before testing its psychometric properties, the SCHFI v.6.2 was translated and adapted from its original English version into Spanish. Subsequently, we tested the instrument’s psychometric properties on a sample of 203 participants with HF. Descriptive statistics were used to analyze the sociodemographic and clinical variables, and to describe item responses. We tested the factorial validity of the SCHFI v.6.2 using confirmatory and exploratory factor analysis. Results: Confirmatory factor analysis (CFA) was performed using the our pre-existing models which resulted with poor fit indices. Thus, we performed exploratory factor analysis (EFA) on each of the SCHFI v.6.2 scales. Conclusion: The Spanish version of the SCHFI v.6.2. has good characteristics of factorial validity and can be used in clinical practice and research to measure self-care in patients with HF.

scholarly journals A Patient-Centric Care Approach to Facilitate the Design of an Artificial Intelligence Application in Geriatric Care Management of Heart Failure Readmissions

2021 ◽  
Vol 3 (5) ◽  
pp. 01-07
Author(s):  
Thomas Wan
Keyword(s):  
Heart Failure ◽  
Decision Support ◽  
Human Factors ◽  
Care Management ◽  
Randomized Clinical Trials ◽  
Self Care ◽  
Geriatric Care ◽  
The Self ◽  
Management Approach ◽  
Heart Failure Readmissions

The examination of human factors’ role in moderating medical interventions and hospitalizations and/or rehospitalization of heart failure (HF) patients. Objectives: The primary purpose of this study is two-fold: 1) to show relevant human factors influencing the rehospitalization of persons with heart failure by developing a systematic algorithm generated from the cited randomized trials; and 2) to examine how the self-care principles, such as choice/efficacy, restfulness, healing environment, activity, trust, interpersonal relationships, outlook, and nutrition, may reduce heart failure readmissions. Methods: The meta-analytic approach generated a theoretically relevant and empirically validated self-care management decision support protocol for HF. Statistical modeling of the effects of eight human factors for the reduction of HF readmissions was presented. Findings: The systematic review and meta-analysis approach documents the results of randomized clinical trials that affect heart failure hospitalization by selected human factors. A patient-centered decision support system was developed to facilitate the self-care management of heart failure. Discussion: Our research generates systematic knowledge about the importance of human-factor principles in the provision of geriatric care for heart failure. Using shared decision-making strategies under the population health management approach could enhance the quality of care and reduce costly readmissions of heart failure, particularly for elderly patients.

scholarly journals Psychometric evaluation of the nine-item heart failure self-care behavior scale (9-EHFScBS)

2021 ◽  
Author(s):  
Reza Negarandeh ◽  
Elham Ghasemi ◽  
Leila Janani
Keyword(s):  
Heart Failure ◽  
Factor Analysis ◽  
Construct Validity ◽  
Internal Consistency ◽  
Self Care ◽  
Psychometric Evaluation ◽  
The Self ◽  
Failure Index ◽  
Behavior Scale ◽  
Care Behavior

Background & Aim: Self-care in patients with heart failure can improve multiple outcomes and reduce mortality. Measuring self-care requires valid and reliable tools. This study aimed to determine the psychometric properties of the 9-items European Heart Failure Self-Care Behavior Scale. Methods & Materials: The present study is a psychometric evaluation. The original version of the tool was translated from English to Persian using the standard Backward-Forward method. The questionnaire's validity was assessed using face, content, criterion (the Self-Care of Heart Failure Index v.6 as a criterion), and construct validity.  An exploratory factor analysis approach was used to construct validity with a sample of 216 patients with chronic heart failure referred to Dr. Shariati and Imam Khomeini Hospital's heart clinics in Tehran; and Ayatollah Mousavi Hospital in Zanjan. The reliability of the questionnaire was evaluated by internal consistency and stability methods. Results: After the validation process (validity and reliability), all 9 items of the questionnaire were approved and remained. The content validity index of the total content of the questionnaire was calculated to be 0.96. Based on factor analysis, only one factor was confirmed for the questionnaire. The correlation between the present questionnaire and the Self-Care of Heart Failure Index v.6 was positive and significant (p<0.001, r=0.753). Internal consistency (α=0.728) and stability (0.897) of the questionnaire were also confirmed. Conclusion: The European Heart Failure Self-Care Behavior Scale is valid and reliable for measuring Iranian patients' self-care behaviors with heart failure.

Abstract 245: Demonstrating the Effectiveness of an Outpatient Occupational Therapy Program for Individuals with Heart Failure

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Olivia Carroll ◽  
Kristin Nxumalo ◽  
Amber Bennett ◽  
Whitney Pike
Keyword(s):  
Heart Failure ◽  
Occupational Therapy ◽  
Care Management ◽  
Assessment Tool ◽  
Lifestyle Modification ◽  
Self Care ◽  
The Self ◽  
Lifestyle Modifications ◽  
Care Needs ◽  
Therapy Program

Objective: To demonstrate the effectiveness of an outpatient occupational therapy program on improving self-care for individuals with heart failure. Background: Hospitalizations for heart failure (HF) are the largest Medicare expenditure, and 12% of these admissions are considered preventable. Effective self-management of the debilitating symptoms associated with HF (shortness of breath, fatigue, fluid retention, cognitive decline) helps keep patients out of the hospital. Individuals often experience difficulty incorporating self-care management activities into their daily lives. Occupational therapy (OT) is well suited to address the self-care needs of people with HF by increasing patient self-efficacy and facilitating lifestyle modification through the incorporation of new habits, roles, and routines. Methods: Participants with HF (n=11, ages 40-86) enrolled in an outpatient OT program focusing on self-care management. Participants received weekly, bi-weekly or monthly one-hour treatments over a six-month period. Sessions addressed the following topics: low sodium diet adherence, medication management, activity tolerance, symptom monitoring and psychosocial coping strategies. The Self-Care of Heart Failure Index (SCHFI) was administered at evaluation and upon completion of the program. The SCHFI is a reliable and valid assessment tool that measures self-care maintenance, management and confidence in people with HF. Results: All participants who received two or more treatments demonstrated 33.33% (16.67 of 49.99) to 190.01% (63.33 of 33.33) improvement in maintenance of self-care routines based on pre and post SCHFI scores. Additionally, half of these participants demonstrated 28.47% (22.16 of 77.84) to 85.33% (38.4 of 45) improvement in confidence with self-care management based on pre and post SCHFI scores. Conclusion: Participation in an outpatient OT program that focused on incorporating lifestyle modifications into daily routines was effective at improving self-care for people with HF, specifically maintenance of self-care routines and confidence with ability to self-manage their chronic condition.

Abstract 17378: “If My Doctors Had Recommended a Mobile App to Me Back Then, I Wouldn't Have Been in This Situation Today”: Identifying the Barriers and Facilitators to the Utilization of mHealth Apps to Improve Self-Care in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ifeanyi Madujibeya ◽  
Salman Alreshidi ◽  
Adaze Aroh
Keyword(s):  
Heart Failure ◽  
Academic Medical Center ◽  
Self Care ◽  
Mobile App ◽  
Perceived Usefulness ◽  
Intention To Use ◽  
Depth Analysis ◽  
Patients With Heart Failure ◽  
Prior Use ◽  
Mhealth Apps

Background: Mobile Health applications (mHealth apps) have been demonstrated as an effective strategy for improving self-care abilities in patients with heart failure (HF). However, the uptake of the apps by patients remains low. Little is known about the patient’s perspectives on the factors that influence their uptake of the apps. This study explored HF patients’ perspectives on the barriers and motivators to the uptake and utilization of mHealth apps. Method: Semi-structure interviews and demographic questionnaires were used to gather data from patients with HF (N= 43) recruited from an academic medical center. An in-depth analysis of the interviews was conducted using a deductive thematic approach with the help of qualitative software, Atias.ti version 8. Results: Among the participants ( median age = 62 [35-92] years, mean±SD ejection fraction = 37.3±17, 41.9% female, 70% smartphone owners), 90.7% (n =39) had no prior use of mHealth apps for self-care. The majority of the participants with no prior use of mhealth (79.5%, n = 31), including 64.7% (n= 17) of participants aged 65yrs and above, expressed an intention to use the apps for self-care. All the participants (100%) stated that their healthcare providers (HCP) had never recommended the use of mHealth apps for self-care. Other barriers included lack of knowledge of the apps, the perceived financial cost of mHealth apps or smartphones, concern for privacy, and security of personal information, resistance to the change of previous self-care strategies, and perceived technology incompetence. Motivators to the uptake of mHealth included perceived usefulness of mHealth apps, mHealth apps’ ease of use, and the belief that the use of mHealth apps may alleviate perceived threat to health, and availability of technical support. Conclusion: This study suggests that patients with HF are willing to use mHealth apps to improve their self-care abilities. Thus, the effort to improve patients’ perceptions of mHealth apps’ usefulness and HCP recommendation of the apps are warranted to turn patients' “intention to use” to actual apps usage.

Abstract P480: The Distinct Role of Occupational Therapy in Addressing the Self-care Management Needs of Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Amber Bennett ◽  
Kristin Nxumalo ◽  
Whitney Pike ◽  
Olivia Carroll
Keyword(s):  
Heart Failure ◽  
Occupational Therapy ◽  
Significant Role ◽  
Care Management ◽  
Self Care ◽  
Continuum Of Care ◽  
The Self ◽  
Care Needs ◽  
Assessment Battery ◽  
The Continuum

Introduction: Hospitalizations for heart failure (HF) are the highest single Medicare expenditure. This cost primarily results from readmissions linked to failed self-care. Evidence suggests that effective self-care routines are equivalent to medication in preventing HF exacerbation and hospitalization. Occupational therapists (OT) are well suited to address HF self-care needs by facilitating self-efficacy and adapting patients’ routines, roles and habits. A recent study determined that OT is the only hospital spending category associated with lower HF readmission rates. Hypothesis: Occupational therapy has a significant role in addressing the self-care management needs of patients with HF throughout the continuum of care. Methods: The OT department launched a HF self-care management program as part of process improvement initiatives at an AHA-recognized teaching hospital. An assessment battery was developed which included the following: The Self-Care of Heart Failure Index (SCHFI) v.6.2, Minnesota Living With Heart Failure Questionnaire, Patient Health Questionnaire-9, and the Montreal Cognitive Assessment. Administration of the OT HF assessment battery to a pilot group of 12 inpatients revealed factors that affect patient adoption and adherence to beneficial self-care management routines. Based on assessment battery data, an outpatient OT program was established. Eleven outpatients were enrolled and completed 3-6 hours of OT treatment. The SCHFI was administered at program evaluation and completion to measure self-care maintenance and confidence. To expand service access, a telehealth self-care program was introduced and a single patient case study was assessed to determine the feasibility and effectiveness of the virtual format. Results: Assessment battery data enabled the development of outpatient treatment modules focusing on symptom monitoring, medication management, low sodium diet, activity tolerance and psychosocial strategies. All outpatients who completed the modules demonstrated improved self-care maintenance (ranging from 16-53 points) and half demonstrated improved self-care confidence (ranging from 6-39 points). The patient assessed after completing the telehealth program demonstrated improved self-care maintenance (70 points) and self-care confidence (28 points). Conclusions: In conclusion, OT has a significant role in addressing the self-care management needs of patients with HF throughout the continuum of care. The utilization of a standardized OT HF assessment battery is effective in determining the needs of this population and for guiding the implementation of targeted individualized treatment. Outpatient and telehealth delivery of OT programming is effective in improving self-care for people with HF.

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