TY  - JOUR
AU  - Keogh, Alison
AU  - Brennan, Carol
AU  - Johnston, William
AU  - Dickson, Jane
AU  - Leslie, Stephen J
AU  - Burke, David
AU  - Megyesi, Peter
AU  - Caulfield, Brian
PY  - 2024
DA  - 2024/3/1
TI  - Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study
JO  - JMIR Form Res
SP  - e52442
VL  - 8
KW  - digital health
KW  - heart failure
KW  - cardiology
KW  - self-care
KW  - behavior change
KW  - eHealth
KW  - mHealth
KW  - mobile health
KW  - mobile app
KW  - mobile phone
KW  - elderly
KW  - self-management
KW  - digital tools
KW  - digital tool
KW  - human-centered design
KW  - app
KW  - apps
KW  - applications
KW  - wearables
KW  - wearable
KW  - Fitbit
KW  - usability
KW  - adherence
KW  - feasibility
KW  - congestive heart failure
KW  - cardiac failure
KW  - myocardial failure
KW  - heart decompensation
AB  - Background: Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people’s acceptance of it in practice. Objective: This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. Methods: A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. Results: Participants wore their devices for an average of 86.2% of the days in the 6-month testing period ranging from 40.6% to 98%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. Conclusions: The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs. 
SN  - 2561-326X
UR  - https://formative.jmir.org/2024/1/e52442
UR  - https://doi.org/10.2196/52442
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38427410
DO  - 10.2196/52442
ID  - info:doi/10.2196/52442
ER  -