JMIR Publications

ABSTRACT

Background:

Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centred 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:

To conduct an observational pilot study to examine the usability, adherence and feasibility of a digital health tool for HF within the Irish healthcare system.

Methods:

Nineteen participants with HF were provided with a digital tool comprising a mobile app, the Fitbit Charge 4 and Aria Air Smart scales for a period of six-months. Changes to their self-care were assessed pre and post 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. Post-study three usability questionnaires were implemented and descriptively analysed (median [inter-quartile range; min-max]): System Usability Scale (SUS); Wearable Technology Motivation Scale (WTMS); and the Comfort Rating Scale (CRS). Participants also undertook a semi-structured interview regarding their experiences with the digital tool. Two healthcare professionals were also interviewed regarding their thoughts and experiences with the system. Interviews were analysed deductively using the Theoretical Domains Framework.

Results:

Participants wore their devices for an average of 86.2% of the days in the testing period ranging from 40.6% to 98%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (p>0.025, following a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (6.3; 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (6.0 [2.0; 1.0-7.0]), while the Fitbit was considered very comfortable as demonstrated by the low CRS results (0.0 [0.0; 0.0-2.0]). 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. Healthcare professionals noted that the system had promise but required additional work, including dedicated time to call back participants if the tool triggered a warning. Changes to the thresholds used to send triggers were suggested.

Conclusions:

The digital health tool demonstrated high levels of adherence and acceptance amongst 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 required 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.