JMIR Publications

ABSTRACT

Background:

Atrial Fibrillation (AF) is a leading cardiac disease associated with an increased risk of stroke, cardiac complications and general mortality. Mobile health (mHealth) interventions that consist of sensing devices such as smartwatches, patch electrodes, handheld recorders, pulse-oximeters, etc., and applications aid in the detection, screening, and management of Atrial Fibrillation in healthcare systems. Embedding approaches that consider user experiences and behaviour in the design of healthcare interventions can yield positive outcomes in the lives of users.

Objective:

To ascertain the extent to which usability, user experiences and or behavioural approaches have been considered in designing mobile health interventions for Atrial Fibrillation (AF) detection, screening and management. More specifically, to show how studies in the context of AF consider user experiences and behavioural approaches taking the United Kingdom’s Medical Research Council’s (MRC) phases of designing complex interventions as reference, namely: identification, development, feasibility, evaluation, and implementation.

Methods:

Studies published until including 7th September 2022 that examined user experiences and behaviour associated with mHealth interventions in the context of AF were extracted from multiple databases as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement guidelines.

Results:

A total of 2219 records were extracted with only 55 records reporting on usability, user experiences or behaviour more widely designing mHealth interventions in the context of AF. When mapping the studies onto the phases of complex interventions, in the identification phase, there were significant differences between the needs of patients and healthcare workers. In the development phase, user perspectives guided the iterative development of applications, interfaces, and intervention protocols in 4 studies. Most studies (n =43) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were not designed together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reporting on challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. To realise envisaged human behaviour according to treatment, review results also show the inclusion, albeit scarce, of behaviour change approaches for mHealth interventions at multiple levels of socio-technical healthcare systems, including the level of the individual (micro), the level of communities (meso), yet no studies were found intervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in the design of long-term behavioural interventions.

Conclusions:

We proposed the novel approaches of mapping, firstly, studies, to different phases of the MRC framework for the design of complex interventions, and secondly, behavioural approaches to different levels of healthcare systems. We discuss the wider implications of our results in guiding future mHealth research.