JMIR Publications

ABSTRACT

Background:

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is a challenging chronic disease to manage. Patients’ daily self-care decisions are associated with improved AF outcomes and quality of life and decreased hospital use and cost. However, many patients find these real-world or naturalistic decisions difficult often because of their inherent complexity and ambiguity, coupled with the uncertainty of AF. Intervention research using technology to support AF self-care has largely emphasized making decisions with clinicians. Patients with AF are increasingly using consumer technology yet little is known about AF patients’ use of technology in independent self-care decision-making. Addressing this gap will facilitate developing interventions that better leverage technology to enhance patients’ naturalistic decision-making.

Objective:

The purpose of this study was to explore the experiences of older adult patients in using technology to support self-care decision-making.

Methods:

Following an interpretive description qualitative approach, older adult patients with AF were recruited from three specialty heart function clinics in a Western Canadian province to participate in one of six facilitated virtual focus groups for 1.5 hrs. Patients were asked about their self-care decision-making since AF diagnosis, their AF-specific technology use and its use in making self-care decisions, their technology motivations, benefits, constraints, and other possibilities for use. Inductive thematic analysis was used to code the transcribed data, moving from open coding, to clustering of common codes into categories, looking for patterns of meaning between and across categories to iteratively arrive at main themes and sub-themes.

Results:

Thirty patients (n = 15; 50% women) with AF (Mean age = 73 years, range 63-85) participated in the focus groups. Participants’ experiences of using technology to make daily self-care decisions were highly variable but centered on its personalized use to meet their individualized needs, preferences, and life context. The personalizing process of technology use in decision-making was characterized by three sub-themes: i) Beginning technology use in their own times and ways, during their AF trajectory - pre-, at the time, at some point AF post-diagnosis, and could be either self-initiated and/or provider recommended or influenced; ii) Developing patterns of AF self-care decision-making using technology, including establishing their personal baseline, keeping out of the danger zone, watchful waiting, and seeking decision-making support; and iii) Finding the place for technology in normalizing daily life, either settling on, or limiting its use to normalize life.

Conclusions:

Findings expand understandings of naturalistic decision making by elucidating the personalized process of technology use in AF self-care.