Abstract
Background: Heart failure (HF) affects over 5.1 million people in the United States and is associated with high rates of exacerbation. Effective self-care behaviors reduce re-hospitalizations. However, patients struggle with discerning changes in symptoms, adherence to medications and lack the necessary tactical and situational skills in order to follow prescribed diets. Supportive technology has the ability to enable patients to both discern changes in their condition and determine what to do about those changes on a daily basis, potentially supporting the patient's ability to perform self-care. Purpose: The purpose of this study is the development, and testing of a smartphone HF application that will be used to provide self-care support to HF patients. Methods: This study was conducted in three phases. Phase one entailed the gathering and rating of evidence-based HF literature which was used to determine the types of education that should be offered to participants. In phase two the HF application was developed and the evidence gathered in phase one guided the types of education that was offered via the application. In phase three of the study, a quasi-experimental pre-test post-test design was used to assess the study outcomes of self-care and symptom awareness along with testing the feasibility and acceptability of the smartphone based HF application intervention. All study participants were exposed to the smartphone intervention. Results: Based on the gathering and rating of evidence in phase one, the following educational topics were offered via the application: symptoms of worsening HF; lifestyle changes; managing blood pressure; how to manage salt intake; physical changes to report to a healthcare provider; and the advantages and disadvantages of potassium use in the diet. A paired t- test was used to compare the pre and post self-care maintenance, self-management and self-confidence scores with a level of significance of p<.05. The results showed that there was a statistically significant mean difference in pretest self-care scores and post test self-care scores. There were improvements noted in the self-care management and confidence subscales. There was no statistically significant difference between pretest and post-test symptom awareness scores. Results of this study suggest that the intervention is feasible in this population and that it was acceptable based on the overall high scores of the acceptability measure. Conclusions: This feasibility study has indicated that a smartphone application that fosters symptom monitoring, offers evidence-based education to support decision making can improve patients' self-care. Also, the use of mobile phones in telemonitoring has the potential to aid patients in improving HF self-care..