Evaluating the use of mobile health technology in older adults with heart failure

Mixed-methods study

Leanne L. Lefler, Sarah Rhoads, Melodee Harris, Ashley E. Funderburg, Sandra A. Lubin, Isis D. Martel, Jennifer L. Faulkner, Janet L. Rooker, Deborah K. Bell, Heather Marshall, Claudia J. Beverly

Research output: Contribution to journalArticle

Abstract

Background: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. Objective: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. Methods: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. Results: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. Conclusions: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.

Original languageEnglish (US)
Article numbere12178
JournalJournal of Medical Internet Research
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2018

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Biomedical Technology
Telemedicine
Heart Failure
Equipment and Supplies
Technology
Self Care
Communication
Health
Hospitalization
Health Fairs
Blood Pressure Monitors
Group Homes
Costs and Cost Analysis
Aptitude
Frustration
Quality of Health Care
Physiologic Monitoring
Telephone
Health Personnel
Uncertainty

All Science Journal Classification (ASJC) codes

  • Health Informatics

Cite this

Lefler, L. L., Rhoads, S., Harris, M., Funderburg, A. E., Lubin, S. A., Martel, I. D., ... Beverly, C. J. (2018). Evaluating the use of mobile health technology in older adults with heart failure: Mixed-methods study. Journal of Medical Internet Research, 20(12), [e12178]. https://doi.org/10.2196/12178

Evaluating the use of mobile health technology in older adults with heart failure : Mixed-methods study. / Lefler, Leanne L.; Rhoads, Sarah; Harris, Melodee; Funderburg, Ashley E.; Lubin, Sandra A.; Martel, Isis D.; Faulkner, Jennifer L.; Rooker, Janet L.; Bell, Deborah K.; Marshall, Heather; Beverly, Claudia J.

In: Journal of Medical Internet Research, Vol. 20, No. 12, e12178, 01.12.2018.

Research output: Contribution to journalArticle

Lefler, LL, Rhoads, S, Harris, M, Funderburg, AE, Lubin, SA, Martel, ID, Faulkner, JL, Rooker, JL, Bell, DK, Marshall, H & Beverly, CJ 2018, 'Evaluating the use of mobile health technology in older adults with heart failure: Mixed-methods study', Journal of Medical Internet Research, vol. 20, no. 12, e12178. https://doi.org/10.2196/12178
Lefler, Leanne L. ; Rhoads, Sarah ; Harris, Melodee ; Funderburg, Ashley E. ; Lubin, Sandra A. ; Martel, Isis D. ; Faulkner, Jennifer L. ; Rooker, Janet L. ; Bell, Deborah K. ; Marshall, Heather ; Beverly, Claudia J. / Evaluating the use of mobile health technology in older adults with heart failure : Mixed-methods study. In: Journal of Medical Internet Research. 2018 ; Vol. 20, No. 12.
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author = "Lefler, {Leanne L.} and Sarah Rhoads and Melodee Harris and Funderburg, {Ashley E.} and Lubin, {Sandra A.} and Martel, {Isis D.} and Faulkner, {Jennifer L.} and Rooker, {Janet L.} and Bell, {Deborah K.} and Heather Marshall and Beverly, {Claudia J.}",
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T1 - Evaluating the use of mobile health technology in older adults with heart failure

T2 - Mixed-methods study

AU - Lefler, Leanne L.

AU - Rhoads, Sarah

AU - Harris, Melodee

AU - Funderburg, Ashley E.

AU - Lubin, Sandra A.

AU - Martel, Isis D.

AU - Faulkner, Jennifer L.

AU - Rooker, Janet L.

AU - Bell, Deborah K.

AU - Marshall, Heather

AU - Beverly, Claudia J.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. Objective: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. Methods: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. Results: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. Conclusions: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.

AB - Background: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. Objective: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. Methods: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. Results: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. Conclusions: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.

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