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Currently submitted to: JMIR Cardio

Date Submitted: Aug 14, 2019
Open Peer Review Period: Aug 14, 2019 - Oct 9, 2019
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Using an Electronic Application to Promote Home-Based Self-Care in Older Heart Failure Patients: A Qualitative Study on Patient and Informal Caregiver Perspectives

  • Sahr Wali; 
  • Karim Keshavjee; 
  • Linda Nguyen; 
  • Lawrence Mbuagbaw; 
  • Catherine Demers; 



Heart failure (HF) affects many older individuals in North America with recurrent hospitalizations despite post-discharge strategies to prevent readmission. Proper HF self-care can potentially lead to better clinical outcomes, yet many older patients find self-care challenging. Mobile health (mHealth) applications can support patients with HF self-care. However, many mHealth apps are not designed to consider potential patient barriers such as literacy, numeracy and cognitive impairment leading to challenges for older patients. We previously demonstrated that a paper-based standardized diuretic decision tool (SDDST) with daily weights and adjustment of diuretic dose led to improved self-care.


The aim of this study was to better understand the self-care challenges that older patients with HF and their informal care-providers (CPs) face on a daily basis leading to the conversion of the SDDST into a user-centered mHealth application.


We recruited 14 patients (male, 57%) with a confirmed diagnosis of HF, aged ≥60 years,, and 7 CPs from the HF Clinic and the cardiology ward at the Hamilton General Hospital. Patients were categorized into three groups, 1) patients with adequate self-care, 2) patients with inadequate self-care without a CP or 3) patients with inadequate self-care with a CP, based on the Self-Care Heart Failure Index (SCHFI). We conducted semi-structured interviews with patients and their CPs using Persona-Scenarios. Interviews were transcribed verbatim and analyzed for emerging themes using an inductive approach.


Six themes were identified: 1) Usability of technology, 2) Communication, 3) Application customization, 4) Complexity of Self-Care, 5) Usefulness of HF Related Information and 6) Long-Term Use and Cost. Many challenges mentioned patients and CPs involved their unfamiliarity with technology and the lack of incentive for its use. However, participants were supportive and more likely to actively use the HFApp when informed of the intervention’s inclusion of volunteer and nurse assistance.


Patients with varying self-care adequacy levels were willing to use an mHealth app if it was simple in its functionality and user-interface. To promote the adoption and usability of these tools, patients confirmed the need for researchers to engage with end-users before developing an application. Findings from this study can be used to help inform the design of an mHealth app to ensure it is adapted for the needs of older individuals with HF.


Please cite as:

Wali S, Keshavjee K, Nguyen L, Mbuagbaw L, Demers C

Using an Electronic Application to Promote Home-Based Self-Care in Older Heart Failure Patients: A Qualitative Study on Patient and Informal Caregiver Perspectives

JMIR Preprints. 14/08/2019:15885

DOI: 10.2196/preprints.15885


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