mHealth for Self-care of Heart Failure in Uganda
Condition: Heart Failure
MeSH terms: Heart Failure
Study type: Interventional

Summary: 
      Heart failure affects more than 38 million people globally. It is responsible for high rates
      of hospitalization and premature mortality, especially in sub-Saharan Africa. Heart failure
      causes multiple debilitating and distressing symptoms. These symptoms can often be managed by
      patients themselves but only when they are able to identify symptoms and select appropriate
      actions. Self-care, a World Health Organization-endorsed intervention for chronic conditions
      like heart failure, is greatly underutilized in lower and middle income countries, including
      Uganda. Self-care refers to the ability of patients, caregivers and communities to maintain
      health, prevent disease, and manage illness, with or without a healthcare provider. Mobile
      health (mHealth) offers a promising platform to address this need gap in lower and middle
      income countries. mHealth takes advantage of the widespread usage of mobile phones to offer
      patients individualized self-care tools such as education, healthy lifestyle prompts, and
      support with making decisions. Since 2016, this multidisciplinary, international research
      team has been designing Medly Uganda, an mHealth application to improve self-care among
      Ugandan patients with heart failure. This application began as a smartphone but was adapted
      for the low-cost feature phones used widely throughout the country. It was also integrated
      into an mHealth system endorsed by the Ugandan Ministry of Health. When patients log in they
      are prompted to report on specific heart failure symptoms. The application then generates
      self-care instructions based on those symptoms. If a patient reports serious symptoms the
      application triggers an alert to the research nurse, who then consults with the patient,
      caregiver, and if needed, cardiologist, to establish a plan of care. This study proposes that
      an mHealth intervention tailored specifically to the local context will improve healthcare
      quality of life for patients with heart failure. The research team hypothesizes that heart
      failure patients who use the program will report improved scores on the Self-Care in Heart
      Failure Index. These scores will be assessed at baseline, three-month, and six-month visits.
      The researchers will also measure changes in patients' clinical conditions, including the
      6-minute walk test, left ventricular ejection fraction, and frequency of acute care visits.
      Finally, the researchers will conduct qualitative interviews with patients and providers to
      understand their experiences.
    

Detailed description: 
      Participants will be asked to initiate self-care sessions using the Medly Uganda application.
      They will dial the sub-code and enter a unique PIN to access the system. They are asked to do
      this every Monday, Wednesday, and Friday morning for six months, as well as anytime that they
      experience concerning symptoms. If a participant has not initiated a session by 11:00am on
      the designated days, the application will generate an SMS reminder. Each interactive session
      will present a series of symptom-based questions to the participant. These questions will be
      followed by a tailored SMS message. While session content will not remain on the
      participant's phone, the SMS messages will. This allows participants to retain and review
      messages, thereby reinforcing educational content. There are four status categories: Stable,
      Fluid Overload, Urgent, and Critical. If Stable, participants will be sent one of six
      encouraging and educational messages. If Fluid Overload, Urgent or Critical, patient
      participants will be sent a message that identifies the symptom and recommends an action and
      the on-duty nurse will be sent an accompanying alert. Urgent and Critical alerts will also be
      sent to the on-duty doctor. The nurse is expected to call the patient for Urgent and Critical
      alerts within 60 and 15 minutes, respectively. Nurse phone call interactions will be guided
      by a standard operating manual. One nurse and one doctor will be designated rotating
      'on-duty' responsibility to monitor clinician alerts and the dashboard seven days a week. The
      doctor will be available to provide clinical supervision to the nurse as needed and they will
      have a daily in-person or by-phone.
    

Intervention name(s): mHealth for heart failure patients in Uganda
Intervention type(s): Other
Intervention description(s): Patients at Uganda Heart Institute will be enrolled in an mHealth program intended to promote self-care for heart failure and improve their healthcare quality of life.
Intervention model: Single Group Assignment
Intervention model description: This is a single-center prospective cohort study. The researchers will use consecutive sampling to identify potential patient participants.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Heart Failure; Telemedicine; Uganda; mHealth; Implementation Science