Self-management app usage and expectations by patients with heart failure: results of a qualitative study
Authors: Steiner B , Neumann A , Boyne J J J , Dinesh Kanna N D , Hill L , Murphy M , Verket M , Mcnulty A , Pelz Y , Barrett M J , Hoedemakers T , Helms T M , Brunner-La Rocca H P , Zippel-Schultz B 
Published: October 2024

Abstract

Background
Effective self-care in heart failure (HF) is essential to prevent acute deterioration and improve treatment adherence and quality of life. The supportive role of eHealth is becoming increasingly important to alert HF patients to changes in symptoms and take greater responsibility for maintaining or improving their state of health. Integrating the expectations, perceptions, and impression of HF patients into the design, customization, and utilization of self-care apps is crucial to ensure sustainable and beneficial implementation of such solutions.

Purpose
To explore patients' with HF expectations, their usage, and first impressions towards a self-care app.

Methods
The self-care app developed could monitor HF symptoms, provide education via e-learning modules, and telemedical services including regular checkups, recommendations, and feedback from healthcare professionals (HCP). Patients from four clinical sites in Europe, Germany (DE), United Kingdom (UK), Ireland (IRL), Netherlands (NL), who had used this app were invited to participate in a semi-structured interview. These were recorded, transcribed, and analysed by two researchers based on qualitative content analysis according to Mayring.

Results
In total 32 male and 6 female HF patients aged between 32 and 84 years (66±13) were interviewed (see figure 1). Average duration was 34 minutes. Most patients had used the app for 1-2 weeks at time of the interview. Most patients planned to use the app 2-3 times a week and integrate it into their daily routines. Patients expressed a preference for sessions (regular checkups, e-learnings) not to exceed 10 minutes.
Patients believed features like reminders, gamification, and direct feedback from the app could positively influence their behaviour. Conversely, technical issues, too frequent data entry or repetitive questioning were perceived as negative. In case the app could give medical advice, some patients (n=12) indicated that they would only follow the app's recommendations after consulting an HCP. Overall, patients expected the app to provide continuous monitoring and an early warning system to detect and counteract deterioration at an early stage. They deemed the combination of telemedical services and patient records to be particularly valuable. Moreover, patients expected the app to serve as an information source on HF and believed it could increase their motivation and self-discipline for better self-care and therapy adherence (see figure 2).

Conclusion
The results show that HF patients consider eHealth apps to be valuable tools for autonomously monitoring and improving their health. However, behaviour and acceptance can be encouraged or inhibited depending on the functionalities and design of the app. The findings underline the increasing relevance of eHealth solutions, such as a self-care app in healthcare and emphasize the necessity of considering patients' needs and preferences during the development.Functions with the greatest benefit