A mobile phone app for obtaining daily reports of symptoms, self-care, and decision making
Authors: Page S D , Wiebe D J , Freedland K E , Lee C , Vellone E , Westland H , Van Rijn M , Aryal S , Stromberg A , Jaarsma T , Riegel B 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Australian Catholic University

Background/Introduction
The number of individuals suffering from cardiovascular disease (CVD) is increasing worldwide. One approach to controlling the prevalence of CVD is the aggressive control of risk factors like hypertension and diabetes. Adults with these conditions may experience symptoms (e.g. high blood sugar) that need to be addressed. However, decision-making that occurs between recognizing a symptom and implementing a self-care management behavior is poorly understood. Ecological daily assessment (EDA) is a data collection method for evaluating self-reported states (i.e., experience of symptoms) and processes (i.e., decision making) in the natural environment.

Purpose
The purpose of this pilot study was to evaluate the feasibility of using a mobile phone EDA app for collecting data about self-reported symptoms, self-care management behaviors, and the factors that influence decisions to engage in self-care.

Methods
In this feasibility study, we recruited adult volunteers from ResearchMatch.org with a chronic illness, who experience symptoms at least three times per week. Participants used the mobile app for two weeks to complete twice-daily questions about a selected symptom, their responses to this symptom, and the factors that influenced their decisions about what to do when the symptom occurred.

Results
Eighteen adults (9 male; ages = 33-73) completed an average of 83% of prompts over the 14-day period. Diabetes was one of the most commonly reported conditions (n =11) and four participants reported on high blood sugar as their selected symptom. Among these four participants, there were 49 reports of high blood sugar and it was severe or somewhat severe 41% of the time. Respondents attributed the symptom to their behavior (49% of the time), a change in mood (41%), and stress (35%), but 20% of the time they did not know what caused the symptom. The most common self-care management behaviors included modifying the diet (57%), taking insulin (49%) and checking blood glucose (43%). In 8% of reports, no action was taken. When asked about decision making, most of the time (59%) participants did what usually works for the symptom. Decisions were also influenced by advice from others (29% of the time), uncertainty about the meaning of the symptom (18%), feeling too unwell to decide (18%), rapid worsening of the symptom (16%) and believing they could tolerate the symptom (10%). The underlying theme about decision making was trying to balance the unpleasantness of a symptom vs. taking action.

Conclusions & Implications
Controlling major risk factors like diabetes can strongly influence the development of CVD. A mobile phone EDA app is feasible for gathering data about symptoms, self-care, and decision making in adults with chronic illness. The next step is to refine the mobile app and use it in an international study on the relationship between symptoms, self-care management, and decision making in adults with chronic illness.