@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2019;11(3):125-131

Background
Heart failure (HF) is a complex and progressive clinical syndrome that results from a functional or structural defect in the heart that results in dysfunction or inability to discharge or fill the ventricles [1].
Previous Studies
... [2-9]. Over the years, several studies have examined the impact of a variety of medication adherence methods including education, reminder systems, self-care support, physician-centered interventions, organizational change, and remote monitoring systems in patients with HF [10]. ... [11]. Today, using smartphones and tablets to provide health-care services to patients through caregiving training and support has been expanded with purposeful communication between the healthcare team and patients [12]. ... [13-22]. Smartphone-based applications have been previously used in chronic diseases, such as obesity, chronic pain, patients with myocardial infarction, and patients with heart valve replacement. One of the limitations of health applications is the lack of appropriate educational content based on scientific and specialized literature [24]. Smartphone technology in disease management, without the need for direct supervision by health care workers can improve quality of life, reduce costs, reduce hospitalizations and ultimately empower the patient in self-care behaviors [25].
Aim(s)
The aim of this study was to design and evaluate a smartphone-based application to manage the treatment of people with heart failure.
Research type
This research was a developmental-applied study with the software design approach
Research society, place and time
This research was done from December 2017 to July 2018.
Sampling method and number
In the second phase of the study, 29 participants were selected to study software, who were selected by convenience sampling from the selected educational centers of Iran University of Medical Sciences.
Used devices&materials
In the first phase, the design of the prototype was performed by gathering information about the main capabilities of applications based on a review of literature and clinical guidelines related to HF and health experts in HF. In the second phase, the application was evaluated in treatment management based on the Mobile Application Rating Scale (MARS) (MARS) [27], the IMS Institute for Healthcare performance score and compliance with the Heart Failure Society of America (HFSA) guidelines [29] to obtain the final application. To design an application with acceptable features consultations were made with skilled software developers and this application was designed in about 8 months with the participation of faculty members of intensive care nursing and senior nursing experts of Iran University of Medical Sciences, Information Technology engineers and Software experts from the Janbazan Medical and Engineering Research Center. Gradually, during the process of application development, in order to improve and fix its defects, consultations were made with faculty of Nursing Intensive Care. This application was developed according to the criteria mentioned in two steps (designing the prototype and its original version) [30]. The educational content of the program was prepared by literature review, clinical guidelines and library searching based on the HFSA guideline. Then, the validity of educational content was approved by a panel of experts (5 members of Nursing faculty of Iran University of Medical Sciences and 2 experts in HF). The application installable on Android system was prepared and its validity was evaluated in terms of several features (such as medication alert, question and answer, reminder, vital signs and daily signs) by the research team, experts in HF, care for people with HF and patients and their caregivers in two stages. To assess the validity of the application, the initial version was provided to 2 patients and their companions, a cardiovascular specialist in HF, and 3 cardiac ward nurses and a software developer. Next, corrections were made based on a few early review comments. In the first phase, there were more changes in the aesthetic dimension, number of pages, the applicability of the educational content, information and general capabilities, which were implemented by referring the comments to the developer. The second version of the software was then developed and submitted to 10 patients and their companions, 3 cardiologists, 4 nurses of Carrdiovascular ward and 3 software developers to finalize. In the second phase, general changes were made to simplify the application and eliminate ambiguities, such as the complexity of the alert or how to search the application and the educational content, creating a question-and-answer link and in the second phase it was assesses from the perspective of different people and changes were added to the software. The application was evaluated in two stages based on the MARS scale [27], the IMS score [28] and compatibility with HFSA [29]. For this purpose, the application was provided to users 1 h later the participants' opinions were collected using self-report data collection tools. Data were analyzed using descriptive statistics in SPSS 16 software.
Findings by Text
Of the 29 participants in the second phase of the study, 17 subjects (58.6%) were female and 12 subjects (41.4%) were male with a mean age of 45.00 ± 18.00 years. Nine subjects (31.0%) had bachelor's degree and above, 13 subjects (44.8%) had diploma and 7 subjects (24.2%) had bachelor's degree. The obtained data consisted of two main bases: the total usability assessment score and IMS score. Based on users’ feedback and adjusting questionnaire responses, more focus was placed on educational content for weight control and nutrition. The following scores were obtained for the software dimensions: interactive dimension based on the MARS scale: in the of the application produced on with a mean score of 17.80 ± 0.79, aesthetic dimension: 8.00 ± 0.83; information: 12.80 ± 0.76 functional dimension: 15.85±0.78 and overall evaluation: 10.70 ± 0.86 and the obtained scores were greater than 60% of the total score on each dimension. The mean IMS score was 9.00 ± 0.87 out of 11. In two cases, the graphs and drug reminder were shown and there were not observed, but by indicating their location and how they are used and referring to the software guide, the full score was finally achieved. Moreover, according to the HFSA criteria, the mean score was 7.00 ± 0.79 out of 8. Only in one case there was a lack of educational content on salt restriction, which by indicating the location and how to research, the total score obtained.
Main comparison to the similar studies
Seto et al. in Canada have designed a smartphone application for patients with HF that can control weight, blood pressure and send motivational messages to continuously support for patients. This study showed that using the application can enhance positive self-care behaviors of patients and also the appropriate alert for abnormal patient-recorded data in the software, which in the mentioned study, the alert alone was used, whereas in the present study, the interaction with the patient and obtaining complete information about the disease process was possible [31]. The results of the study by Lekdizaji et al. showed the effectiveness of tele and remote-education programs on quality of life of patients with HF. The content of this program was based on the HFSA guideline [32]. In addition, Portez et al. designed an application to record weight, symptoms, and severity of symptoms of a disease. Their results indicated the efficacy of this program to monitor the symptoms of patients with HF [33] .... [34, 35].
Suggestions
It is recommended that this study be conducted with a larger sample size and at longer research time.
Limitations
One of the limitations of this study is the limited time to review software that most participants tended to use more.
Conclusions
The use of a smartphone-based application can be useful in treatment management and self-care of patients with HF.
Acknowledgments
We would like to express our gratitude to all the participants who participated in the present study, the staff of the Faculty of Nursing and Midwifery of Iran University of Medical Sciences, the Janbazan Medical and Engineering Research Center and the research centers, which provided the opportunity to conduct the research.
Conflict of interest
None declared.
Ethical Permissions
This research project was conducted after obtaining the ethics permission from the Faculty of Nursing and Midwifery of Iran University of Medical Sciences (Ethics code: IR.IUMS.REC1396.32025).
Funding Sources
The study is funded by the Janbazan Medical and Engineering Research Center.