Cardiomeds a mobile application supporting patient empowerment in heart failure: a two-stage usability study (Preprint)

BACKGROUND Mobile health (m-health) applications (app) have shown promising results in improving patient self-management of several chronic diseases. We have developed a mhealthapp (named Cardiomeds) dedicated to patients with heart failure (HF). This app which features an interactive medication list, daily self-monitoring of symptoms, weight, blood pressure, and heart rate, as well as HF educational information delivered through text, figures, video clips, and an interactive quiz. OBJECTIVE The aim of this study was to perform a mix-methods usability study of Cardiomeds. METHODS Patients with HF who were smartphone users were recruited from the HF outpatient clinic of the University Hospital of Geneva. The usability test was conducted in two stages, with modifications made to the app after the first stage to address major usability issues. Each stage required 10 participants to perform 14 tasks, such as entering vital signs, entering a new medication with its dosage and time of intake, or finding specific information about HF. Each task was timed; the sessions were recorded, and all data anonymized. After completing the tasks, patients filled out the System Usability Scale (SUS) 10-item questionnaire and answered 5 open questions about their perceptions of the app. RESULTS Twenty HF patients (75 % men) with a mean age of 55 years were included overall. The average time to complete all 14 tasks was 18 ± 5.7 minutes overall. Manual insertion of medications was the most time-consuming task, taking an average of 154.40 seconds (SD ± 68.08) in the first stage and 103.10 seconds (SD ± 42.76) in the second stage, and 128 ± 63 seconds overall. The average SUS score was 80%, showing a slight increase from 79% in the first stage to 80% in the second stage, which qualifies the app as “good” in terms of usability. Between the two stages, part of the app interface was redesigned to address the most acute issues identified in the first stage. Despite these improvements, guidance problems remained the most frequent issue, occurring in 36% (8/22) of problems in the first stage and in 40% (6/15) in the second stage. In response to open questions, 85% of the participants indicated they would use the app when it becomes available. CONCLUSIONS The usability test indicates that Cardiomeds is a suitable and user-friendly app for HF patients. The app will be further tested in a randomized clinical trial (study identifier: 2022-00731) during the transition phase after an acute HF hospitalization to assess its impact on patients’ knowledge about HF, self-care, and quality of life.