A Mobile Health Intervention System for Women With Coronary Heart Disease: Usability Study

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Abstract

Background

Coronary heart disease (CHD) is the leading cause of death and disability among American women. The prevalence of CHD is expected to increase by more than 40% by 2035. In 2015, the estimated cost of caring for patients with CHD was US $182 billion in the United States; hospitalizations accounted for more than half of the costs. Compared with men, women with CHD or those who have undergone coronary revascularization have up to 30% more rehospitalizations within 30 days and up to 1 year. Center-based cardiac rehabilitation is the gold standard of care after an acute coronary event, but few women attend these valuable programs. Effective home-based interventions for improving cardiovascular health among women with CHD are vital for addressing this gap in care.

Objective

The ubiquity of mobile phones has made mobile health (mHealth) behavioral interventions a viable option to improve healthy behaviors of both women and men with CHD. First, this study aimed to examine the usability of a prototypic mHealth intervention designed specifically for women with CHD (herein referred to as HerBeat). Second, we examined the influence of HerBeat on selected health behaviors (self-efficacy for diet, exercise, and managing chronic illness) and psychological (perceived stress and depressive symptoms) characteristics of the participants.

Methods

Using a single-group, pretest, posttest design, 10 women participated in the 12-week usability study. Participants were provided a smartphone and a smartwatch on which the HerBeat app was installed. Using a web portal dashboard, a health coach monitored participants’ ecological momentary assessment data, their behavioral data, and their heart rate and step count. Participants then completed a 12-week follow-up assessment.

Results

All 10 women (age: mean 64.4 years, SD 6.3 years) completed the study. The usability and acceptability of HerBeat were good, with a mean system usability score of 83.60 (SD 16.3). The participants demonstrated statistically significant improvements in waist circumference ( P=.048), weight ( P=.02), and BMI ( P=.01). Furthermore, depressive symptoms, measured with the Patient Health Questionnaire-9, significantly improved from baseline ( P=.04).

Conclusions

The mHealth prototype was feasible and usable for women with CHD. Participants provided data that were useful for further development of HerBeat. The mHealth intervention is expected to help women with CHD self-manage their health behaviors. A randomized controlled trial is needed to further verify the findings.

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Most cited references 57

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Chronic disease self-management program: 2-year health status and health care utilization outcomes.

K Lorig, P Ritter, A Stewart … (2001)

To assess the 1- and 2-year health status, health care utilization and self-efficacy outcomes for the Chronic Disease Self-Management Program (CDSMP). The major hypothesis is that during the 2-year period CDSMP participants will experience improvements or less deterioration than expected in health status and reductions in health care utilization. Longitudinal design as follow-up to a randomized trial. Community. Eight hundred thirty-one participants 40 years and older with heart disease, lung disease, stroke, or arthritis participated in the CDSMP. At 1- and 2-year intervals respectively 82% and 76% of eligible participants completed data. Health status (self-rated health, disability, social/role activities limitations, energy/fatigue, and health distress), health care utilization (ER/outpatient visits, times hospitalized, and days in hospital), and perceived self-efficacy were measured. Compared with baseline for each of the 2 years, ER/outpatient visits and health distress were reduced (P <0.05). Self-efficacy improved (P <0.05). The rate of increase is that which is expected in 1 year. There were no other significant changes. A low-cost program for promoting health self-management can improve elements of health status while reducing health care costs in populations with diverse chronic diseases.

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Home-based versus centre-based cardiac rehabilitation

Georgina Sharp, Lindsey N Anderson, Rebecca Norton … (2017)

Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015.

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The mHealth App Usability Questionnaire (MAUQ): Development and Validation Study

Leming Zhou, Jie Bao, I Made Agus Setiawan … (2019)

Background After a mobile health (mHealth) app is created, an important step is to evaluate the usability of the app before it is released to the public. There are multiple ways of conducting a usability study, one of which is collecting target users’ feedback with a usability questionnaire. Different groups have used different questionnaires for mHealth app usability evaluation: The commonly used questionnaires are the System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ). However, the SUS and PSSUQ were not designed to evaluate the usability of mHealth apps. Self-written questionnaires are also commonly used for evaluation of mHealth app usability but they have not been validated. Objective The goal of this project was to develop and validate a new mHealth app usability questionnaire. Methods An mHealth app usability questionnaire (MAUQ) was designed by the research team based on a number of existing questionnaires used in previous mobile app usability studies, especially the well-validated questionnaires. MAUQ, SUS, and PSSUQ were then used to evaluate the usability of two mHealth apps: an interactive mHealth app and a standalone mHealth app. The reliability and validity of the new questionnaire were evaluated. The correlation coefficients among MAUQ, SUS, and PSSUQ were calculated. Results In this study, 128 study participants provided responses to the questionnaire statements. Psychometric analysis indicated that the MAUQ has three subscales and their internal consistency reliability is high. The relevant subscales correlated well with the subscales of the PSSUQ. The overall scale also strongly correlated with the PSSUQ and SUS. Four versions of the MAUQ were created in relation to the type of app (interactive or standalone) and target user of the app (patient or provider). A website has been created to make it convenient for mHealth app developers to use this new questionnaire in order to assess the usability of their mHealth apps. Conclusions The newly created mHealth app usability questionnaire—MAUQ—has the reliability and validity required to assess mHealth app usability.

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Author and article information

Contributors

Kaushik Dutta:

ORCID: https://orcid.org/0000-0001-8076-1472

Information Systems and Decision SciencesUniversity of South Florida4202 E Fowler AvenueTampa, FL, 33620United States1 8139746338duttak@usf.edu

Journal

Journal ID (nlm-ta): JMIR Form Res

Journal ID (iso-abbrev): JMIR Form Res

Journal ID (publisher-id): JFR

Title: JMIR Formative Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2561-326X

Publication date Collection: June 2020

Publication date (Electronic): 3 June 2020

Volume: 4

Issue: 6

Electronic Location Identifier: e16420

Affiliations

[1 ] Information Systems and Decision Sciences University of South Florida Tampa, FL United States

[2 ] College of Nursing University of South Florida Tampa, FL United States

[3 ] College of Engineering University of South Florida Tampa, FL United States

Author notes

Corresponding Author: Kaushik Dutta duttak@ 123456usf.edu

Author information

Avijit Sengupta https://orcid.org/0000-0002-9275-1383

Theresa Beckie https://orcid.org/0000-0001-8985-2725

Kaushik Dutta https://orcid.org/0000-0001-8076-1472

Arup Dey https://orcid.org/0000-0001-9356-7388

Sriram Chellappan https://orcid.org/0000-0002-5330-8549

Article

Publisher ID: v4i6e16420

DOI: 10.2196/16420

PMC ID: 7301266

PubMed ID: 32348270

SO-VID: 54dff356-c41c-4f2a-ae76-b3e198efdaff

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on http://formative.jmir.org, as well as this copyright and license information must be included.

History

Date received : 26 September 2019

Date revision requested : 19 November 2019

Date revision received : 5 March 2020

Date accepted : 11 March 2020

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