Co-design and evaluation of a mHealth intervention to enhance dietary self-management and adherence in patients with heart failure

Medical and dietary therapies (i.e., sodium and fluid restriction) are key to improving heart failure (HF) outcomes, a leading cause of morbidity and mortality in Canada. Despite support from healthcare providers (HCPs), ~50% of patients are nonadherent to these therapies. Mobile applications (apps) may support patient adherence to treatment; however, little is known about patient and HCP perspectives regarding the adoption of apps for HF management, which is critical to successful development and implementation. Moreover, a majority of existing HF apps have focused solely on symptom monitoring, and only a few have addressed dietary education and adherence. This research conducted three studies. Two descriptive qualitative studies using focus groups and interviews assessed patient (Study 1) and HCP (cardiologists and nurses; Study 2) needs, motivations, and challenges related to using apps for HF management. Study 3 reported on the co-design, development, and user-testing (via quasi-experimental design) of a mobile app to support dietary education and adherence among patients with HF. App engagement, satisfaction, and usability were measured using a patient-reported questionnaire. Patients included in the research were outpatients with HF, ≥18 years, on stable medical therapy, and smartphone users. Patients (n= 19) and HCPs (n=21) felt apps present opportunities for education (e.g., diet, medication, symptoms), patient engagement and communication, and enhanced efficiency of care (e.g., remote care). Factors such as time and workload impact on HCPs, age, and accessibility of technology were seen as challenges to app use. App features like reminders/alarms, quizzes, and gamification were favoured. These findings, integrated with behavioural and educational theories informed the co-design and development of a nutrition-focused mobile app by an interdisciplinary team of dietitians, researchers, and industry partner. The app included six educational modules on sodium and fluid restriction, ten behaviour change techniques (e.g., feedback on behaviour, goal setting) and gamified components (i.e., avatar, point-system). The app demonstrated a high level of usability, engagement, and satisfaction among patients with HF. Together, these findings support the importance of patient and HCP perspectives in the development and adoption of mobile apps and the potential of such tools to support dietary education and adherence for HF management.

Name thesis:degree_name

Doctor of Philosophy (PhD)

Discipline thesis:degree_discipline

Health Sciences

Grantor

University of Ontario Institute of Technology

Year dc:date.issued

2025

Author dc:creator

• Sivakumar, Bridve

Advisors dc:contributor.advisor

• Arcand, JoAnne
• Lemonde, Manon

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10155/1943

OAI identifier oai:identifier

oai:ontariotechu.scholaris.ca:10155/1943