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Supporting patients undertaking heart failure self-management using multi-stakeholder co-design of a mobile health application

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Woods, LS ORCID: 0000-0003-4811-4608 2019 , 'Supporting patients undertaking heart failure self-management using multi-stakeholder co-design of a mobile health application', PhD thesis, University of Tasmania.

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Abstract

Heart failure is a prevalent, progressive chronic condition of considerable economic burden which places great strain on patients, family caregivers and health services. Self-management is supported by healthcare policy and is the mainstay for long-term heart failure care, however adherence to recommended guidelines is challenging with the existing literature reporting that patients are struggling to apply them to daily life.
The aim of this research was to explore how patients might be supported in heart failure self-management with a mobile health app co-designed by patients, family caregivers and clinicians.
Design Science Research Cycles, Design Thinking and co-design informed the research design. The Design Science Research Cycles framework focuses on a design that is relevant to the environment and consistent with the knowledge base. Design Thinking provided structure to the innovation process and co-design principles facilitated stakeholder interactions.
A four-phased study was conducted using a multi-stakeholder team of seven patients, four family caregivers and seven clinicians. The process was facilitated by the lead clinician researcher embedded in the health service as a cardiac clinical nurse specialist.
In Phase I stakeholder perspectives on heart failure self-management were explored prior to app design and development. Patient, family caregiver and clinician experiences and opinions were collected, analysed and visually represented as research outputs. Phase II involved the conceptual design and iterative development of the app. Patient personas were created from research outputs from Phase I, and these were used in two multi-stakeholder design workshops and two app wireframe feedback cycles. Next, in Phase III, the Care4myHeart app was tested in a 14-day usability study with a new subset of patients in the home setting to understand the patient user experience. Phase IV involved a process evaluation whereby experiences of those involved in the co-design process were explored.
This thesis is structured around and includes nine publications: seven articles have been peer-reviewed and published; one is in press; and one article is currently under review.
Key findings are reported in relation to each of the stakeholder groups involved in the research. For patients, daily self-management habits were established without the use of technology, so they were unsure how the app would fit in their current routines. Clinicians were easily-recruited, motivated research participants involved in each development stage and highly regarded the final app design. The lead clinician researcher led a highly structured Design Thinking process which allowed efficient development of the app. Executing the nurse-led innovation project required strong leadership and commitment in a negotiation of competing priorities as a clinician, researcher and app developer. Additionally, discovering the art and science of design was found to be powerful for this research. In regard to stakeholder interactions, co-design methods helped negotiate tensions between stakeholders as the design unfolded, especially because clinicians were more involved than patients. Co-design methods also provided a format to account for power differences between the healthcare consumer and healthcare provider. Overall, stakeholder interactions were effectively managed.
Local mobile health app design can be achieved through partnering with patients, family caregivers and clinicians. This thesis contributes to the emerging body of knowledge on clinician-led context-specific apps, co-design processes and collaborative engagement with healthcare teams. There is appetite to engage more service users into healthcare improvement projects so further research is urgently needed to empower clinical teams to operationalise co-design in practice.

Item Type: Thesis - PhD
Authors/Creators:Woods, LS
Keywords: mobile health, digital health, co-design, participatory design, heart failure, self-management
DOI / ID Number: 10.25959/100.00034627
Copyright Information:

Copyright 2019 the author

Additional Information:

Chapter 2.3 appears to be the equivalent of a post-print version of an article published as: Woods, L., Duff, J., Cummings, E., Walker, K., 2019. Evaluating the development processes of consumer mHealth interventions for chronic condition self-management: a scoping review, CIN: computers, informatics, nursing, 37(7), 373-385

Chapter 3.2 is the following published article: Woods, L., Cummings, E., Duff, J., Walker, K., 2017. Design thinking for mHealth application co-design to support heart failure self-management, 97-102, in, Nehr, C., Kuziemsky, C. E., Z. S.-Y.Wong, (eds.), Context sensitive health informatics: redesigning healthcare work, Amsterdam, IOP Press, Copyright 2017, the authors and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International (CC BY-NC 4.0) license https://creativecommons.org/licenses/by-nc/4.0/deed.en_US

Chapter 4.2 is the following published article: Woods, L., Duff, J., Roehrer, E., Walker, K., Cummings, E., 2019. Representing the patient experience of heart failure through empathy, journey and stakeholder mapping, Patient experience journal, 6(1), 55-62

Chapter 4.4 is the following published article: Woods, L., Cummings, E., Duff, J., Walker, K., 2018. Partnering in digital health design: engaging the multidisciplinary team in a needs analysis, 176-181, in, Cummins, E., Ryan, A., Schaper, L. K., (eds.), Connecting the system to enhance the practitioner and consumer experience in healthcare : selected papers from the 26th Australian National Health Informatics Conference (HIC 2018), Amsterdam, IOS Press, © 2018 The authors and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International (CC BY-NC 4.0) license https://creativecommons.org/licenses/by-nc/4.0/deed.en_US

Chapter 5.2 is the following published article: Woods, L., Duff, J., Cummings, E., Walker, K., 2017. The development and use of personas in a user-centred mHealth design project, in, Proceedings of the 29th Australian Conference on Human Computer Interaction (OzCHI '17), Nov 28- Dec 1, Brisbane, QLD, Australia, Soro, A., Vyas, D., Ploderer, B., Morrison, A., Waycott, J., Brereton, M., (Eds.), ACM, New York, 560-565

Chapter 5.4 is the following published article: Woods, L., Cummings, E., Duff, J., Walker, K., 2018. Conceptual design and iterative development of a mHealth app by clinicians, patients and their families, 170-175, in, Cummins, E., Ryan, A., Schaper, L. K., (eds.), Connecting the system to enhance the practitioner and consumer experience in healthcare : selected papers from the 26th Australian National Health Informatics Conference (HIC 2018), Amsterdam, IOS Press, © 2018 The authors and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International (CC BY-NC 4.0) license https://creativecommons.org/licenses/by-nc/4.0/deed.en_US

Chapter 6.2 appears to be the equivalent of a post-print version of an article published as: Woods, L., Duff, J., Roehrer, E., Walker, K., Cummings, E., 2019. Design of a consumer mobile health app for heart failure: findings from the nurse-led co-design of Care4myHeart, JMIR nursing, 2(1) e14633. © Leanna Woods, Jed Duff, Erin Roehrer, Kim Walker, Elizabeth Cummings. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) 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 the Journal of Medical Internet Research, is properly cited

Chapter 6.4 is the following published article: Woods, L., Duff, J., Roehrer, E., Walker, K., Cummings, E., (2019). Patients’ experiences of using a consumer mHealth app for self-management of heart failure: mixed-methods study, JMIR human factors, 6(2), e13009. © Leanna Sarah Woods, Jed Duff, Erin Roehrer, Kim Walker, Elizabeth Cummings. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) 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 the Journal of Medical Internet Research, is properly cited

Chapter 7.2 appears to be the equivalent of a post-print version of an article published as: Woods, L., Roehrer, E., Walker, K., Cummings, E., 2019. Co-design of a mobile health app for heart failure: perspectives from the team, 183-188, in, Cummings, E., Merolli, M., Schaper, L. K., (eds.), Digital health: changing the way healthcare is conceptualised and delivered : selected papers from the 27th Australian National Health Informatics Conference (HIC 2019), Amsterdam, IOS Press, © 2019 The authors and IOS Press. This article is published online with Open Access and distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International (CC BY-NC 4.0) license https://creativecommons.org/licenses/by-nc/4.0/deed.en_US

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