None listed
Conditions
Brief summary
Heart failure (HF) is a large public health burden. Heart failure is a debilitating illness especially among older people and is a major cause of mortality, morbidity and poor quality of life worldwide. Despite advances in medical, pharmacological, and surgical treatment, the outcomes of heart failure remain poor with high rates of death and hospitalisation. Self-care is the core for health programs to prevent acute decompensation in heart failure. Studies have shown that optimal outcomes in heart failure can be achieved through effective self-care. Limited health literacy is associated with high system cost, and it is a challenge to the healthcare system globally. In 2011 the Australian Bureau of Statistics reported that 47% of Australians are functionally illiterate. This means they cannot read the instruction on a medicine bottle, read a map, or a recipe. Self-care is pivotal in heart failure management. Lack of knowledge in self-care is associated with non-adherence to medication and lifestyle recommendations; as well as failure to detect deterioration that eventually leads to potentially preventable hospitalization. An avatar is an icon or figure representing a particular person in a computer game, internet forum, etc. An avatar-based application will enhance patient learning by using modern computerized tools such as animation (heart and anatomy, links to videos (demonstrating how to self-care), voice (no need to read) and touch screen response. The use of an avatar will make the teaching, more engaging and relevant to patients, therefore achieve greatest impact on patients' outcomes and make significant contribution to nursing practice in clinical setting as well as in primary care. The benefit of technology in education has already been demonstrated in a small number of conditions. Avatar based technology has been used as an aid in chronic diseases patient education such as cancer, diabetes, and depression for improving knowledge, self-care behaviors, and quality of life. Findings from these studies demonstrate positive outcomes in clinical practice. For example, an avatar-based intervention embedded into an online self-management program improved over-active bladder health-related quality of life (HRQoL) and symptoms in women. In another study, an avatar-based interactive application improved knowledge and stoma care self-efficacy in hospitalized patients with a new ileostomy. Avatar technology also reduced depressive symptoms over time in a group of young adults and prevented relapse in smoking in hospitalized cancer patients. This study is a pragmatic randomised controlled trial. There are two parallel groups, the usual care group, and the intervention group. The intervention group will be received usual care plus the avatar-based education application during the study period of six months. Both groups will be followed-up at one-month and six-month post discharge from heart failure clinic.
Interventions
1. Brief name
Fluid Watchers
2. Why
Avatar-based technologies for supporting education are an innovative approach for patients with low literacy, low health literacy and English as a second language. The use of avatar technology for patient education have shown benefit in chronic diseases such as cancer, diabetes and depression for improving knowledge, self-care behaviours and quality of life. Research has demonstrated positive outcomes in clinical practice. However this technology has not been
1. Brief name Fluid Watchers 2. Why Avatar-based technologies for supporting education are an innovative approach for patients with low literacy, low health literacy and English as a second language. The use of avatar technology for patient education have shown benefit in chronic diseases such as cancer, diabetes and depression for improving knowledge, self-care behaviours and quality of life. Research has demonstrated positive outcomes in clinical practice. However this technology has not been evaluated among patients with HF. 3. What (Material) A tablet computer will be provided to all intervention group participants to view the app and to take home for the study period. 4. What (Procedure) Once participants are assigned to the avatar-based education group, a research nurse will provide them a tablet computer with the app installed. The research nurse will provide explanations and instructions to participants on how to use the avatar-based education application. Participants in this group will be asked to use the app before they are discharged from heart failure clinic. The app will be provided information about heart failure and self-care. After that, the research nurse will ask them some questions regarding the information provided and their thoughts about the app. 5. Who provided This study intervention is a self-administered avatar-based education application. The avatar-based education application is installed on a tablet computer. The research nurse will provide a tablet computer to the participant to use the app during the six-month study period. 6. How The avatar-based education application will be presented to the participants in the intervention group. The participant will be asked to review the app and the research nurse will assist the participant to become familiar with using the app before participant take the app home to use during six-month study period. 7. Where The avatar-based education application will be provided to participants to use at their own time. The application is installed on a tablet computer, and does not require internet for operation. Participants can review the app at any time and any location that is convenient to them. 8. When and How much Participants will be encouraged to use the app as often as they like during the six-month study period. Two telephone follow-up calls (at one-month and six-month) will be scheduled with the participants. Information on the number of times the participant has reviewed the app will be collected during the follow-up telephone calls. 9. Tailoring The avatar-based education application contains information on heart failure and heart failure self-care, based on the Heart Foundation, “Living well with heart failure” booklet. When using the app, the participant can make and customise their own avatar and the participant can skip sections of the app, or repeat sections, and can exist at any point, based on their individual needs. Page logic is also built in the app, and are specific for individual patient based on their answer to a specific question. For example, is the participant answers “no” to the question, “if you have a pace maker?”, then the app will skip the pacemaker information section. However, the participant can choose to view that section later, if they still would like to learn about pacemaker, despite they do not have one. 10. Modification The education app was developed through an action research. It has been reviewed by clinical research, research and academic experts in the area of HF. Any errors and glitches in the app reported by research nurse or the participant will be forward to the IT experts for immediate modification. We do not foresee a modification that would be required on the contents of the education app. 11. How well (Planned) The frequency of using the avatar-based education application will be assessed by asking participants and recording in tablet for confirmation of the data. 12. How well (Action) The intervention is a self-administered education application. The number of times that participants reviewed the app will be collected during the telephone follow-up.
Sponsors
Flinders University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. A confirmed diagnosis of HF 2. Individuals with a newly diagnosed HF within 1 year; with a previous hospitalisation for HF 2. New York Heart Association Functional Class (NYHA-FC) I-IV 3. Normal cognitive function. Normal cognitive function is defined as a score of 26 or higher on the Montreal Cognitive Assessment (MOCA-Test). 4. Sufficient English language ability to communicate and to follow the study procedure 5. Willing to give informed consent.
Exclusion criteria
1. Clinically unstable. Clinically unstable is defined as patients who do not achieve the five normal vital signs (i.e. heart rate, systolic blood pressure, respiratory rate, oxygen saturation, and temperature) plus normal mental status and ability to eat, for at least 24 hours prior to enrol in the study. 2. Cognitive impairment 3. Refuse to give informed consent.
Outcome results
None listed