The INFORM-AF Pilot Study – A Pilot Feasibility Study of mHealth education program for patients living with Atrial Fibrillation.

This study will employ a pilot feasibility, quasi-experimental pre-post test design, to evaluate the feasibility and efficacy of a novel digital education program via the QStream platform. The QStream-based online learning module, will comprise of 6 case-based AF learning scenarios. The key topic areas have been identified as priority areas for improvement from an earlier research led by Dr Ferguson and the research team. This novel intervention will combine: (a) authentic case-based anticoagulation learning scenarios; (b) real-time audit and feedback; and (c) online links to evidence-based learning materials. The intervention is delivered directly to consenting participants’ smart phone. There will be two themes covered by the QStream including ‘Understanding Atrial Fibrillation’ and ‘Managing Atrial Fibrillation’. This includes 6 topics, (1) AF symptoms, (2) AF risk factors, (3) AF complications, (4) Managing Medications, (5) Lifestyle Management and (6) Engaging with your health provider. Participants receive pop-up notifications (by default). The INFORM-AF Pilot module is currently being developed by interdisciplinary experts, clinicians who care for AF patients and patients with AF. This process will include the development of unique case studies. Answers to the case scenarios are informed and supported by the best evidence available in open access format to participants at the time of completing the module. An open access format will be selected to remove any paywall access barrier for participants to review the evidence base once completed. Participants will be provided a short introduction about the study and will be assisted by the study nurse to download the application to their smartphone device. The study nurse will on-board the patient and provide education on how the QStream learning module works. Automated delivery of the 6 case scenarios by the QStream platform will follow a standardised spaced algorithm: (a) two questions based on the 2 scenarios per delivery, every 2 days; b) questions answered incorrectly are repeated after 7 days, and questions answered correctly are repeated after 13 days; (c) two consecutive correct answers are required to retire a question, and a maximum of three attempts are provided before retiring a question. Cases will be retired once the participant correctly answers a question on two consecutive occasions. It is estimated that using the app may take approximately 5-10 minutes of the participants’ time, on every 2nd day of the week. The app is designed to be interactive and will provide users with some resources about your condition to read. Participants can read and interact with these resources at their leisure, this may take approx. 30 minutes to one hour of your time per week. It is expected that participation in the study will take no longer than 2 hours of participants time per week for a total of 6 weeks whilst using the app. Once participants have completed the learning module, which is anticipated to take 6 weeks to complete, they will then be provided (conducted by the study nurse via the phone) with a follow-up survey to complete. Participants will be able contact the research team via calling or email if there are any technical difficulties with the intervention during the 6-week intervention phase. The INFORM-AF pilot module is currently being developed. Examples of evidence based materials include references materials from the Heart Foundation, Stroke Foundation and AF Association. Each question is linked to a single case scenario. QStream app analytics will be used to monitor adherence and usage of the intervention.