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首页> 外文期刊>JMIR cardio. >The Atrial Fibrillation Health Literacy Information Technology System: Pilot Assessment
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The Atrial Fibrillation Health Literacy Information Technology System: Pilot Assessment

机译：心房颤动健康素养信息技术系统：试点评估

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Background: Atrial fibrillation (AF) is a highly prevalent heart rhythm condition that has significant associated morbidity and requires chronic treatment. Mobile health (mHealth) technologies have the potential to enhance multiple aspects of AF care, including education, monitoring of symptoms, and encouraging and tracking medication adherence. We have previously implemented and tested relational agents to improve outcomes in chronic disease and sought to develop a smartphone-based relational agent for improving patient-centered outcomes in AF. Objective: The objective of this study was to pilot a smartphone-based relational agent as preparation for a randomized clinical trial, the Atrial Fibrillation Health Literacy Information Technology Trial (AF-LITT). Methods: We developed the relational agent for use by a smartphone consistent with our prior approaches. We programmed the relational agent as a computer-animated agent to simulate a face-to-face conversation and to serve as a health counselor or coach specific to AF. Relational agent’s dialogue content, informed by a review of literature, focused on patient-centered domains and qualitative interviews with patients with AF, encompassed AF education, common symptoms, adherence challenges, and patient activation. We established that the content was accessible to individuals with limited health or computer literacy. Relational agent content coordinated with use of the smartphone AliveCor Kardia heart rate and rhythm monitor. Participants (N=31) were recruited as a convenience cohort from ambulatory clinical sites and instructed to use the relational agent and Kardia for 30 days. We collected demographic, social, and clinical characteristics and conducted baseline and 30-day assessments of health-related quality of life (HRQoL) with the Atrial Fibrillation Effect on Quality of life (AFEQT) measure; self-reported medication adherence with the Morisky 8-item Medication Adherence Scale (MMAS-8); and patient activation with the Patient Activation Measure (PAM). Results: Participants (mean age 68 [SD 11]; 39% [12/31] women) used the relational agent for an average 17.8 (SD 10.0) days. The mean number of independent log-ins was 19.6 (SD 10.7), with a median of 20 times over 30 days. The mean number of Kardia uses was 26.5 (SD 5.9), and participants using Kardia were in AF for 14.3 (SD 11.0) days. AFEQT scores improved significantly from 64.5 (SD 22.9) at baseline to 76.3 (SD 19.4) units at 30 days ( P .01). We observed marginal but statistically significant improvement in self-reported medication adherence (baseline: 7.3 [SD 0.9], 30 days: 7.7 [SD 0.5]; P =.01). Assessments of acceptability identified that most of the participants found the relational agent useful, informative, and trustworthy. Conclusions: We piloted a 30-day smartphone-based intervention that combined a relational agent with dedicated content for AF alongside Kardia heart rate and rhythm monitoring. Pilot participants had favorable improvements in HRQoL and self-reported medication adherence, as well as positive responses to the intervention. These data will guide a larger, enhanced randomized trial implementing the smartphone relational agent and the Kardia monitor system.
机译：背景：房颤（AF）是一种高度流行的心律状况，具有明显的相关发病率，需要长期治疗。移动健康（mHealth）技术具有增强房颤护理多个方面的潜力，包括教育，症状监测以及鼓励和跟踪药物依从性。我们先前已经实施和测试了关系药物以改善慢性疾病的预后，并试图开发一种基于智能手机的关系药物以改善以患者为中心的房颤。目的：本研究的目的是试行基于智能手机的关系代理程序，以准备进行一项随机临床试验，即房颤健康素养信息技术试验（AF-LITT）。方法：我们开发了用于智能手机的关系代理，与我们以前的方法一致。我们将关系代理编程为计算机动画代理，以模拟面对面的对话，并担任AF的健康顾问或教练。关系代理人的对话内容以文献综述为基础，重点关注以患者为中心的领域和对房颤患者的定性访谈，包括房颤教育，常见症状，依从性挑战和患者激活。我们确定，健康或计算机知识有限的个人可以访问该内容。关系代理的内容与智能手机AliveCor Kardia心律和心律监视器的使用相协调。从非卧床临床站点招募参与者（N = 31）作为便利队列，并指示他们使用关系代理和Kardia 30天。我们收集了人口统计学，社会和临床特征，并通过心房颤动对生活质量的影响（AFEQT）进行了与健康相关的生活质量（HRQoL）的基线和30天评估;使用Morisky 8项药物依从性量表（MMAS-8）自我报告药物依从性;和患者激活措施（PAM）激活患者。结果：参与者（平均年龄68 [SD 11]; 39％[12/31]妇女）平均每天使用关系代理17.8（SD 10.0）天。独立登录的平均次数为19.6（SD 10.7），在30天内的中位数为20次。 Kardia的平均使用次数为26.5（SD 5.9），而使用Kardia的参与者在AF停留了14.3（SD 11.0）天。 AFEQT分数从基线时的64.5（SD 22.9）显着提高到30天时的76.3（SD 19.4）单位（P <.01）。我们观察到自我报告的药物依从性略有改善，但在统计学上有显着改善（基线：7.3 [SD 0.9]，30天：7.7 [SD 0.5]; P = .01）。可接受性评估表明，大多数参与者发现关系代理是有用的，信息丰富的和值得信赖的。结论：我们进行了为期30天的基于智能手机的干预试验，该干预措施将关系代理与AF专用内容结合起来，用于Kardia心率和心律监测。试点参与者在HRQoL和自我报告的药物依从性方面均取得了有利的改善，并且对干预措施的反应积极。这些数据将指导实施智能手机关联代理和Kardia监控系统的更大，增强的随机试验。

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