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. 2022 Sep 27:8:20552076221129064.
doi: 10.1177/20552076221129064. eCollection 2022 Jan-Dec.

A digital self-care intervention for Ugandan patients with heart failure and their clinicians: User-centred design and usability study

Jason Hearn  1   2 , Sahr Wali  2   3 , Patience Birungi  4 , Joseph A Cafazzo  1   2   3 , Isaac Ssinabulya  5   6   7 , Ann R Akiteng  7 , Heather J Ross  8   9 , Emily Seto  2   3 , Jeremy I Schwartz  7   10
Affiliations

A digital self-care intervention for Ugandan patients with heart failure and their clinicians: User-centred design and usability study

Jason Hearn et al. Digit Health. .

Abstract

Background: The prevalence of heart failure (HF) is increasing in Uganda. Ugandan patients with HF report receiving limited information about their illness and associated self-care behaviours. Interventions targeted at improving HF self-care have been shown to improve patient quality of life and reduce hospitalizations in high-income countries. However, such interventions remain underutilized in resource-limited settings like Uganda. This study aimed to develop a digital health intervention that enables improved self-care amongst HF patients in Uganda.

Methods: We implemented a user-centred design (UCD) process to develop a self-care intervention entitled Medly Uganda. The ideation phase comprised a scoping review and preliminary data collection amongst HF patients and clinicians in Uganda. An iterative design process was then used to advance an initial prototype into a functional digital health intervention. The evaluation phase involved usability testing of the intervention amongst Ugandan patients with HF and their clinicians.

Results: Medly Uganda is a digital health intervention that allows patients to report daily HF symptoms, receive tailored treatment advice and connect with a clinician when showing signs of decompensation. The system harnesses Unstructured Supplementary Service Data (USSD) technology that is already widely used in Uganda for mobile phone-based financial transactions. Usability testing showed Medly Uganda to be both acceptable and feasible amongst clinicians, patients and caregivers.

Conclusions: Medly Uganda is a functional digital health intervention with demonstrated acceptability and feasibility in enabling Ugandan HF patients to better care for themselves. We are hopeful that the system will improve self-care efficacy amongst HF patients in Uganda.

Keywords: Cardiovascular disease; cardiology; digital health; education; general; lifestyle; medicine; personalized medicine; remote patient monitoring.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
User-centred design (UCD) framework (adapted from McCurdie et al.).
Figure 2.
Figure 2.
Overview of Medly Uganda.
Figure 3.
Figure 3.
Simulated screenshots of the USSD workflow and resulting SMS message.
Figure 4.
Figure 4.
Overview of RapidPro system.
Figure 5.
Figure 5.
User interface for clinician dashboard as seen on a smartphone.
See this image and copyright information in PMC

References

    1. Institute for Health Metrics and Evaluation. Global burden of disease study 2017. (2018).
    1. World Health Organization. Noncommunicable Diseases Country Profiles: Uganda. (2018).
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    1. Ponikowski P, Voors AA, Anker SDet al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J 2016; 37: 2129–2200. - PubMed
    1. Namukwaya E, Murray S, Leng Met al. et al. Experience of living with advanced heart failure in Uganda. BMJ Support. Palliat. Care 2014; 4: A82–A82.