Development and Evaluation of a Patient-Family Caregiver Dyad mHealth Intervention for Heart Failure Self-Care: Quasi-Experimental Study

Abstract

Background: A patient-family caregiver dyad approach is necessary to improve adherence to self-care behaviors by patients with heart failure (HF). However, there is a lack of mobile health (mHealth) interventions that engage both patients and their family caregivers to promote HF self-care.

Objective: The purpose of this quasi-experimental study was to develop and confirm the feasibility and effectiveness of a novel mHealth intervention based on patient-family caregiver dyads for promoting adherence to self-care by patients with HF.

Methods: We developed a dyadic mHealth program with 2 main features: a basic feature app and an interactive text-based chatbot. The intervention group (35 of 70 HF patient-family caregiver dyads; 50%) underwent a dyadic mHealth program for 24 weeks, while the control group (35 of 70 dyads; 50%) received usual care. Adherence to self-care behaviors, family caregivers' contributions to self-care behaviors, and health-related quality of life were evaluated. Data were collected using self-administered questionnaires at baseline and at 1 month, 3 months, and 6 months post enrollment. The outcomes were analyzed using intention-to-treat analysis.

Results: The intervention group had significantly better adherence to self-care behaviors (β=4.68, 95% CI 0.99-8.37) and family caregivers' contributions to self-care behaviors (β=8.76, 95% CI 4.63-12.88) over 6 months compared with the control group. The 6-month follow-up health-related quality of life scores for patients (β=0.07, 95% CI 0.00-0.13) and family caregivers (β=0.08, 95% CI 0.03-0.13) were significantly greater in the intervention group than in the control group. The 1-month follow-up disease knowledge scores for patients (β=0.16, 95% CI 0.03-0.29) and family caregivers (β=0.12, 95% CI 0.00-0.25) were significantly greater in the intervention group than in the control group. The intervention also had a significant effect on mutuality at the 1-month follow-up for patients (β=0.11, 95% CI 0.00-0.21) and family caregivers (β=0.15, 95% CI 0.01-0.30). However, health literacy was significantly higher in the intervention group than in the control group only for patients at 1 month (β=0.14, 95% CI 0.04-0.25). The intervention had no significant effects on depressive symptoms, social support with patient and family caregivers, and caregiver burden with family caregivers.

Conclusions: This study found that the dyadic mHealth intervention was beneficial for improving patients' adherence to self-care behaviors and family caregivers' contributions to self-care behaviors by providing information and motivation and improving health-related quality of life for patients with HF and family caregivers. Further studies should confirm the generalizability, feasibility, and long-term health outcomes of this intervention.

Trial registration: Clinical Research Information Service (CRIS) KCT0008786; https://tinyurl.com/3684ur4r.

Keywords: behavioral change; digital interventions; family caregiver; heart failure; mHealth; patients; quality of life; quasi-experimental study; self-care; smartphone apps.