Intervention Mapping Approach in the Design of an Interactive Mobile Health Application to Improve Self-care in Heart Failure.

Heart failure is a complex syndrome among older adults who may experience and interpret symptoms differently. These differences in symptom interpretation may influence decision-making in symptom management. A well-informed and motivated person may develop the knowledge and skills needed to successfully manage symptoms. Therefore, the patient-centered mobile health application HeartMapp was designed to engage patients with heart failure in self-care management by offering tailored alerts and feedback using mobile phones. The main objective of this article is to describe the six-step intervention mapping approach including (1) the initial needs assessment, (2) proximal program objective, (3) selection of theory-based methods, (4) the translation of objectives into an actual program plan for mobile health intervention, (5) adaptation and implementation plan, and (6) evaluation plan that assisted the team in the development of a conceptual framework and intervention program matrix during the development of HeartMapp. The HeartMapp intervention takes the information, motivation, and behavioral skills model as the theoretical underpinning, with "patient engagement" as the key mediator in achieving targeted and persistent self-care behavioral changes in patients with heart failure. The HeartMapp intervention is proposed to improve self-care management and long-term outcomes.

"Mobile technology to improve heart failure outcomes: A proof of concept paper".

BACKGROUND: Heart failure (HF) causes significant symptom burden and human suffering with considerable economic burden due to hospital readmissions. Targeted interventions to encourage and support self-management behavior is warranted. AIM: To test the proof of concept of a mobile application (HeartMapp) in improving self-care management of patients with heart failure. METHOD: An exploratory inquiry used a field study strategy with purposeful sampling and constant comparative analysis to test the proof of concept of HeartMapp using The Business Model Canvas framework. RESULTS: A total of 125 individuals, who were identified as potential candidates to use the HeartMapp completed the interview over a seven-week period in 2016. Constant comparative analysis indicated themes that Skilled Nursing Facilities had increased readmissions. Participants from Skilled Nursing Facilities reported concern on lack of staffing, star rating, and malpractice claims. Two types of patients were identified as early adapters of technology and those in denial. Health care facilities reported challenges on transitional care, nurses struggle with engagement of patients on self-care management. To avoid readmission penalty, hospitals task home care agencies to keep the patients home for 30-days. While home care agencies rely on remote telemonitoring reported that current telemonitoring devices are costly to maintain, thus exploring novel technology. CONCLUSION: The Business Model Canvas provided directions for future testing of HeartMapp for its usability as an adjunct device in home health setting to improve self-management and enhance communication with providers, and ultimately reduce readmissions.

Features and usability assessment of a patient-centered mobile application (HeartMapp) for self-management of heart failure.

BACKGROUND: Mobile health technologies have emerged as a way to actively engage patients in their healthcare decision-making process. One who is well informed and motivated is thought to engage in self-management activities. Thus, the conceptual framework included "information, motivation, and behavioral change" model, with patient engagement as a mediator in the development and assessment of a mobile health application "HeartMapp" for chronic heart failure (CHF) self-management. PURPOSE: To describe the development and features of the HeartMapp and preliminary assessment of the usability of HeartMapp. METHOD: A descriptive survey design was employed. A total of 37 participants (25 patients with CHF and 12 health care workers) navigated the HeartMapp and completed self-confidence and usability questionnaires. RESULTS: More than half of the patients used mobile phones to obtain health information. Patients reported moderate self-confidence (mean 26.60±12.18) in using HeartMapp. One in five patients reported a lack of confidence in using the chest-worn Bluetooth device. The observational data indicated that all patients completed the task of navigating the HeartMapp with little or no help. The health care members (n=12) demonstrated high confidence in recommending HeartMapp to patients (mean 4.58±0.67) and in utilizing data from HeartMapp for clinical decision making (mean 4.50±0.67). The self-confidence and usability questionnaires showed good reliability in this sample. CONCLUSION: Having access to CHF symptom monitoring and education readily available in a mobile app may motivate individuals to engage in the prescribed self-management skills to ultimately attain desired outcomes, which warrants further exploration.

A genetic analysis of a Spanish population with early onset Parkinson's disease.

INTRODUCTION: Both recessive and dominant genetic forms of Parkinson's disease have been described. The aim of this study was to assess the contribution of several genes to the pathophysiology of early onset Parkinson's disease in a cohort from central Spain. METHODS/PATIENTS: We analyzed a cohort of 117 unrelated patients with early onset Parkinson's disease using a pipeline, based on a combination of a next-generation sequencing panel of 17 genes previously related with Parkinson's disease and other Parkinsonisms and CNV screening. RESULTS: Twenty-six patients (22.22%) carried likely pathogenic variants in PARK2, LRRK2, PINK1, or GBA. The gene most frequently mutated was PARK2, and p.Asn52Metfs*29 was the most common variation in this gene. Pathogenic variants were not observed in genes SNCA, FBXO7, PARK7, HTRA2, DNAJC6, PLA2G6, and UCHL1. Co-occurrence of pathogenic variants involving two genes was observed in ATP13A2 and PARK2 genes, as well as LRRK2 and GIGYF2 genes. CONCLUSIONS: Our results contribute to the understanding of the genetic architecture associated with early onset Parkinson's disease, showing both PARK2 and LRRK2 play an important role in Spanish Parkinson's disease patients. Rare variants in ATP13A2 and GIGYF2 may contribute to PD risk. However, a large proportion of genetic components remains unknown. This study might contribute to genetic diagnosis and counseling for families with early onset Parkinson's disease.