Effectiveness of an avatar educational application for improving heart failure patients' knowledge and self-care behaviors: A pragmatic randomized controlled trial.

AIM: To evaluate the effectiveness of education using avatars for improving patients' heart failure knowledge and self-care. BACKGROUND: A lack of knowledge and self-care contributes to poor outcomes and rehospitalization for people with heart failure. DESIGN: A multi-centred, non-blinded pragmatic randomized controlled trial. METHODS: Heart failure patients were randomly assigned to intervention (avatar education application) or usual care groups. Participants were followed up at baseline, 30 and 90 days. ANCOVA was used to compare the scores of heart failure knowledge and self-care, between the two groups. Fisher's exact test was used to compare the two groups' heart failure-cause readmission. Bivariate exact binary logistic regression was used to identify the predictors associated with baseline levels of knowledge. RESULTS: A total of 36 participants were recruited (between October 2018 - March 2019). The mean age of participants was 67.5 (SD 11.3) years. At enrolment, approximately half (47.2%) have been living with Heart Failure for over 5 years. Two groups were comparable at baseline in their demographic and clinical characteristics. At 90 days, the intervention group participants had a higher increase in knowledge score on the Dutch Heart Failure Knowledge Scales compared with the control group (22.2% versus 3.7% P = .002, partial η2  = 0.262, 95% CI -2.755 to -0.686). There was no between-group difference observed at 30- or 90-day follow-up, on self-care behaviour (Self-care of heart failure index) or healthcare use. Overall satisfaction with the avatar app was 91.3%. CONCLUSION: The addition of a co-designed avatar app to usual care improved knowledge in our group of Heart Failure participants at 30 days and continued to increase up to 90 days. The results suggest that our avatar app was perceived as an enjoyable and engaging means of delivering critical knowledge and self-care information. IMPACT: Heart failure is associated with poor clinical outcomes (i.e., readmission rates and mortality rate) and substantial economic burden. The effectiveness of Heart Failure patient education using avatar have not been investigated previously. In this study, the avatar app improved knowledge and self-care behaviours. This innovation could be used at the bedside, at home by nurses, patients and families. TRIAL REGISTRATION: Australian New Zealand Trial Registry ACTRN12617001403325.

Exploration of a nurse practitioner-led phase two cardiac rehabilitation programme on attendance and compliance.

AIMS AND OBJECTIVES: To evaluate the impact of a nurse practitioner-led phase two cardiac rehabilitation and secondary prevention programme on attendance and compliance. BACKGROUND: Despite strong evidence for the benefits of cardiac rehabilitation, attendance/completion rates remain low. Nurse practitioner-led services have been reported as more effective than physician-led services at increasing patient adherence to evidence-based recommendations. However, nurse practitioner-led programmes are uncommon and there appears to be no current evidence examining the impact of these programmes on attendance/completion rates. METHODS: A retrospective audit of the Country Access to Cardiac Health (CATCH) database was undertaken to identify patients who attended a nurse practitioner-led cardiac rehabilitation programme between April 2014 and May 2016. Data from key performance indicators were exported to Stata/SE 15.0. The study utilised the Strengthening the Reporting of OBservational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies to ensure quality reporting during this study (See Data S1). RESULTS: Seventy-seven per cent (n = 199) of participants were men, and participants had a mean age of 67 years. Half (52.5%) of participants completed all CR sessions. Male participants (78%) were more likely to complete the CR programme as compared with women (67%). Participants with a family history of cardiovascular disease and a higher number of risk factors at baseline were more likely to commence and complete the programme. Attendance and completion had a positive impact on smoking cessation. CONCLUSIONS: The nurse practitioner-led programme evaluated in this study demonstrated high levels of attendance and completion rates compared to standard programmes. This high attendance/completion rate could in turn decrease the rate of subsequent cardiac events and improve mortality and morbidity rates. Relevance to clinical practice provides valuable insights into the effectiveness of nurse practitioner-led cardiac rehabilitation and secondary prevention on attendance/complete rates. These findings could guide future research and clinical practice development.

Emergent literacy in print and electronic contexts: The influence of book type, narration source, and attention.

Young children learn from traditional print books, but there has been no direct comparison of their learning from print books and tablet e-books while controlling for narration source. The current project used a between-subjects design and examined how 4-year-olds (N = 100) learned words and story content from a print book read aloud by a live adult, a print book narrated by an audio device, an e-book read aloud by a live adult, and an e-book narrated by an audio device. Attention to the book and prior experience with tablet e-books were also measured and included in analyses. When controlling for vocabulary, the overall pattern of results revealed that children learned more words from the e-book and from the audio narrator, but story comprehension did not differ as a function of condition. Attention predicted learning, but only in some print book contexts, and significant effects of prior experience did not emerge.