Lived Experiences and Technological Literacy of Heart Failure Patients and Clinicians at a Cardiac Care Centre in Uganda.

Jason Hearn,Joseph A. Cafazzo,Isaac Ssinabulya,Quynh Pham,Jeremy I. Schwartz,Ann R. Akiteng,Heather J. Ross

doi:10.5334/aogh.2905

Abstract

Background:Digital health could serve as a low-cost means of enabling better self-care in patients living with heart failure (HF) in resource-limited settings such as Uganda. However, digital health interventions previously deployed in such settings have been unsuccessful due to a lack of local patient and clinician engagement in the design process.Objective:To engage Ugandan HF patients and clinicians regarding their experiences with HF management and technology, so as to inform the future design of a digital health intervention for HF patients in Uganda.Methods:The study employed a convergent parallel mixed-methods design. Data collection was completed at the Uganda Heart Institute in Kampala, Uganda. Data were ascertained through a patient survey and semi-structured interviews completed with HF patients, caregivers, physicians, and nurses. A conventional content analysis approach was used to qualitatively examine interview transcripts.Findings:Survey data were collected from 101 HF patients (62 female/39 male, aged 54.2 ± 17.5 years). Nearly half (48%) disagreed that they knew what to do in response to changes in their HF symptoms. Almost all patients (98%) had access to a mobile device. Many patients (63%) identified as comfortable in using mobile money – a local set of services that use Unstructured Supplementary Service Data (USSD). Interviews were completed with 19 HF patients, three caregivers, seven physicians, and three nurses. Qualitative analysis revealed four clusters of themes: overdependence of patients on the clinic, inconvenience associated with attending the clinic, inconsistent patient self-care behaviours at home, and technological abilities that favoured USSD-based services.Conclusions:Ugandan HF patients possess unmet information needs that leave them ill-equipped to care for themselves. Future digital health interventions for this population should empower patients with HF-specific information and reassurance in their self-care abilities. Based on patient preferences, such systems should harness USSD technology with which most patients are already comfortable.

Highlights

Digital health could serve as a low-cost means of enabling better self-care in patients living with heart failure (HF) in resource-limited settings such as Uganda
Cardiovascular disease (CVD) is the number-one cause of death globally [1], with over three-quarters of deaths associated with CVD occurring in low- and middle-income countries (LMICs) [2]
The rising burden of CVD in LMICs has led to an increased prevalence of heart failure (HF) [5, 6] – a common end result of CVD where the heart is unable to meet bodily demands for blood and oxygen [7]

Summary

Introduction

Digital health could serve as a low-cost means of enabling better self-care in patients living with heart failure (HF) in resource-limited settings such as Uganda. Objective: To engage Ugandan HF patients and clinicians regarding their experiences with HF management and technology, so as to inform the future design of a digital health intervention for HF patients in Uganda. Digital health interventions have recently been developed to simplify the process of managing and tracking the symptoms of HF [10,11,12,13,14,15,16,17,18,19] One such intervention, which was developed alongside HF patients and clinicians living in Canada, has been shown to improve patient self-care and quality of life amongst Canadian HF patients [19, 20]

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