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

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