Design thinking for mHealth application co-design to support heart failure self-management

Heart failure is a prevalent, progressive chronic disease costing in excess of $1billion per year in Australia alone. Disease self-management has positive implications for the patient and decreases healthcare usage. However, adherence to recommended guidelines is challenging and existing literature reports sub-optimal adherence. mHealth applications in chronic disease education have the potential to facilitate patient enablement for disease self-management. To the best of our knowledge no heart failure self-management application is available for safe use by our patients. In this paper, we present the process established to co-design a mHealth application in support of heart-failure self-management. For this development, an interdisciplinary team systematically proceeds through the phases of Stanford University's Design Thinking process; empathise, define, ideate, prototype and test with a user-centred philosophy. Using this clinician-led heart failure app research as a case study, we describe a sequence of procedures to engage with local patients, carers, software developers, eHealth experts and clinical colleagues to foster rigorously developed and locally relevant patient-facing mHealth solutions. Importantly, patients are engaged in each stage with ethnographic interviews, a series of workshops and multiple re-design iterations

Partnering in Digital Health Design: Engaging the Multidisciplinary Team in a Needs Analysis

Using participatory co-design methods and in partnership with consumers we have developed a mHealth application to support heart failure self-management. In the first phase of the research we conducted a needs analysis with clinicians. The objectives were to define the features to perceivably support self-management and the clinical requirements in preparation for its implementation as an adjunct to existing multidisciplinary care. Interviews were conducted using the 'Rose, Thorn, Bud' technique from Design Thinking together with a brainstorming session with post-it notes. Six sixty-minute interviews and one email exchange with seven clinicians produced 154 data points in total; 97 relating to self-management support and 57 to clinical relevance. Analysis of these data points resulted in design implications articulated in a design brief for use in subsequent co-design workshops. Our discussion focuses on a critique of the technique, which appears to be useful for this stakeholder group although concerns of adequately representing complexity emerged. This method was considered inadequately comprehensive for use in the needs analysis with patients and family. The authors encourage further research evaluating in-hospital processes for co-designed health technologies

Conceptual Design and Iterative Development of a mHealth App by Clinicians, Patients and heir Families

Heart failure self-management can be challenging but appropriatelydesigned, user-centred mobile health (mHealth) innovations may help. We havebuilt a consumer mHealth application which we plan to implement as an adjunct toexisting specialist multidisciplinary heart failure care at our health service. We havethe double aim to meet the needs of patients and ensure clinical relevance in orderto be recommended by clinicians. This paper reports the participatory, user-centredco-design process of the conceptual design and iterative development of theapplication. Two nurse-led participatory design workshops were conducted with sixclinicians and a patient, which determined user-experience opinions, key featuresand priority functions. The iterative development phase encompassed twoapplication wireframe feedback cycles with seven clinicians, three patients and afamily member. Workshops and wireframe feedback activities took place on thehospital campus predominantly using resources available to clinicians. Softwarebuild was outsourced and was followed by the design team reaching consensus withfeatures and functions of the app. Further development and evaluation of flexibleparticipatory, user-centred methods for use by clinicians to facilitate co-design withconsumers will advance consumer digital health strategies

Representing the patient experience of heart failure through empathy, journey and stakeholder mapping

Heart failure is a long-term condition requiring those affected to manage numerous self-care related activities. People with heart failure report multiple challenges accommodating self-care activities in their every-day life. The aim of this study is to (1) understand the experience of people with heart failure and their caregivers in the local patient population, and (2) visually represent these experiences to inform the design of a mobile health intervention supporting self-care. Seven patients and four family caregivers were interviewed using an empathic approach. Data was collected using rapid design methods including an empathy map to uncover patient and caregiver perspectives and a journey map to document daily self-care activities. Content analysis resulted in a needs and insights summary, a journey map and stakeholder map. The needs and insights are summarised in five themes; controlling, trusting, concerned, symptom-laden and accepting. Negative experiences - restlessness, breathlessness and urination - occurred overnight as visualised in the journey map. Overwhelmingly the spouse and general practitioner were the personal and professional stakeholders involved in self-care activities. Understanding the experience of people with heart failure was the first step in the creation of a patient-centred mobile health intervention. Rapid design methods such as the three presented in this paper can give voice to the patient experience, their frustrations, challenges and existing support structures in a clear, visual format to aid empathic design

Co-design of a mobile health app for heart failure : perspectives from the team

Using a Design Thinking and co-design methodology, hospital staff andconsumers developed a novel mobile health app for heart failure self-management.Various stakeholders engaged in three development stages: interviews, designworkshops and prototype iterations. Eleven of 18 co-design team members reflectedon the co-design process and design outcomes. A total of 144 data points werecollected: 96 about the co-design process and 48 about the design outcomes.Successes and failures reflect the strengths and weaknesses of operationalising codesign in practice. Overall, participants were surprised the design outcomes wereachieved. The app was considered a supportive tool for meaningful self-monitoringand patients believed the app would be applicable to their situations. Our findingssuggest that local co-design can be achieved through meaningful partnerships, andmanaging stakeholders was key to the project’s success

Elemental analysis of lung tissue particles and intracellular iron content of alveolar macrophages in pulmonary alveolar proteinosis

<p>Abstract</p> <p>Background</p> <p>Pulmonary alveolar proteinosis (PAP) is a rare disease occurred by idiopathic (autoimmune) or secondary to particle inhalation. The in-air microparticle induced X-ray emission (in-air micro-PIXE) system performs elemental analysis of materials by irradiation with a proton microbeam, and allows visualization of the spatial distribution and quantitation of various elements with very low background noise. The aim of this study was to assess the secondary PAP due to inhalation of harmful particles by employing in-air micro-PIXE analysis for particles and intracellular iron in parafin-embedded lung tissue specimens obtained from a PAP patient comparing with normal lung tissue from a non-PAP patient. The iron inside alveolar macrophages was stained with Berlin blue, and its distribution was compared with that on micro-PIXE images.</p> <p>Results</p> <p>The elements composing particles and their locations in the PAP specimens could be identified by in-air micro-PIXE analysis, with magnesium (Mg), aluminum (Al), silicon (Si), phosphorus (P), sulfur (S), scandium (Sc), potassium (K), calcium (Ca), titanium (Ti), chromium (Cr), copper (Cu), manganase (Mn), iron (Fe), and zinc (Zn) being detected. Si was the major component of the particles. Serial sections stained by Berlin blue revealed accumulation of sideromacrophages that had phagocytosed the particles. The intracellular iron content of alveolar macrophage from the surfactant-rich area in PAP was higher than normal lung tissue in control lung by both in-air micro-PIXE analysis and Berlin blue staining.</p> <p>Conclusion</p> <p>The present study demonstrated the efficacy of in-air micro-PIXE for analyzing the distribution and composition of lung particles. The intracellular iron content of single cells was determined by simultaneous two-dimensional and elemental analysis of paraffin-embedded lung tissue sections. The results suggest that secondary PAP is associated with exposure to inhaled particles and accumulation of iron in alveolar macrophages.</p

Alendronate increases BMD at appendicular and axial skeletons in patients with established osteoporosis

<p>Abstract</p> <p>Background</p> <p>To identify high-risk patients and provide pharmacological treatment is one of the effective approaches in prevention of osteoporotic fractures. This study investigated the effect of 12-month Alendronate treatment on bone mineral density (BMD) and bone turnover biochemical markers in postmenopausal women with one or more non-traumatic fractures, i.e. patients with established osteoporosis.</p> <p>Methods</p> <p>A total of 118 Hong Kong postmenopausal Chinese women aged 50 to 75 with low-energy fracture at distal radius (Colles' fracture) were recruited for BMD measurement at lumbar spine and non-dominant hip using Dual-Energy X-ray Absorptiometry (DXA). 47 women with BMD T-score below -2 SD at either side were identified as patients with established osteoporosis and then randomized into Alendronate group (n = 22) and placebo control group (n = 25) for BMD measurement at spine and hip using DXA and distal radius of the non-fracture side by peripheral quantitative computed tomography (pQCT), and bone turnover markers, including bone forming alkaline phosphatase (BALP) and bone resorbing urinary Deoxypyridinoline (DPD). All measurements were repeated at 6 and 12 months.</p> <p>Results</p> <p>Alendronate treatment significantly increased BMD, more in weight-bearing skeletons (5.1% at spine and 2.5% at hip) than in non-weight bearing skeleton (0.9% at distal radius) after 12 months treatment. Spine T-score was significant improved in Alendronate group (p < 0.01) (from -2.2 to -1.9) but not in control placebo group. The Alendronate treatment effect was explained by significant suppression of bone turnover.</p> <p>Conclusion</p> <p>12 months Alendronate treatment was effective to increase BMD at both axial and appendicular skeletons in postmenopausal women with established osteoporosis.</p