RESUMO
BACKGROUND: Atrial fibrillation (AFib) is the most common form of heart arrhythmia and a potent risk factor for stroke. Nonvitamin K antagonist oral anticoagulants (NOACs) are routinely prescribed to manage AFib stroke risk; however, nonadherence to treatment is a concern. Additional tools that support self-care and medication adherence may benefit patients with AFib. OBJECTIVE: The aim of this study was to evaluate the perceived usability and usefulness of a mobile app designed to support self-care and treatment adherence for AFib patients who are prescribed NOACs. METHODS: A mobile app to support AFib patients was previously developed based on early stage interview and usability test data from clinicians and patients. An exploratory pilot study consisting of naturalistic app use, surveys, and semistructured interviews was then conducted to examine patients' perceptions and everyday use of the app. RESULTS: A total of 12 individuals with an existing diagnosis of nonvalvular AFib completed the 4-week study. The average age of participants was 59 years. All participants somewhat or strongly agreed that the app was easy to use, and 92% (11/12) reported being satisfied or very satisfied with the app. Participant feedback identified changes that may improve app usability and usefulness for patients with AFib. Areas of usability improvement were organized by three themes: app navigation, clarity of app instructions and design intent, and software bugs. Perceptions of app usefulness were grouped by three key variables: core needs of the patient segment, patient workflow while managing AFib, and the app's ability to support the patient's evolving needs. CONCLUSIONS: The results of this study suggest that mobile tools that target self-care and treatment adherence may be helpful to AFib patients, particularly those who are newly diagnosed. Additionally, participant feedback provided insight into the varied needs and health experiences of AFib patients, which may improve the design and targeting of the intervention. Pilot studies that qualitatively examine patient perceptions of usability and usefulness are a valuable and often underutilized method for assessing the real-world acceptability of an intervention. Additional research evaluating the AFib Connect mobile app over a longer period, and including a larger, more diverse sample of AFib patients, will be helpful for understanding whether the app is perceived more broadly to be useful and effective in supporting patient self-care and medication adherence.
RESUMO
BACKGROUND: The objective of this study was to investigate the use of novel surveillance tools in a malaria endemic region where prevalence information is limited. Specifically, online reporting for participatory epidemiology was used to gather information about malaria spread directly from the public. Individuals in India were incentivized to self-report their recent experience with malaria by micro-monetary payments. METHODS: Self-reports about malaria diagnosis status and related information were solicited online via Amazon's Mechanical Turk. Responders were paid $0.02 to answer survey questions regarding their recent experience with malaria. Timing of the peak volume of weekly self-reported malaria diagnosis in 2010 was compared to other available metrics such as the volume over time of and information about the epidemic from media sources. Distribution of Plasmodium species reports were compared with values from the literature. The study was conducted in summer 2010 during a malaria outbreak in Mumbai and expanded to other cities during summer 2011, and prevalence from self-reports in 2010 and 2011 was contrasted. RESULTS: Distribution of Plasmodium species diagnosis through self-report in 2010 revealed 59% for Plasmodium vivax, which is comparable to literature reports of the burden of P. vivax in India (between 50 and 69%). Self-reported Plasmodium falciparum diagnosis was 19% and during the 2010 outbreak and the estimated burden was between 10 and 15%. Prevalence between 2010 and 2011 via self-reports decreased significantly from 36.9% to 19.54% in Mumbai (p = 0.001), and official reports also confirmed a prevalence decrease in 2011. CONCLUSIONS: With careful study design, micro-monetary incentives and online reporting are a rapid way to solicit malaria, and potentially other public health information. This methodology provides a cost-effective way of executing a field study that can act as a complement to traditional public health surveillance methods, offering an opportunity to obtain information about malaria activity, temporal progression, demographics affected or Plasmodium-specific diagnosis at a finer resolution than official reports can provide. The recent adoption of technologies, such as the Internet supports self-reporting mediums, and self-reporting should continue to be studied as it can foster preventative health behaviours.
