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Operationalization of heart failure patients engagement with mHealth


 
 
 Type of funding sources: None.
 
 
 
 The computing and communication features of mobile devices have been leveraged in mobile Health (mHealth) interventions to provide comprehensive and tailored support that may have positive outcomes in patients with heart failure (HF.  However, the effects of the interventions have shown mixed evidence. Considering that patients’ engagement is a prerequisite for the effectiveness of the interventions, understanding how patients engage with the interventions, and the effects of patients’ engagement on HF outcomes may explain the mixed findings.
 
 
 
 This study aimed to synthesize current evidence on measures of HF patients’ engagement with mHealth interventions, and the effects of the interventions on HF outcomes.
 
 
 
 In accordance with the Arksey and O’Malley framework for scoping review, a comprehensive search of the literature was conducted in 7 databases for relevant studies published in the English language from 2009 to Feb. 2021. The descriptive characteristics of the studies were reported. Thematic analysis was conducted to identify themes that described patients’ engagement in the qualitative studies included in the review.
 
 
 
 The review synthesized 29 studies that operationalized engagement with mHealth interventions in 3665 patients with HF, ranging from a sample of 7 to 1571, with a median of 80 patients. Patients’ engagement with mHealth interventions was measured quantitively based on system usage data (82.7%, 24/29), qualitatively by semi-structured interviews and focus groups (10.3%, 3/29), and by mixed methods or combination of qualitative and system usage data (17.2%, 5/29). System usage data were evaluated using 7 metrics: (1) number of physiological parameters measured (88.5%, 3/26); (2) duration of use or time spent (3.8%, 6/26);  (3) features accessed/screen viewed (11.5%, 3/26); (4) number of HF educational videos viewed (7.7%, 2/26); (5) number of SMS response (3.8%, 1/26); (6) number of HF questionnaire completed (3.8%,  1/26; (7)numbers of logins (5%, 1/19).  There is a lack of consistency in how system usage metrics were reported across the studies; 73.7 % of the studies reported only the descriptive statistics of the System usage data. Intervention usage was the most identified subtheme in the qualitative measure. The effect of patients’ engagement with mHealth interventions on HF-related outcomes was inconclusive.
 
 
 
 The operational definitions of patients’ engagement with mHealth interventions are underreported and lack consistency. The application of inferential analytical methods to the engagement data is extremely limited, which indicates a gap in mHealth research in patients with HF. More research focusing on developing optimal and standardized measures of patients’ engagement that may be applied across different study designs is warranted
