Generic placeholder image

Cardiovascular & Hematological Agents in Medicinal Chemistry

Editor-in-Chief

ISSN (Print): 1871-5257
ISSN (Online): 1875-6182

Research Article

Preparing India to Leverage Power of Mobile Technology: Development of a Bilingual Mobile Health Tool for Heart Patients

Author(s): Yojna Sah Jain*, Arun Garg, D.K. Jhamb, Praful Jain and Akash Karar

Volume 17, Issue 2, 2019

Page: [125 - 134] Pages: 10

DOI: 10.2174/1871525717666190912152938

Abstract

Background: Mobile health technology offers promising means to implement public health strategies for the prevention and management of chronic conditions. However, at the moment, there is a dearth of both; specific mobile health tools tailored for the knowledge and language needs of Indian population; as well as enough systematic and scientific clinical data to analyse their impact in varied Indian socioeconomic and disease populations.

Objective: To develop a smartphone-based bilingual educational mobile application for heart patients and pilot test in an Indian clinical setting.

Methods: An Android™ based mobile application was developed according to a systematic instructional design model. Thereafter, expert assessment was done by 3 software engineers and 2 healthcare professionals using a peer-reviewed, objective and multidimensional Mobile Application Rating Scale (MARS). A pilot user satisfaction evaluation was done based on feedback from 35 Coronary Artery Disease patients visiting Cardiology outpatient Department of a North Indian tertiary care centre.

Results: An Android™ based mobile application named as ‘Happy Heart’ was developed. The content was developed in both Hindi and English under professional supervision. For this mobile application, the Mean MARS score was 3.60 ± 0.86 and subjectivity score was 3.30 ± 1.03. The overall user satisfaction response for the mobile application was 4.09 ± 0.75 indicating that most of the testers found it useful.

Conclusion: This mobile application is developed as a research tool to further conduct a clinical study in Coronary Artery Disease Patients. Current evaluation was a pilot testing wherein this application showed promising results.

Keywords: CAD secondary prevention, cardiovascular agent, coronary artery disease, lifestyle modification, m-health, medical education, mobile health technology, patient education.

Graphical Abstract

[1]
GBD 2016 Causes of death collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet, 2017, 390(10100), 1151-1210.
[http://dx.doi.org/10.1016/S0140-6736(17)32152-9] [PMID: 28919116]
[2]
Srinath Reddy, K.; Shah, B.; Varghese, C.; Ramadoss, A. Responding to the threat of chronic diseases in India. Lancet, 2005, 366(9498), 1744-1749.
[http://dx.doi.org/10.1016/S0140-6736(05)67343-6] [PMID: 16291069]
[3]
Harikrishnan, S.; Leeder, S.; Huffman, M.; Jeemon, P.; Prabhakaran, D. A Race against Time: The Challenge of Cardiovascular Disease in Developing Economies; In: Centre for Chronic Disease Control: New Delhi, 2014.
[4]
Yusuf, S.; Rangarajan, S.; Teo, K.; Islam, S.; Li, W.; Liu, L.; Bo, J.; Lou, Q.; Lu, F.; Liu, T.; Yu, L.; Zhang, S.; Mony, P.; Swaminathan, S.; Mohan, V.; Gupta, R.; Kumar, R.; Vijayakumar, K.; Lear, S.; Anand, S.; Wielgosz, A.; Diaz, R.; Avezum, A.; Lopez-Jaramillo, P.; Lanas, F.; Yusoff, K.; Ismail, N.; Iqbal, R.; Rahman, O.; Rosengren, A.; Yusufali, A.; Kelishadi, R.; Kruger, A.; Puoane, T.; Szuba, A.; Chifamba, J.; Oguz, A.; McQueen, M.; McKee, M.; Dagenais, G. PURE Investigators. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N. Engl. J. Med., 2014, 371(9), 818-827.
[http://dx.doi.org/10.1056/NEJMoa1311890] [PMID: 25162888]
[5]
Prabhakaran, D.; Jeemon, P.; Sharma, M.; Roth, G.; Johnson, C.; Harikrishnan, S.; Gupta, R.; Pandian, J.; Naik, N.; Roy, A.; Dhaliwal, R.; Xavier, D.; Kumar, R.; Tandon, N.; Mathur, P.; Shukla, D.; Mehrotra, R.; Venugopal, K.; Kumar, G.; Varghese, C.; Furtado, M.; Muraleedharan, P.; Abdulkader, R.; Alam, T.; Anjana, R.; Arora, M.; Bhansali, A.; Bhardwaj, D.; Bhatia, E.; Chakma, J.; Chaturvedi, P.; Dutta, E.; Glenn, S.; Gupta, P.; Johnson, S.; Kaur, T.; Kinra, S.; Krishnan, A.; Kutz, M.; Mathur, M.; Mohan, V.; Mukhopadhyay, S.; Nguyen, M.; Odell, C.; Oommen, A.; Pati, S.; Pletcher, M.; Prasad, K.; Rao, P.; Shekhar, C.; Sinha, D.; Sylaja, P.; Thakur, J.; Thankappan, K.; Thomas, N.; Yadgir, S.; Yajnik, C.; Zachariah, G.; Zipkin, B.; Lim, S.; Naghavi, M.; Dandona, R.; Vos, T.; Murray, C.; Reddy, K.; Swaminathan, S.; Dandona, L. India State-Level Disease Burden Initiative CVD Collaborators. The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob. Health, 2018, 6(12), e1339-e1351.
[http://dx.doi.org/10.1016/S2214-109X(18)30407-8] [PMID: 30219317]
[6]
Patel, V.; Chatterji, S.; Chisholm, D.; Ebrahim, S.; Gopalakrishna, G.; Mathers, C.; Mohan, V.; Prabhakaran, D.; Ravindran, R.D.; Reddy, K.S. Chronic diseases and injuries in India. Lancet, 2011, 377(9763), 413-428.
[http://dx.doi.org/10.1016/S0140-6736(10)61188-9] [PMID: 21227486]
[7]
Cardiovascular Diseases (CVDs). Available from: https://www. who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) (Accessed Jun 7, 2019).
[8]
Diet, nutrition and the prevention of chronic diseases. A report of the WHO Study Group on Diet, Nutrition and Prevention of Noncommunicable Diseases. Nutr. Rev., 1991, 49(10), 291-301.
[PMID: 1749527]
[9]
Saunders, T.J.; Chaput, J-P.; Tremblay, M.S. Sedentary behaviour as an emerging risk factor for cardiometabolic diseases in children and youth. Can. J. Diabetes, 2014, 38(1), 53-61.
[http://dx.doi.org/10.1016/j.jcjd.2013.08.266] [PMID: 24485214]
[10]
McGill, H.C., Jr; McMahan, C.A.; Gidding, S.S. Preventing heart disease in the 21st century: Implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study. Circulation, 2008, 117(9), 1216-1227.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.107.717033] [PMID: 18316498]
[11]
Saha, S.; Nordstrom, J.; Gerdtham, U-G.; Mattisson, I.; Nilsson, P.M.; Scarborough, P. Prevention of cardiovascular disease and cancer mortality by achieving healthy dietary goals for the swedish population: A macro-simulation modelling study. Int. J. Environ. Res. Public Health, 2019, 16(5), 890.
[http://dx.doi.org/10.3390/ijerph16050890] [PMID: 30870975]
[12]
Lloyd-Jones, D.M.; Leip, E.P.; Larson, M.G.; D’Agostino, R.B.; Beiser, A.; Wilson, P.W.; Wolf, P.A.; Levy, D. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation, 2006, 113(6), 791-798.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.105.548206] [PMID: 16461820]
[13]
Department of Health and Social Care. Start active, stay active: report on physical activity in the UK. Start active, stay active: report on physical activity in the UK., Available from: https://www. gov.uk/government/publications/start-active-stay-active-a-report-on-physical-activity-from-the-four-home-countries-chief-medical-offi cers (Accessed Jun 7, 2019).
[14]
Chiuve, S.E.; Cook, N.R.; Shay, C.M.; Rexrode, K.M.; Albert, C.M.; Manson, J.E.; Willett, W.C.; Rimm, E.B. Lifestyle-based prediction model for the prevention of CVD: the Healthy Heart Score. J. Am. Heart Assoc., 2014, 3(6)e000954
[http://dx.doi.org/10.1161/JAHA.114.000954] [PMID: 25398889]
[15]
Daviglus, M.L.; Stamler, J.; Pirzada, A.; Yan, L.L.; Garside, D.B.; Liu, K.; Wang, R.; Dyer, A.R.; Lloyd-Jones, D.M.; Greenland, P. Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. JAMA, 2004, 292(13), 1588-1592.
[http://dx.doi.org/10.1001/jama.292.13.1588] [PMID: 15467061]
[16]
Yang, Q.; Cogswell, M.E.; Flanders, W.D.; Hong, Y.; Zhang, Z.; Loustalot, F.; Gillespie, C.; Merritt, R.; Hu, F.B. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. JAMA, 2012, 307(12), 1273-1283.
[http://dx.doi.org/10.1001/jama.2012.339] [PMID: 22427615]
[17]
Berry, J.D.; Dyer, A.; Cai, X.; Garside, D.B.; Ning, H.; Thomas, A.; Greenland, P.; Van Horn, L.; Tracy, R.P.; Lloyd-Jones, D.M. Lifetime risks of cardiovascular disease. N. Engl. J. Med., 2012, 366(4), 321-329.
[http://dx.doi.org/10.1056/NEJMoa1012848] [PMID: 22276822]
[18]
Elmer, P.J.; Obarzanek, E.; Vollmer, W.M.; Simons-Morton, D.; Stevens, V.J.; Young, D.R.; Lin, P.H.; Champagne, C.; Harsha, D.W.; Svetkey, L.P.; Ard, J.; Brantley, P.J.; Proschan, M.A.; Erlinger, T.P.; Appel, L.J. PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-Month results of a randomized trial. Ann. Intern. Med., 2006, 144(7), 485-495.
[http://dx.doi.org/10.7326/0003-4819-144-7-200604040-00007] [PMID: 16585662]
[19]
Chow, C.K.; Jolly, S.; Rao-Melacini, P.; Fox, K.A.; Anand, S.S.; Yusuf, S. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation, 2010, 121(6), 750-758.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.891523] [PMID: 20124123]
[20]
Teo, K.; Lear, S.; Islam, S.; Mony, P.; Dehghan, M.; Li, W.; Rosengren, A.; Lopez-Jaramillo, P.; Diaz, R.; Oliveira, G.; Miskan, M.; Rangarajan, S.; Iqbal, R.; Ilow, R.; Puone, T.; Bahonar, A.; Gulec, S.; Darwish, E.A.; Lanas, F.; Vijaykumar, K.; Rahman, O.; Chifamba, J.; Hou, Y.; Li, N.; Yusuf, S. PURE Investigators. Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study. JAMA, 2013, 309(15), 1613-1621.
[http://dx.doi.org/10.1001/jama.2013.3519] [PMID: 23592106]
[21]
Holben, D.H.; Rambo, C.; Howe, C.; Murray, D.H.; Shubrook, J.H. Cardiovascular disease risk factors after an employer-based risk reduction program: An observational cohort study. J. Am. Osteopath. Assoc., 2017, 117(7), 425-432.
[http://dx.doi.org/10.7556/jaoa.2017.088] [PMID: 28662555]
[22]
Brinks, J.; Fowler, A.; Franklin, B.A.; Dulai, J. Lifestyle modification in secondary prevention: Beyond pharmacotherapy. Am. J. Lifestyle Med., 2016, 11(2), 137-152.
[http://dx.doi.org/10.1177/1559827616651402] [PMID: 30202327]
[23]
Balady, G.J.; Williams, M.A.; Ades, P.A.; Bittner, V.; Comoss, P.; Foody, J.A.M.; Franklin, B.; Sanderson, B.; Southard, D. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: A scientific statement from the American heart association exercise, cardiac rehabilitation, and prevention committee, the council on clinical cardiology; The councils on cardiovascular nursing, epidemiology and prevention, and nutrition, physical activity, and metabolism; and the american association of cardiovascular and pulmonary rehabilitation. J. Cardiopulm. Rehabil. Prev., 2007, 27(3), 121-129.
[http://dx.doi.org/10.1097/01.HCR.0000270696.01635.aa] [PMID: 17558191]
[24]
Willet, W.C. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes, 2nd ed; Disease Control Priorities in Developing Countries, 2006, pp. 833-850.
[25]
Smith, S.C., Jr; Benjamin, E.J.; Bonow, R.O.; Braun, L.T.; Creager, M.A.; Franklin, B.A.; Gibbons, R.J.; Grundy, S.M.; Hiratzka, L.F.; Jones, D.W.; Lloyd-Jones, D.M.; Minissian, M.; Mosca, L.; Peterson, E.D.; Sacco, R.L.; Spertus, J.; Stein, J.H.; Taubert, K.A. World Heart Federation and the Preventive Cardiovascular Nurses Association. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 2011, 124(22), 2458-2473.
[http://dx.doi.org/10.1161/CIR.0b013e318235eb4d] [PMID: 22052934]
[26]
F Piepoli, M. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Int. J. Behav. Med., 2017, 24(3), 321-419.
[http://dx.doi.org/10.1007/s12529-016-9583-6] [PMID: 28290077]
[27]
India is digitising fast but the pace is leaving many behind. Available from: https://www.businessinsider.in/digital-india-mckinsey-report-analysis-of-indias-digital-economy/articleshow/68686474 cms (Accessed Jun 7, 2019).
[28]
Future of India: The Winning Leap - PwC. Available from: https://www.pwc.in/assets/pdfs/future-of-india/future-of-india-the-winning-leap.pdf (Accessed Jun 7, 2019).
[29]
Smartphone penetration in India 2014-2019. https://www.statista. com/statistics/257048/smartphone-user-penetration-in-india/ (Accessed Jun 7, 2019).
[30]
Bhavnani, S.P.; Narula, J.; Sengupta, P.P. Mobile technology and the digitization of healthcare. Eur. Heart J., 2016, 37(18), 1428-1438.
[http://dx.doi.org/10.1093/eurheartj/ehv770] [PMID: 26873093]
[31]
mHealth - who.int. Available from: https://www.who.int/goe/publications/goe_mhealth_web.pdf (Accessed Jun 7, 2019).
[32]
McCabe, C.; McCann, M.; Brady, A.M. Computer and mobile technology interventions for self-management in chronic obstructive pulmonary disease. Cochrane Database Syst. Rev, 2017. 5CD011425
[http://dx.doi.org/10.1002/14651858.CD011425.pub2] [PMID: 28535331]
[33]
Farhat, A.; Al-Hajje, A.; Rachidi, S.; Zein, S.; Zeid, M.B.; Salameh, P.; Bawab, W.; Awada, S. Risk factors and quality of life of dyslipidemic patients in Lebanon: A cross-sectional study. J. Epidemiol. Glob. Health, 2016, 6(4), 315-323.
[http://dx.doi.org/10.1016/j.jegh.2016.10.001] [PMID: 27842211]
[34]
Whitehead, L.; Seaton, P. The Effectiveness of Self-Management Mobile Phone and Tablet Apps in Long-term Condition Management: A Systematic Review. J. Med. Internet Res., 2016, 18(5)e97
[http://dx.doi.org/10.2196/jmir.4883] [PMID: 27185295]
[35]
Chow, C.K.; Redfern, J.; Hillis, G.S.; Thakkar, J.; Santo, K.; Hackett, M.L.; Jan, S.; Graves, N.; de Keizer, L.; Barry, T.; Bompoint, S.; Stepien, S.; Whittaker, R.; Rodgers, A.; Thiagalingam, A. Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: A randomized clinical trial. JAMA, 2015, 314(12), 1255-1263.
[http://dx.doi.org/10.1001/jama.2015.10945] [PMID: 26393848]
[36]
Liu, F.; Kong, X.; Cao, J.; Chen, S.; Li, C.; Huang, J.; Gu, D.; Kelly, T.N. Mobile phone intervention and weight loss among overweight and obese adults: a meta-analysis of randomized controlled trials. Am. J. Epidemiol., 2015, 181(5), 337-348.
[http://dx.doi.org/10.1093/aje/kwu260] [PMID: 25673817]
[37]
Hamine, S.; Gerth-Guyette, E.; Faulx, D.; Green, B.B.; Ginsburg, A.S. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: A systematic review. J. Med. Internet Res., 2015, 17(2)e52
[http://dx.doi.org/10.2196/jmir.3951] [PMID: 25803266]
[38]
Hilgart, M.M.; Ritterband, L.M.; Thorndike, F.P.; Kinzie, M.B. Using instructional design process to improve design and development of Internet interventions. J. Med. Internet Res., 2012, 14(3)e89
[http://dx.doi.org/10.2196/jmir.1890] [PMID: 22743534]
[39]
Stoyanov, S.R.; Hides, L.; Kavanagh, D.J.; Zelenko, O.; Tjondronegoro, D.; Mani, M. Mobile app rating scale: A new tool for assessing the quality of health mobile apps. JMIR Mhealth Uhealth, 2015, 3(1)e27
[http://dx.doi.org/10.2196/mhealth.3422] [PMID: 25760773]
[40]
Cho, M.J.; Sim, J.L.; Hwang, S.Y. Development of smartphone educational application for patients with coronary artery disease. Healthc. Inform. Res., 2014, 20(2), 117-124.
[http://dx.doi.org/10.4258/hir.2014.20.2.117] [PMID: 24872910]
[41]
Cernvall, M.; Sveen, J.; Johannesson, K.B.; Arnberg, F. A pilot study of user satisfaction and perceived helpfulness of the swedish version of the mobile app PTSD coach. Eur. J. Psychotraumatol., 2018, 9(1)1472990
[http://dx.doi.org/10.1080/20008198.2018.1472990]
[42]
Kuhn, E.; Greene, C.; Hoffman, J.; Nguyen, T.; Wald, L.; Schmidt, J.; Ramsey, K.M.; Ruzek, J. Preliminary evaluation of PTSD Coach, a smartphone app for post-traumatic stress symptoms. Mil. Med., 2014, 179(1), 12-18.
[http://dx.doi.org/10.7205/MILMED-D-13-00271] [PMID: 24402979]
[43]
Free, C.; Phillips, G.; Watson, L.; Galli, L.; Felix, L.; Edwards, P.; Patel, V.; Haines, A. The effectiveness of mobile-health technologies to improve health care service delivery processes: A systematic review and meta-analysis. PLoS Med., 2013, 10(1)e1001363
[http://dx.doi.org/10.1371/journal.pmed.1001363] [PMID: 23458994]
[44]
Hung, C-S.; Yu, J-Y.; Lin, Y-H.; Chen, Y-H.; Huang, C-C.; Lee, J-K.; Chuang, P-Y.; Ho, Y-L.; Chen, M-F. Mortality benefit of a fourth-generation synchronous telehealth program for the management of chronic cardiovascular disease: A longitudinal study. J. Med. Internet Res., 2016, 18(5)e102
[http://dx.doi.org/10.2196/jmir.5718] [PMID: 27177497]
[45]
Badawy, S.M.; Kuhns, L.M. Economic evaluation of text-messaging and smartphone-based interventions to improve medication adherence in adolescents with chronic health conditions: A systematic review. JMIR Mhealth Uhealth, 2016, 4(4)e121
[http://dx.doi.org/10.2196/mhealth.6425] [PMID: 27780795]

© 2024 Bentham Science Publishers | Privacy Policy