Co-design of an atrial fibrillation mHealth intervention to increase medication adherence

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Chief Scientist Office

Atrial fibrillation (AF) related stroke risk can be reduced with oral anticoagulants (OACs). OACs need to be taken once or twice a day to maintain effectiveness but non-adherence remains a challenge mHealth applications are one way to support patients to take medication.

We aimed to co-design an mHealth intervention to increase medication adherence to OACs in patients with AF.

We recruited individuals with AF via British Heart Foundation social media advertisement and using established contacts from the Scottish AF survey to take part in a series of remote and in-person workshops. These were 1) an initial patient experience session, gathering personal stories to contextualise the intervention 2) an interactive session, using existing mHealth AF applications identified via scoping review, and 3) a pilot session of the co-designed mobile app prototype. Data were collected using flipchart, post-it notes and researcher field notes, with emphasis placed on the use of direct quotations and storytelling. Development work was overseen by a steering group including clinicians, digital health experts, and four AF patient representatives.

Eleven patients (7 males) aged 35-80 years took part. Six participants were diagnosed with AF within the last five years and eight had one or more co-morbidities. Number of daily medications ranged from 0-12, with 8/11 (72%) of participants taking OACs. Experience with smartphone use varied and only two reported using a smartphone to manage their own health. We developed a prototype mHealth app, MyAFNurse. The talking avatar-based app increases accessibility regardless of user health literacy level. It incorporates behaviour change techniques including a medication tracker and reminders, information about AF, advice on when and where to seek help, and a quiz to test knowledge.

A robust co-design process developed an avatar-based mHealth app that incorporates behaviour change techniques which will be evaluated in a feasibility trial.