Co-design of an educational intervention for patients with an implantable cardioverter defibrillator

Implantable cardioverter defibrillators (ICDs) are essential for the treatment of life-threatening arrhythmias, yet many patients do not understand the device and its functions. (1) This can hinder their acceptance of the ICD with a detrimental impact on their psychological well-being and quality of life; especially for those who receive a shock. (2,3)

To co-design and optimise the Choice-ICD mobile health (mHealth) App aimed at reducing patients’ anxiety and improving their understanding of the device.

A six-step co-design process informed the development of the Choice-ICD App. (4) A central research team established a multidisciplinary Steering Group (n=25) of patients with an ICD, caregivers, cardiologists, specialist nurses and a software developer. Over 12 months, two online workshops were held to identify and refine the core components of the Choice-ICD App. Development was underpinned by theory and prior research by the team. Between meetings, each component of the prototype was iteratively developed, discussed and periodically tested by patients, caregivers and healthcare professionals (n=14). Their feedback enabled optimisation of the content, until the final prototype was approved by the Steering Group. (Refer Image 1) Ethical approval was sought and received. The Choice-ICD will now be tested for feasibility, acceptability and usability within the United Kingdom.

The Choice-ICD App has been co-designed according to patients’, caregivers’ and healthcare professionals’ preferences. Components of the App include a ‘chatbot’ which covers five key topics, including ICD functions and practical daily considerations, delivered through written content, animation, videos, visual aids, as well as weblinks to relevant external services. (Refer image 2) Patients have access to a personal ‘diary’ function, where they can keep a note of pending appointments etc, and a ‘discussion forum with other users’, which will be moderated by the research team. Ease of downloading the App and navigating through its content, prompt access to emergency contact numbers, data privacy and data retrieval from the App were the pertinent issues identified by the members of the Steering Group.

A collaborative, patient-centred design process has led to the development of a user-friendly, evidence-informed mHealth tool tailored to support ICD patients. The Choice-ICD App is now ready for testing within the United Kingdom.