EGUARDIAN ANGEL: DEVELOPMENT OF AN INTERACTIVE PEER SUPPORT DIGITAL HEALTH SYSTEM

N. Luxton¹, R. Gallagher², S.K. Poon³, K. Sutarlim⁴, J. Redfern^1,5

Background: Cardiac rehabilitation programs improve morbidity, mortality and quality of life in patients with cardiovascular disease (CVD). However, referral , access to and engagement with cardiac rehabilitation remains suboptimal, particularly among priority populations.  Emotional and peer support are important components of cardiac rehabilitation, as patients with the same CVD condition can provide support to each other as they share similar experiences and challenges. Adapting these support elements for delivery on a digital platform will maximise their benefit and reach to patients with CVD.  

Purpose: To co-design an interactive peer support digital health system, known as eGuardian Angel, and create a smartphone app prototype suitable for testing among patients with cardiovascular disease.

Methods: A qualitative co-design approach involving multidisciplinary participants from: health informatics; software engineering; clinical experts and academics involved in CVD management; and consumers with diagnosed heart disease. The co-design was conducted in three phases. Phase 1 saw the development of features, content and design of the front (wireframes) and back end of the digital health system through an iterative process, using a series of face to face workshops. Phase 2 comprised of in-depth interviews with clinical CVD experts to refine the content of the wireframes for utility, appropriateness and alignment with current CVD practice guidelines. Phase 3 included two consumer workshops, and involved modifications to the features, content and design of the wireframes and development of smartphone app prototype based on interview results.

Results: Phase 1 involved three iterative feedback cycles between the development team: three CVD clinicians and academics, one health informatics student and one software engineer. The developed digital software allowed paired individuals to log, track and view their CVD risk factor metrics such as exercise, smoking and mood. An interface was also created that enabled text-based communication between the paired individuals, whereby positive peer support and encouragement could occur. During phase 2, eight experts from cardiology, physiotherapy, nursing, exercise physiology and nutrition were interviewed. Major themes were identified that informed wireframe refinement and creation of an app prototype in Phase 3 by the development team, that included: changing words to enable easier understanding of logging risk factor metrics; adding brief guidelines about the expectations of the peer support relationship; and ensuring the app prototype can be personalised to increase acceptability and engagement.

Conclusion(s): An interactive peer support digital health system and app prototype were successfully co-designed and created by multidisciplinary clinicians, academics, health informatics and software engineers.

Implications: The eGuardian Angel wireframes and app prototype are ready for full software build. Further co-development and evaluation of the eGuardian Angel app incorporating user-centred (patient) design process will occur, followed by a pilot randomised clinical trial. This will provide evidence as to whether a digital health system based on peer support and social interaction helps improve cardiovascular risk and emotional support and wellbeing amongst patients with CVD.

Funding, acknowledgements: No funding

Keywords: Social interactions, cardiac rehabilitation, mobile application

Topic: Cardiorespiratory

Did this work require ethics approval? Yes

Institution: The University of Sydney

Committee: Research Integrity and Ethics Administration

Ethics number: Project number: 2020/515