The Feasibility Of A Mobile Application To Improve Heart Failure Care In Suriname

INTRODUCTION: The use of mobile applications has been shown to be beneficial in heart failure (HF) management. In high income countries, mobile app use has significantly increased during the COVID-19 pandemic. Limited information exists regarding the use and effectiveness of mobile apps for HF management in Low- and Middle-Income Countries such as Suriname. The Suriname Heart Failure study is designed to assess the effectiveness of a mobile app for HF management tailored to the country's culturally diverse community. To evaluate its effectiveness, we first examined factors influencing successful implementation. Specifically, we assessed the receptiveness of HF patients and their healthcare providers (HCP) and potential facilitators and barriers associated with the proposed HF management app. METHODS: We developed the “Mi Ati” (My Heart in local language) culturally tailored mobile app using previously validated HF mobile apps as a foundation. All HF patients admitted to the Academic Hospital Thorax Centrum Paramaribo (AZP-TCP) between September-December 2021 and their HCPs were invited to complete a feasibility survey after sharing the β-version of the Mi Ati app with them. The survey consisted of five-point Likert scale (disagree completely to agree completely) and open-ended questions to assess the confidence in using mobile apps, their perceptions about virtual/telemonitoring, and potential barriers, facilitators, benefits and challenges. In addition, we collected patients’ socio-demographic information and their access to a mobile phone and the internet. RESULTS: Sixty nine (62.3%, mean age: 57.8± SD 14.8 years, 44 (63.8%) male) of the 111 HF patients hospitalized during our inclusion period completed the survey. Fifty six (81.2%) had mobile phone access, and 55 (98.2%) of those had internet access. Forty nine (71.1%) patients indicated they were confident using a mobile phone for health purposes once taught and would like to receive HF education (N=53, 76.8%) and information on diet, exercise, and weight management(N:67,97.1%). Approximately 85% (N= 59) of patients felt confident to self-monitor their symptoms but did not know how to respond to possible symptom changes. In total 16 HCPs (11 cardiologists, 4 ward doctors, and 1 HF nurse) completed the questionnaire of which 15 (93.8%) were comfortable in using a mobile app for patient telemonitoring and all (100%) agreed this could be done by a HF nurse. The majority of HCPs (N= 15, 93.8%) also perceived the app would reduce their workload and 12 (75%) agreed that app usage would not have a negative impact on the patient-HCP relationship. The qualitative analysis for the HCP surveys showed that perceived barriers for the app implementation are low digital and health literacy and the country's current financial economic crisis. Identified facilitators were HF care expertise and existing digital infrastructure at the TCP. CONCLUSION: HF patients and HCPs in Suriname feel confident using a mobile app for monitoring and education purposes. The application must take into account digital and health literacy barriers.