Context | Findings related to context | Mechanisms | Findings related to mechanisms | Outcomes | Findings related to outcomes |
---|---|---|---|---|---|
C1. Limited access to technical support during deployment of the system | Telephone support on weekdays, potential for face to face visits | M1. Systems that have technical problems can result in low usability, and poor engagement. Therefore the system will be glitch free and fully functioning. | There were technical problems and usability was reduced. | O1. Engagement with system. Data sources: Interview; system data; System Usability Scale. | Low SUS scores, interview data showed users were engaged with the content. |
C2. Differing levels of computer literacy amongst users | All participants had high levels of computer literacy | M2. User-centred design process undertaken to identify a touch screen system with simple instructions designed to be operated by those with little or no computer knowledge | Could not be tested | O2. All are able to use the system and continue to use it for the duration of the evaluation. Data sources: Interview; System Usability Scale. | This was supported, but all participants had high computer literacy. |
C3. Over exertion on days when users are feeling well can result in a negative impact on subsequent days (the `over activity/ rest cycle') | Not supported, at this stage | M3. Pacing is taught by the system by providing feedback on activity, and showing users weekly plans, highlighting instances of over activity. | Activity planner was not used as intended. Following initial set up participants did not keep it up to date resulting in an inaccurate record | O3. Balance between activity and rest. Data sources: Interview; system data | Not supported, further research needed to investigate context and potential mechanisms |
C4. Loss of fitness and sedentary lifestyle of users resulting in fewer hobbies and interests | Not supported with the post-deployment interviews, but had been mentioned in CMO development interviews and focus groups | M4. Walking intervention to increase physical fitness | Most people reported completing the walking intervention, although not all walks were recorded by the system | O4. Ability to walk further. Data sources: Walking data, interview | Some reported improvements, objective data was unavailable due to technical problems. |
C5. Lack of recognition in users of worsening condition resulting in exacerbations of symptoms and potential for admission to hospital | Not supported, participants were stable and had good awareness of symptoms that could lead to exacerbation | M5. Increasing awareness of blood pressure, weight and symptoms through self-monitoring and tailored feedback provision | Some participants reported this in the interviews | O5. Improved symptom control thus reducing need for health professional involvement. Data sources: Interview; system data | Could not be objectively tested. One person reported going to the Dr as a result of high blood pressure readings. |
C6. Lack of knowledge as user is left alone to self-manage when their heart failure is stable, resulting in fewer opportunities for the health care professional to educate patients. | Although participants acknowledged they self-managed their heart failure, it was felt that as they were stable, this was appropriate, most participants had high levels of heart failure related knowledge | M6. Information and advice section contains educational material and quizzes, feedback from this and other sections should increase awareness. | Information was looked at and quizzes completed pre and post-deployment | O6. Increased levels of knowledge about self management. Data sources: Interview; Knowledge of Heart Failure questionnaire (TELER method). | Significant increase in knowledge between pre and post-deployment quizzes for those with low levels initially |
C7. Self-management of heart failure involves engagement with a variety of lifestyle changes, e.g., adhering to a medication regime, restrictions to diet, monitoring weight and taking regular exercise. | Not challenged by participants. Interview data suggests participants felt behaviour change was important. | M7. The SMART2 system incorporates the following behaviour change techniques: 1. Self-monitoring of symptoms; 2. setting and reviewing goals related to user's lifestyle; 3. providing regular feedback on performance. | Some problems with self-monitoring. Goal-setting generally supported, feedback not always attended to. Interview data reported that the system did increase walking behaviour. | O7. Behaviour change that is sustainable over the long term. Data source: Interview. | Could not be objectively tested. Interview data suggested participants perceived this as possible, if current problems were addressed. |