Table 3 Results of the realist evaluation
Context | Mechanisms | Outcomes |
|---|---|---|
New CMOs | ||
The CHF PSMS is used in a home-setting | Hardware is acceptable to people in their homes, and fits with their everyday life | Engagement and happiness to use the system |
People with CHF may have co-morbidities that will affect PSMS use | Increased pain or discomfort while walking | Participant won't complete the recommended walk, no improvement and perhaps decline in physical activity or increase in weight. |
Revised CMOs | ||
C1. Access to technical support throughout the project | M1. System had technical problems, but participants used the aspects they could, and called for technical support as they needed it. | O1a. Poor SUS score |
O1b. Continued engagement with system. | ||
C2. High level 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 | O2. All are able to use the system and continue to use it for the duration of the evaluation. |
C4. Relatively active individuals have goals to lose weight and get more active | M4. Walking intervention encouraged goal setting and increased activity | O4. Goals were set and met, this was perceived to be useful. Weight was lost by some participants. |
C5. Stable individuals can benefit from monitoring symptoms | M5. Increasing awareness of blood pressure, weight and symptoms through self-monitoring and tailored feedback provision | O5. Self-reported increased awareness of symptoms, this resulted in increased health professional involvement in one case, and medications were reviewed |
C6. For people with low levels of heart failure knowledge | M6. Information and advice section contains educational material and quizzes, feedback from this and other sections should increase awareness. | O6. Increased levels of knowledge about self-management. Data sources: Interview; Knowledge of Heart Failure questionnaire (TELER® method). |
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. | 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. These features must be fully functioning | O7. Behaviour change may be sustainable over the long term |
Rejected CMO | ||
C3. Over exertion on days when users are feeling well can result in a negative impact on subsequent days (the `over activity/ rest cycle) | M3. Pacing is taught by the system by providing feedback on activity, and showing users weekly plans, highlighting instances of over activity. | O3. Balance between activity and rest. Data sources: Interview; system data |