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Table 3 Results of the realist evaluation

From: The SMART personalised self-management system for congestive heart failure: results of a 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 (TELERĀ® 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
  1. Bold text identifies the components of the CMOs that have been revised.