Development of an integrated e-health tool for people with,or at high risk of,cardiovascular disease: The Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) web application |
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| Affiliation: | 1. Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Dr. Esquerdo, 46, 28007 Madrid, Spain;2. Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;3. QU Health, Qatar University, Al Jamiaa St, Doha, Qatar;4. York University, 4700 Keele Street, Toronto, Ontario M3J1P3, Canada;5. Peiking University People'' Hospital, 11 Xizhimen S St, Xicheng Qu, Beijing Shi, China;6. Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG 31270-901, Brazil;7. Institute for Cardiology and Sports Medicine, Dep. Preventive and Rehabilitative Sport Medicine and Exercise Physiology, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany;8. Stellenbosch University & International Olympic Committee Research Center South Africa, Francie Van Zijl Drive, Stellenbosch 7599, South Africa;9. Hospital Santa Marta, R. de Santa Marta 50, Lisbon 1169-024, Portugal;10. Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal - 576104, Karnataka;11. Mediagnóstica Duitama, Cra16 #14-68 oficina 201, Duitama, Boyacá, Colombia;12. Hospital Raja Isteri Pengiran Anak Saleha, Bandar Seri Begawan BA1710, Brunei;13. Philippine Heart Center, East Avenue, Quezon City 1100, Philippines;14. National University Heart Centre Singapore, National University Health System Tower Block, 1E Kent Ridge Road, Level 9, Cardiac Department, Singapore 119228, Singapore;15. University of the West Indies at Cave Hill, St. Michael, Barbados;p. University of Iceland, Saemundargata 2, IS-101 Reykjavik, Iceland;q. Central Hospital of Social Security Institute, Asuncion, Paraguay;r. Institute of Cardiovascular Diseases, Clinical Center of Serbia, Dr. Koste Todorovića 8, 11000 Beograd, Serbia;s. University of Banja Luka, Faculty of Medicine, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina;t. Institute of Cardiology, Str. Testemitanu, 20, Chisinau, Republic of Moldova;u. Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, Wales, United Kingdom;v. Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece;w. Marmara University, School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak Mah Muhsin Yazıcıoğlu Cad. No:10 Üst Kaynarca Pendik / İstanbul, Turkey;x. Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, Republic of Korea;y. Asociacion Cardiovascular Centroccidental (ASCARDIO), 17 Callejón 12, Barquisimeto 3001, Lara, Venezuela;z. ICCCV Instituto de Cardiología y Cirugía Cardiovascular, No. 702 entre A y Paseo, Vedado, Calle 17, La Habana, Cuba;11. Instituto Nacional Cardiovascular (INCOR), Jirón Coronel Zegarra, Jesus Maria, Lima 11, Peru;12. National Cardiovascular Center Harapan Kita, Kav 87, Jl. Letjen. S. Parman, Jakarta, Indonesia;13. University of Medicine & Pharmacy “Victor Babes”, Cardiovascular Prevention & Rehabilitation Clinic, Bvd CD Loga 49, 300020 Timisoara, Romania;14. State Hospital for Cardiology, Gyógy tér 2, Balatonfüred 8230, Hungary;15. Fu Jen Catholic University Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City 24352, Taiwan;16. The University of Auckland, 71 Merton Road, Private Bag 92019, Auckland 1142, New Zealand;17. 12 Octubre Universitary Hospital, Av. Cordoba, s/n, 28041 Madrid, Spain;18. Tbilisi State Medical University, 33 Vazha Pshavela Ave, Tbilisi, Georgia;19. Spanish Association Hospital, Bulevar Gral. Artigas 1471, Montevideo 1471, Uruguay;110. PHYSIS Prevencion Cardiovascular, Cdla Bolivariana Av. del Libertador - Mz I Villa 5, Guayaquil, Ecuador;111. Instituto Nacional de Cardiología, Belisario Domínguez Sección 16, Tlalpan, 14080 CDMX, Mexico;112. Cardiac Rehabilitation Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Hezar-Jerib Ave., Isfahan 81746 73461, IR, Iran;113. University of Palacky, University Hospital Olomouc, I.P. Pavlova 185/6, Nová Ulice, 779 00 Olomouc, Czech Republic;114. Cardiovascular Research Group, Division of Cardiology, Oulu University Hospital, University of Oulu, Finland;115. Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas 44307, Lithuania;1p. Istituti Clinici Scientifici Maugeri, Care and Research Institute, Department of Cardiac Rehabilitation, Pavia, Italy;1q. Edinburgh Napier University, 9 Sighthill Ct, Edinburgh EH11 4BN, Scotland, United Kingdom;1r. Shaare Zedek Medical Center, the Hebrew University, Jerusalem, Israel;1s. Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, Netherlands;1t. Ślaskie Centrum Rehabilitacji w Ustroniu, Zdrojowa 6, 43-450 Ustroń, Poland;1u. Heart House Martin, Bagarova 30, Martin, Podháj, Slovakia;1v. Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom;1w. Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 København, NV, Denmark;1x. Sociedad Chilena de Cardiología, Alfredo Barros Errázuriz 1954, Providencia, Región Metropolitana, Chile;1y. Cardiovascular Institute of Buenos Aires, Av. del Libertador 6302, 1428 Buenos Aires, Argentina;1z. Loire-Vendée-Océan Hospital, Boulevard des Régents, 44270 Machecoul, France;21. Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, 182 88 Stockholm, Sweden;22. University of British Columbia, 2206 East Mall, Vancouver, British Colombia V6T 1Z3, Canada;23. Moncton Hospital, 135 Macbeath Ave, Moncton, New Brunswick E1C 6Z8, Canada;24. Beijing United Family Hospital, 2 Jiangtai Rd, Chaoyang Qu, Beijing Shi 100096, China;25. University Health Network, 399 Bathurst St, Toronto, ON M5T 2S8, Canada |
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| Abstract: | BackgroundCardiovascular disease is the leading killer globally and secondary prevention substantially reduces risk. Uptake of, and adherence to, face-to-face preventive programs is often low. Alternative models of care are exploiting the prominence of technology in daily life to facilitate lifestyle behavior change.ObjectiveTo inform the development of a web-based application integrated with the primary care electronic health record, we undertook a collaborative user-centered design process to develop a consumer-focused e-health tool for cardiovascular disease risk reduction.MethodsA four-phase iterative process involved ten multidisciplinary clinicians and academics (primary care physician, nurses and allied health professionals), two design consultants, one graphic designer, three software developers and fourteen proposed end-users. This 18-month process involved, (1) defining the target audience and needs, (2) pilot testing and refinement, (3) software development including validation and testing the algorithm, (4) user acceptance testing and beta testing. From this process, researchers were able to better understand end-user needs and preferences, thereby improving and enriching the increasingly detailed system designs and prototypes for a mobile responsive web application.ResultsWe reviewed 14 relevant applications/websites and sixteen observational and interventional studies to derive a set of core components and ideal features for the system. These included the need for interactivity, visual appeal, credible health information, virtual rewards, and emotional and physical support. The features identified as essential were: (i) both mobile and web-enabled ‘apps’, (ii) an emphasis on medication management, (iii) a strong psychosocial support component. Subsequent workshops (n = 6; 2 × 1.5 h) informed the development of functionality and lo-fidelity sketches of application interfaces. These ideas were next tested in consumer focus groups (n = 9; 3 × 1.5 h). Specifications for the application were refined from this feedback and a graphic designer iteratively developed the interface. Concurrently, the electronic health record was linked to the consumer portal. A written description of the final algorithms for all decisions and outputs was provided to software programmers. These algorithmic outputs to the app were first validated against those obtained from an independently programmed version in STATA 11. User acceptance testing (n = 5, 2 × 1.0 h) and beta testing revealed technical bugs and interface concerns across commonly-used web browsers and smartphones. These were resolved and re-tested until functionality was optimized.ConclusionEnd-users of a cardiovascular disease prevention program have complex needs. A user-centered design approach aided the integration of these needs into the concept, specifications, development and refinement of a responsive web application for risk factor reduction and disease prevention. |
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| Keywords: | Cardiovascular disease eHealth Electronic health record Risk factor management User-centered design Web application |
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