The Development and evaluation of an avatar-based education application for improving the knowledge and response of patients with symptoms of acute coronary syndromes

Author: Jintana Tongpeth

Tongpeth, Jintana, 2018 The Development and evaluation of an avatar-based education application for improving the knowledge and response of patients with symptoms of acute coronary syndromes, Flinders University, College of Nursing and Health Sciences

Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact with the details.


Background: A patient’s ability to recognise and respond to symptoms of acute coronary syndrome (ACS) is imperative for seeking timely medical intervention. Delay in seeking medical treatment is associated with a poor understanding and difficulty in the recognition of heart attack symptoms and is associated with preventable death and complications. Innovative patient education interventions are needed to educate and support patient education and self-management.

Aims: This study aims to develop and evaluate the effectiveness of a Simple Avatar-based application for improVing ACS Education (SAVE app) on knowledge and response to ACS symptoms.

Methods: A mixed-methods design. Study 1. Participatory action research was used to engage 10 consumers and 12 cardiovascular clinical and gaming IT experts to design and develop the education application. Ten additional consumers were recruited to test the SAVE app. Study 2. A prospective, pragmatic, randomised, non-blinded, single-centre study was used to undertake the research. Seventy patients with documented CVD who had previously experienced heart attack symptoms consented to participate in the study and were randomised, and 66 patients completed the follow-up. The usual care group received routine ACS discharge education. The intervention group received routine ACS discharge education plus the SAVE app. The ACS Response Index was used to collect data for both groups on knowledge, attitudes, beliefs, actions and help-seeking behaviour about ACS at baseline, one month and six months.

Results: Study 1. Using the PAR method, ten consumers with ACS and 12 cardiovascular experts from clinical and information technology fields participated in the design and development of the education application. Ten additional consumers (mean age of 52.2 ±10.4 years) were recruited to test the feasibility of the SAVE app for improving ACS knowledge. A high level (87.3%) of satisfaction with using the application was reported. After using the SAVE app, there was an increase in the sub-scale scores of the ACS Response Index of 15.7 per cent for knowledge, 25.7 per cent for beliefs and 24.2 per cent for attitudes. Study 2. Among the 66 participants who completed the six-month follow-up, participants in the intervention group showed significant improvements in knowledge of ACS symptoms (p < .001), attitudes (p = .009) and beliefs (p < .001) sustained at the six-month follow-up. As was the intention in the implementation of the Heart Attack Action Plan, the between-group differences were statistically significant at both the one-month (p = .001) and six-month follow-ups (p = .027). The number of cardiac emergency department visits by ambulance (p = .154) was not statistically significant (intervention group = 89% and control group = 43%). Finally, the majority (94.23%) of participants were satisfied with the SAVE app.

Conclusion: The SAVE app is feasible and has the potential to support patient education by enhancing their engagement and improving their knowledge, attitudes and beliefs of ACS symptoms and response actions to symptoms and their intention to use ambulance services. The education application has the potential to reduce mortality and morbidity among patients with ACS. Future studies with a larger sample size and longer follow-up are necessary to evaluate the effect of this intervention on clinical outcomes.

Keywords: Avatar-Based Education Application, Acute Coronary Syndromes, patient education, education application, participatory action research, heart attack, heart attack symptoms, pragmatic randomised controlled trial, mixed method design

Subject: Cardiology thesis, Health Sciences thesis

Thesis type: Doctor of Philosophy
Completed: 2018
School: College of Nursing and Health Sciences
Supervisor: Professor Robyn A Clark