Development and evaluation of an interactive avatar-based educational application to improve heart failure patients’ knowledge and self-care behaviours

Author: Parichat Wonggom

Wonggom, Parichat, 2019 Development and evaluation of an interactive avatar-based educational application to improve heart failure patients’ knowledge and self-care behaviours, Flinders University, College of Nursing and Health Sciences

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Background: Self-care is an essential part of heart failure (HF) management to prevent avoidable hospitalisation and achieve optimal patient outcomes. Avatar-based technologies to support patient education are an innovative approach for patients with low literacy or low health literacy, or for whom English is a second language. The use of avatar technologies for patient education has shown benefits in improving knowledge, self-care behaviours and quality of life in patients with chronic diseases.

Aims: This study aimed to develop and evaluate an interactive avatar-based application to improve knowledge and self-care of patients with HF.

Methods: The systematic review is used to examine the use of avatar-based technology in patient education, and to evaluate its effects on the knowledge and self-care behaviours of patients with chronic disease. A mixed methods design is adopted, involving participatory action research and feasibility evaluation using pre-post comparison methods.

Results: The findings of systematic review showed that avatar-based technology in patient education can have a positive effect on a wide range of healthcare outcomes. The intervention can improve knowledge, self-care behaviours and self-efficacy in patients with chronic diseases. There was limited evidence on improvement in health-related quality of life, adherence to medication and no study has evaluated its effects on readmission.

Six HF patients, two of their family members and 15 cardiovascular and information technology experts were involved in the design and development of the avatar-based education application through two cycles of development and critical reflection. After one cycle of development and critical reflection, the application was updated to improve user experience of the avatar’s characteristics and the application’s illustrations, presentation of information, concepts and random quizzes.

Subsequent to the application update, 13 participants (67 ± 13 years, 76.9% male) were recruited to assess the application’s feasibility to improve knowledge and self-care behaviours of patients with HF. After using the application, there was a significant improvement in HF knowledge (p = 0.020), self-care maintenance (p = 0.027) and self-care confidence p = 0.002). Self-care management did not significantly improve (p = 0.113). Overall satisfaction with the revised avatar application was high at 90%. No particular characteristics were found to correlate with improved HF knowledge and self-care behaviours.

Conclusion: An avatar-based application is feasible to improve HF knowledge and self-care behaviour. Using a participatory approach in development the application is acceptable and valuable to meet appropriate user experience and health-related outcomes.

Keywords: avatar education, application, knowledge, self-care behaviours, action research, nursing, heart failure

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Nursing and Health Sciences
Supervisor: Dr Huiyun Du