CAPTURING SELF MANAGEMENT OF CHRONIC DISEASE IN DAILY LIFE

Aim: The purpose of this study was to evaluate the feasibility and effectiveness of a novel approach for capturing self-management of chronic disease in daily life.

Background: Changes in the healthcare system are prompting more patients to manage their complex (mostly chronic) conditions in daily-living settings, transforming these informal settings into primary sites of care. However, understanding what activities patients conduct at daily living environments and how they manage their chronic conditions is a methodological challenge. To overcome this challenge, we used a novel data collection approach that involves innovative tablet, computer-based journaling.

Methods: We tested this approach with eight patients (ages 30 to 83 years) who received anticoagulation therapy with Warfarin. Patients used a tablet computer based data collection tool for a month, to journal their health activities related to their chronic condition. The tablet computers included special software that allowed patient voice entry. Two guiding questions were used to facilitate patients' journaling: (1) "What did you do for your anticoagulation treatment over the last two days?" and (2) "Did you experience any challenges over the last two days when following your provider's instructions and recommendations?" In order to assess the feasibility of using tablet computers to keep track of health activities we: 1) asked patients to call us if they encountered any problems with the tablet; 2) called the patients if data had not been entered for four days; and 3) asked patients about the usability of the tablet computers. Answers to usability questions and data entries were qualitative analyzed using content analysis.

Results: The eight patients entered a total of 125 entries regarding their health management. Three patients contacted the investigators due to technical issues (e.g. receiving weak cellular signal), while three were contacted due to lack of entry (Table 1). Those requiring contact also were those with the fewest entries. Patients stated that two features of the tablet were critical to usability of the computer: (1) small (7") size; and (2) ability to enter data via voice. Qualitative theme analysis of the patient entries revealed various health activities the patients needed to do at home (e.g. monitoring food and alcohol intake) and challenges they faced with social engagement and their daily routine.

Patient ID	1	2	3	4	5	6	7	8	Total
Number of entries	15	13	10	15	31	21	5	15	125
Patients contacted investigators	X				X			X	3
We contacted patients		X	X				X		3

Table 1. Feasibility of the tablet application.

Implications: Journaling with tablet computers for one month is feasible and is effective in capturing some health activities conducted to manage their need for anticoagulation. Feedback on the challenges and usability of the tablet computer provides guidance to further exploration of this mode of data collection for research and communication between nurses and patients for patient care.