Experiences of Patients With Atrial Fibrillation Using Technology to Personalize Self-Care Decision-Making: Interpretive Description Study

Clinical Snapshot

Key Findings

• P Value: Not applicable for qualitative research

• Effect Size: Not applicable for qualitative research

• Primary Outcome: Three themes characterizing personalized technology use: beginning use in own ways, developing decision-making patterns, and finding technology's place in normalizing life

• Nnt Or Sensitivity: Transferability depends on context and population characteristics

• Confidence Interval: Not applicable for qualitative research

Clinical Application

Findings suggest need for individualized approach to technology integration in AF care, requiring clinician awareness of patient preferences and contexts Relevant to Australian cardiology practice and RACGP chronic disease management guidelines, particularly with increasing digital health initiatives and Medicare-funded telehealth services Older adults with atrial fibrillation, particularly those using or considering technology for self-care management

Abstract

BACKGROUND: Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is a challenging chronic disease to manage. Patients' daily self-care decisions are associated with improved AF outcomes, quality of life, and decreased hospital use and cost. However, many patients find these real-world or naturalistic decisions difficult, often because of their inherent complexity and ambiguity, coupled with the uncertainty of AF. Intervention research using technology to support AF self-care has largely emphasized making decisions with clinicians. Patients with AF are increasingly using consumer technology; yet, little is known about the use of technology by patients with AF in independent self-care decision-making. Addressing this gap will facilitate developing interventions that better leverage technology to enhance patients' naturalistic decision-making. OBJECTIVE: This study aimed to explore the experiences of older adult patients in using technology to support self-care decision-making. METHODS: Following an interpretive descriptive qualitative approach, older adult patients with AF were recruited from 3 specialty heart function clinics in a Western Canadian province to participate in 1 of 6 facilitated virtual focus groups for 1.5 hours. Patients were asked about their self-care decision-making since AF diagnosis, their AF-specific technology use and its use in making self-care decisions, their technology motivations, benefits, constraints, and other possibilities for use. Inductive thematic analysis was used to code the transcribed data, moving from open coding to clustering of common codes into categories, looking for patterns of meaning between and across categories to iteratively arrive at main themes and subthemes. RESULTS: Thirty patients (n=15, 50% women) with AF (mean age, 73, SD 5.7 years; range 63-85 years) participated in the focus groups. Participants' experiences of using technology to make daily self-care decisions were highly variable but centered on its personalized use to meet their individualized needs, preferences, and life context. The personalizing process of technology use in decision-making was characterized by three themes: (1) beginning technology use in their own times and ways, during their AF trajectory-pre-, at the time, at some point AF post diagnosis, and could be either self-initiated and/or provider recommended or influenced; (2) developing patterns of AF self-care decision-making using technology, including establishing their personal baseline, keeping out of the danger zone, watchful waiting, and seeking decision-making support; and (3) finding the place for technology in normalizing daily life, either settling on or limiting its use to normalize life. CONCLUSIONS: Findings expand understandings of naturalistic decision-making by elucidating the personalized process of technology use in AF self-care.

References

1. 1.Rush, K. L., Seaton, C. L., Lukey, A., Wang, V., Loewen, P. S., Chiu, W., Patapoff, M., Moroz, L., & Andrade, J. G. (2026). Experiences of patients with atrial fibrillation using technology to personalize self-care decision-making: Interpretive description study. JMIR Cardio. https://doi.org/10.1016/j.cjca.2020.09.001