title: Attitudes and preferences on the use of mobile health technology and health games for self-management: interviews with older adults on anticoagulation therapy.
abstract: BACKGROUND
  Older adults are at substantial risk for cardiovascular disorders that may require anticoagulation therapy. Those on warfarin therapy report dissatisfaction and reduced quality of life (QOL) resulting from the treatment. Advances in the area of mobile health (mHealth) technology have resulted in the design and development of new patient-centric models for the provision of personalized health care services to improve care delivery. However, there is a paucity of research examining the effectiveness of mHealth tools on knowledge, attitudes, and patient satisfaction with treatment, as well as self-management, adherence to therapy, and QOL in older adults with chronic illness conditions requiring long-term warfarin therapy.
  
  
  OBJECTIVE
  The objective of the study was to explore the attitudes and preferences of older adults on warfarin therapy regarding the use of mHealth technology and health games to gain skills for self-management.
  
  
  METHODS
  We conducted group and individual interviews with patients (60 years or older) on warfarin therapy at two anticoagulation clinics affiliated with an academic medical center. We held 4 group and 2 individual interviews, resulting in 11 patient participants and 2 family caregiver participants. We used structured questions on three topic areas including medication self-management strategies, mHealth technology use, and health games for exercise. We demonstrated some commercial health apps related to medication management, vitamin K content of food, and a videogame for balance exercise. Discussions were audiotaped and transcribed verbatim. Common themes were drawn using content analysis.
  
  
  RESULTS
  The participants reported awareness of the importance of staying on schedule with warfarin therapy. They also acknowledged that negative experiences of friends or family members who were taking warfarin influenced their desire to keep on schedule with warfarin therapy. In addition, the participants expressed that the use of mHealth technology may be helpful for medication management. They also expressed the need for family support in the use of health technology devices. Moreover, the participants discussed concerns and challenges to use health technology and health games, and provided suggestions on ways to make mHealth technology and health games elder-friendly.
  
  
  CONCLUSIONS
  These findings indicate that our older adults on warfarin therapy are interested in mHealth technology specific to warfarin medication management and health games. Further research needs to be done to validate these findings. Elder-friendly designs, technology support, and physical safety using mHealth technology may be useful in this population. These findings can be used to inform a larger study to design and test an elder-centered mHealth technology in this target population.
authors.affiliation: University of California, Irvine, Program in Nursing Science, Irvine, CA, United States. jungahl@uci.edu.
authors.forename: Jung-Ah
authors.identifier: http://orcid.org/0000-0003-0678-5956
authors.initials: JA
authors.lastname: Lee
authors.forename: Annie Lu
authors.identifier: http://orcid.org/0000-0002-1543-0383
authors.initials: AL
authors.lastname: Nguyen
authors.forename: Jill
authors.identifier: http://orcid.org/0000-0003-0241-789X
authors.initials: J
authors.lastname: Berg
authors.forename: Alpesh
authors.identifier: http://orcid.org/0000-0002-9790-0245
authors.initials: A
authors.lastname: Amin
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0001-8761-0204
authors.initials: M
authors.lastname: Bachman
authors.forename: Yuqing
authors.identifier: http://orcid.org/0000-0002-9177-0144
authors.initials: Y
authors.lastname: Guo
authors.forename: Lorraine
authors.identifier: http://orcid.org/0000-0003-1708-4186
authors.initials: L
authors.lastname: Evangelista
keywords: anticoagulation therapy; health apps; health games; mobile health technology; self-management
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