title: The SMART personalised self-management system for congestive heart failure: results of a realist evaluation.
abstract: BACKGROUND
  Technology has the potential to provide support for self-management to people with congestive heart failure (CHF). This paper describes the results of a realist evaluation of the SMART Personalised Self-Management System (PSMS) for CHF.
  
  
  METHODS
  The PSMS was used, at home, by seven people with CHF. Data describing system usage and usability as well as questionnaire and interview data were evaluated in terms of the context, mechanism and outcome hypotheses (CMOs) integral to realist evaluation.
  
  
  RESULTS
  The CHF PSMS improved heart failure related knowledge in those with low levels of knowledge at baseline, through providing information and quizzes. Furthermore, participants perceived the self-regulatory aspects of the CHF PSMS as being useful in encouraging daily walking. The CMOs were revised to describe the context of use, and how this influences both the mechanisms and the outcomes.
  
  
  CONCLUSIONS
  Participants with CHF engaged with the PSMS despite some technological problems. Some positive effects on knowledge were observed as well as the potential to assist with changing physical activity behaviour. Knowledge of CHF and physical activity behaviour change are important self-management targets for CHF, and this study provides evidence to direct the further development of a technology to support these targets.
authors.affiliation: Rehabilitation and Assistive Technology Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK. k.bartlett@sheffield.ac.uk.
authors.forename: Yvonne K
authors.initials: YK
authors.lastname: Bartlett
authors.affiliation: Public Health, School of Health and Related Research, University of Sheffield, Sheffield, UK. a.haywood@sheffield.ac.uk.
authors.forename: Annette
authors.initials: A
authors.lastname: Haywood
authors.affiliation: Rehabilitation and Assistive Technology Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK. c.bentley@sheffield.ac.uk.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Bentley
authors.affiliation: Rehabilitation and Assistive Technology Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK. jack.parker@sheffield.ac.uk.
authors.forename: Jack
authors.initials: J
authors.lastname: Parker
authors.affiliation: Rehabilitation and Assistive Technology Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK. mark.hawley@sheffield.ac.uk.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Hawley
authors.affiliation: Rehabilitation and Assistive Technology Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK. g.a.mountain@sheffield.ac.uk.
authors.forename: Gail A
authors.initials: GA
authors.lastname: Mountain
authors.affiliation: Rehabilitation and Assistive Technology Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK. s.mawson@sheffield.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Mawson
mesh_terms: D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008838:Microcomputers; D063731:Mobile Applications; D018670:Monitoring, Ambulatory / Q000295:instrumentation / Q000379:methods*; D018802:Patient-Centered Care / Q000379:methods* / Q000458:organization & administration; D016730:Program Development / Q000379:methods; D015397:Program Evaluation; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*