title: An eHealth Diary and Symptom-Tracking Tool Combined With Person-Centered Care for Improving Self-Efficacy After a Diagnosis of Acute Coronary Syndrome: A Substudy of a Randomized Controlled Trial.
abstract: BACKGROUND
  Patients with cardiovascular diseases managed by a person-centered care (PCC) approach have been observed to have better treatment outcomes and satisfaction than with traditional care. eHealth may facilitate the often slow transition to more person-centered health care by increasing patients' beliefs in their own capacities (self-efficacy) to manage their care trajectory. eHealth is being increasingly used, but most studies continue to focus on health care professionals' logic of care. Knowledge is lacking regarding the effects of an eHealth tool on self-efficacy when combined with PCC for patients with chronic heart diseases.
  
  
  OBJECTIVE
  The objective of our study was to investigate the effect of an eHealth diary and symptom-tracking tool in combination with PCC for patients with acute coronary syndrome (ACS).
  
  
  METHODS
  This was a substudy of a randomized controlled trial investigating the effects of PCC in patients hospitalized with ACS. In total, 199 patients with ACS aged <75 years were randomly assigned to a PCC intervention (n=94) or standard treatment (control group, n=105) and were followed up for 6 months. Patients in the intervention arm could choose to use a Web-based or mobile-based eHealth tool, or both, for at least 2 months after hospital discharge. The primary end point was a composite score of changes in general self-efficacy, return to work or prior activity level, and rehospitalization or death 6 months after discharge.
  
  
  RESULTS
  Of the 94 patients in the intervention arm, 37 (39%) used the eHealth tool at least once after the index hospitalization. Most of these (24/37, 65%) used the mobile app and not the Web-based app as the primary source of daily self-rating input. Patients used the eHealth tool a mean of 38 times during the first 8 weeks (range 1-118, SD 33) and 64 times over a 6-month period (range 1-597, SD 104). Patients who used the eHealth tool in combination with the PCC intervention had a 4-fold improvement in the primary end point compared with the control group (odds ratio 4.0, 95% CI 1.5-10.5; P=.005). This improvement was driven by a significant increase in general self-efficacy compared with the control group (P=.011). Patients in the PCC group who did not use the eHealth tool (n=57) showed a nonsignificant composite score improvement compared with those in the control group (n=105) (odds ratio 2.0, 95% CI 0.8-5.2; P=.14).
  
  
  CONCLUSIONS
  We found a significant effect on improved general self-efficacy and the composite score for patients using an eHealth diary and symptom-tracking tool in combination with PCC compared with traditional care.
  
  
  BACKGROUND
  Swedish registry, Researchweb.org, ID NR 65 791.
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. axel.wolf@gu.se.
authors.forename: Axel
authors.identifier: http://orcid.org/0000-0001-6111-8377
authors.initials: A
authors.lastname: Wolf
authors.forename: Andreas
authors.identifier: http://orcid.org/0000-0001-8980-0538
authors.initials: A
authors.lastname: Fors
authors.forename: Kerstin
authors.identifier: http://orcid.org/0000-0003-1737-5039
authors.initials: K
authors.lastname: Ulin
authors.forename: Jörgen
authors.identifier: http://orcid.org/0000-0001-7302-0481
authors.initials: J
authors.lastname: Thorn
authors.forename: Karl
authors.identifier: http://orcid.org/0000-0002-6358-2154
authors.initials: K
authors.lastname: Swedberg
authors.forename: Inger
authors.identifier: http://orcid.org/0000-0002-5559-5203
authors.initials: I
authors.lastname: Ekman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000208:Acute Disease; D000368:Aged; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care; D020377:Self Efficacy; D017216:Telemedicine / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: acute coronary syndrome; eHealth; mobile health; patient-centered care; person-centred care: telemedicine; self-efficacy