Effectiveness of an avatar educational application for improving heart failure patients' knowledge and self-care behaviors: A pragmatic randomized controlled trial

Aim: To evaluate the effectiveness of education using avatars for improving patients' heart failure knowledge and self-care. Background: A lack of knowledge and self-care contributes to poor outcomes and rehospitalization for people with heart failure. Design: A multi-centred, non-blinded pragmatic randomized controlled trial. Methods: Heart failure patients were randomly assigned to intervention (avatar education application) or usual care groups. Participants were followed up at baseline, 30 and 90 days. ANCOVA was used to compare the scores of heart failure knowledge and self-care, between the two groups. Fisher's exact test was used to compare the two groups' heart failure-cause readmission. Bivariate exact binary logistic regression was used to identify the predictors associated with baseline levels of knowledge. Results: A total of 36 participants were recruited (between October 2018 - March 2019). The mean age of participants was 67.5 (SD 11.3) years. At enrolment, approximately half (47.2%) have been living with Heart Failure for over 5 years. Two groups were comparable at baseline in their demographic and clinical characteristics. At 90 days, the intervention group participants had a higher increase in knowledge score on the Dutch Heart Failure Knowledge Scales compared with the control group (22.2% versus 3.7% P = .002, partial eta(2) = 0.262, 95% CI -2.755 to -0.686). There was no between-group difference observed at 30- or 90-day follow-up, on self-care behaviour (Self-care of heart failure index) or healthcare use. Overall satisfaction with the avatar app was 91.3%. Conclusion: The addition of a co-designed avatar app to usual care improved knowledge in our group of Heart Failure participants at 30 days and continued to increase up to 90 days. The results suggest that our avatar app was perceived as an enjoyable and engaging means of delivering critical knowledge and self-care information. Impact: Heart failure is associated with poor clinical outcomes (i.e., readmission rates and mortality rate) and substantial economic burden. The effectiveness of Heart Failure patient education using avatar have not been investigated previously. In this study, the avatar app improved knowledge and self-care behaviours. This innovation could be used at the bedside, at home by nurses, patients and families.