A Descriptive Correlational Study of Rate and Determinants of Parental mHealth Adherence to Symptom Home Monitoring for Infants with Congenital Heart Disease during the Single Ventricle Interstage Period: The DOMAIN Study
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Single ventricle heart disease care in the ambulatory setting affects approximately 4,000 infants in the United States annually. Treatment typically involves a three-staged surgical strategy over the first three years of life with parental home monitoring of the infant during the interstage period, which is the time between the first two surgeries. Symptom home monitoring during the interstage period increasingly requires technology to maximize patient outcomes. Mobile health, or mHealth, transfers infant hemodynamic monitoring data captured by parents from the home to designated registered nurse coordinators who monitor the data remotely. Parental mHealth symptom home monitoring adherence is critical to improve morbidity and reduce mortality in infants during this high-risk period. However, rates and determinants of mHealth adherence have yet to be studied. The purpose of this research was to quantify the rate of parental mHealth adherence and to describe the relationship between patient-related, family-related, community-related, and healthcare system-related determinants of parental mHealth adherence for infants with congenital heart disease during the single ventricle interstage period. The pediatric self-management conceptual framework was used with a retrospective, descriptive, correlational research design. De-identified data from 312 infants treated at nine pediatric hospitals between March 2014-September 2019 were included from the Cardiac High Acuity Monitoring Program multi-site registry. This registry was developed in 2014 by Children’s Mercy Kansas City and includes patient, family, and medical record data. SPSS AMOS software was used to refine a model to develop a theoretically identified, recursive structural equation model. The rate of parental mHealth adherence-data days was 75.54%. The overall model variance was 24.0%, with good local and global fit. A higher parental age (p<.001) and Medicaid insurance (p=.009) were positively associated with parental mHealth adherence. Higher rates of implementation of oxygen saturation symptom home monitoring were associated with lower clinic visits (p< .001) and increased education levels (p=.001). Adherence to mHealth video use was associated with increased healthcare team driven communications (p=.047). Future research areas proposed from these findings include determining mHealth adherence rates associated with optimized clinical outcomes and ways to reduce parental mHealth non-adherence.
Table of Contents
Introduction -- Review of literature -- Methodology -- Results -- Discussion -- Appendix
Ph.D. (Doctor of Philosophy)