Dr. Caleb Ferguson is an Associate Professor of Nursing (Chronic & Complex Care) at the University of Wollongong & Western Sydney Local Health District. In addition to his nursing degree, he also holds a Masters of Health Leadership from the University of Tasmania and a PhD from the University of Technology Sydney. He has been researching cardiovascular disease for over 10 years and is currently studying digital technologies for the management of atrial fibrillation and stroke prevention through a National Health & Medical Research Council Emerging Leader Fellowship.
Atrial fibrillation (AFib or AF), which is characterized as an irregular, often rapid heart rate that commonly causes poor blood flow, is the most common heart rhythm disorder and a major risk factor for stroke. A historic lack of adherence to traditional disease management plans have contributed to an increase in hospitalizations over the years in Australia.
“Atrial fibrillation often goes undiagnosed, and optimization of therapies is quite poor, as is long-term persistence with medicines that prevent stroke,” Dr. Caleb Ferguson, Associate Professor of Nursing at the University of Wollongong & Western Local Sydney Health District, explains. “So, we know that patients who get started on anticoagulants (life-saving, stroke prevention medications), which are bloodthinning drugs, are often not adherent or persistent with taking that medicine in the long-term.”
He says that standard approaches for patient education of chronic diseases in hospitals, which typically include providing pamphlets and brochures, are relatively ineffective at producing real behavior change.
Caleb attributes the problem to the busy and often chaotic nature of acute care, where clinicians cannot spend as much time with patients as needed as well as information overload and readiness to learn on the patient’s part. He believes that “more knowledgeable and empowered patients and caregivers are likely to enhance uptake, adherence and persistence to AF related medications and contribute to better patient outcomes.”
He and his team of researchers set out to test this theory, citing the following objective: To determine the feasibility and efficacy of a digital education program for patients living with AF on patient knowledge and quality of life at 6 months. The next step was to select a learning technology provider that could help them optimize this program.
Privy to the promising results he and his colleague saw using Qstream a few years back during a study with nurses, he approached the microlearning and knowledge retention vendor. His team ultimately selected Qstream for its science-backed approach and demonstrated knowledge and behavior change in more than 20 clinical studies. Unlike literature that is presented to a patient upon diagnosis, Qstream’s spaced repetition of information builds sustainable habit change, making sure the patient understands how to properly care for themselves and reduce health risks.
“I was quite impressed by how Qstream could be used as what we now call a ‘digital therapeutic’, or an app to change a biomarker or patient’s behavior, in relation to not only improving knowledge but improving self-management and self-care behavior,” Caleb says. “Qstream was also selected for its theoretical base in terms of the short bursts of education and the effectiveness of spaced learning. It was really important as researchers that we select a modality based on the evidence.”
Over the six-month period, patients showed significant improvements in the three areas of focus. “We’ve managed to show not only improvement in knowledge but also in the quality of life as well in those patients,” Caleb concludes.
Scenario-based questions helped patients critically think through realistic situations related to their disease. Qstream’s spaced algorithms and repetitive delivery of content ensured that best practices were mastered and pushed from short-term to long-term memory. This provides peace of mind that patients can recall the information when the need arises, enabling them to better care for their chronic AF.
There were significant improvements in AF quality of life at 6 months after using Qstream
This metric was determined using a validated instrument specific to AF. The AFQoL is a questionnaire that specifically measures quality of life related to symptoms such as anxiety and ability to participate in physical activity and exercise.
System usability rating was excellent
Caleb says the participants enjoyed the simple reinforcement, additional information provided from trusted, credible sources and the fact that the questions could be answered on the go in just a few minutes. These microlearning case studies could be completed on the patient’s own time to optimize their knowledge about the disease between appointments.
“We frequently provided links to evidence-based resources, credible outlets and published works,” Caleb says. “We also used a variety of formats. Qstream gives us the flexibility to embed, for example, a heart foundation video, or an animation that they might find a bit more visually appealing.”
Analytics drive future education initiative improvements
Qstream’s deep yet simple analytics offer a clear picture of what learners know and don’t know. Program managers get insight into topics and questions that participants are struggling with, both across the entire cohort and at the individual level. This level of granular detail is critical for high-risk industries—and in this case, high-risk patients—so knowledge gaps can quickly be corrected.
For Caleb and his team, these analytics helped them draw several conclusions and identify areas for improvement.
First, several responses confirmed what they already suspected to be true: many patients knew very little about their condition and some had been given inaccurate information.
“Qstream gave us an excellent insight into some of the myths and misconceptions around the origin of their disease, what caused it, some of the signs and symptoms and the severity of the illness as well,” he says.
They were also able to see which questions had the greatest proficiency increase. This information alerted them to questions that may need to be reworded to ensure the takeaway message is understood. Caleb explains, “Knowledge improvements were greatest in the risk factor, symptom recognition and when to seek assistance domains.”
He and his team proudly presented the results of the pilot study at the 2022 14th Annual World Stroke Congress.