1. Assignments for workgroups
See appendix for submitted assignments.
2. Critical evaluation of Low Intensity Psychological intervention
1. Choose a Low-Intensity Psychological intervention
Topic Serious gaming: Home automated Telemanagement (HAT) for congestive heart failure
(CHF). It includes education, monitoring and treatment of their symptoms.
b) Go through the intervention
The system is adapted for Wii, Xbox and laptop use. It daily monitors factors such as weight,
limb swelling, heart rate and mood through a gaming platform. Based on the responses, the
system gives personalised advice, education and psycho-education. For example, you have
entered that you have a higher breathing rate. The program will show according information on
possible causes and techniques to lower your breathing rate. It also advises when to seek medical
help. The intervention has proven to increase self-management, motivation, and overall
wellbeing and ultimately reduce CHF hospital admissions.
1) Credibility (content)
• Theoretical foundation
Congestive heart failure (CHF) is a major cause of premature death and high costs in healthcare.
Modification of risk factors reduces this mortality rate (WHO, 2017). Leading to heart failure
there are physical symptoms that fall out of norms. These include, but are not limited to jugular
venous pressure, arterial pressure, blood pressure, ventricle dis-functions, arrhythmias and
bodyweight (Nicholls, 2007). Additionally, the patient understanding of their disease and its
imact is increased by educating the individual. Nicholls et all (2007) suggest that an increased
rate of monitoring increases positive disease outcome. Home automated Telemanagement (HAT)
has great potential as it lowers the barrier of seeking care, assesses daily symptom changes and
provides fitting education (Mohammadzadeh, 2014).
A meta-analysis of remote monitoring of heart failure patients done by Klersy et al., (2009)
showed that monitoring was associated with a significantly lower number of deaths. More recent
results confirmed this by showing that the number of hospitalisations was reduced in 38% of
studies and emergency visits for CHF were reduced by 13% (Auener S, 2021).
, Compared to the normal population and individuals with other chronic diseases, patients
suffering from CHF have significant impairments in their social functioning. This results in
higher rates of psychopathology amongst this subgroup (Fairbrother, 2009). Studies show that
HAT for this subgroup improves their quality of life by improving self-care, health and
psychological knowledge and health management (Inglis SC, 2012., Whitten, P 2009.,
Fairbrother, 2009).
• Developers expertise
Home Automated Telemanagement system design is based on Wagner’s model of chronic
disease. It assesses blood pressure, body weight, shortness of breath, medication compliance,
mood, anxiety and progress. The program consists of the home unit, HAT server and clinician
unit. It is personalised to the patient's illnesses and symptoms which are measured and can be
altered by the physician. The content of the intervention is not solely based on the developers but
also on the physician. This leads to higher expertise and thus better treatment results.
• The content is regularly updated
The content of the HAT is CHF specific but dynamic to the patient's needs. The individual
differences amongst CHF patients are recognised by the clinician and according monitoring
programs are uploaded to the HAT server.
The education on the patient's symptoms and disease is less dynamic. Whilst an explanation and
help on experienced symptoms are present, specific questions regarding the content need to be
found or uploaded into the FAQ or discussed in person. Compared to face to face treatment, this
is a barrier to gaining the required information.
• The product is valid and reliable
A systematic review of home telemonitoring for chronic diseases done by Pare et al., (2007)
showed that there is high reliability and validity in this method. Few technical problems were
present in the projects and the measurements were accurate and were received accurately at the
clinicians unit. The quantity and quality of the data help in the decision-making process of the
clinician.
• The target group is described and the aim of the intervention is clear
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