This subsection is based on the principles within the Australian standards [21] and recommendations [7] for the ongoing management of HF which emphasize the need for self-care education and support [7]. The core requirements of these standards are the provision of clear and reliable information on symptoms, exacerbating factors, and both medical and lifestyle management [7]. The benefit of My Plan subsection is the modular approach providing an option as to which subsections are pertinent, in appreciation that individually tailored management plans are recommended as a tool to support care coordination [21] and optimize wellness. For relevance to the health care context, clinicians believed individualized care planning could be improved in current practice with a key design priority to involve a self-care plan. The favorites function—allowing users to select their individual priority My Plan components—displays important self-management subsections on the home screen. Having favorites displayed on the home screen was especially relevant as it actively facilitates the involvement of patients and family in individualized care planning during the set-up process, through choice of components from the My Plan list and number of components based on their preferences and goals.

HF information, written in plain English including an overview of the condition, common symptoms, and treatments, is found via a button on the home screen accessible by patients and their family. The information was sourced from the St Vincent’s Heart Health website [22] and deemed an appropriate inclusion by clinicians and patients alike. The HF information section provides an opportunity to communicate educational material in patient-friendly language as a useful, clearly displayed repository of evidence-based information, as prioritized by clinicians and noted in the design brief. Clinicians recognized that educational material for patients with HF should be given early, regularly and should be clear, appropriate, basic, and needs-based. Previous work with health writers for the website content was discussed in the design workshops, and thus, paragraph sizes were limited to 4 to 5 lines, and large text sizes were used to improve readability for patients. Providing a HF information summary clearly visible on the home page was deemed important by the co-design team who often encounters family members asking for details about the condition and its treatments.

A summary list of self-management tasks for the user to complete for the day (today’s alerts) was a priority design inclusion. Local clinicians believed that follow-up with patients should be improved in current care to aid memory. The co-design team members considered reminders and scheduling important functions of the app to be addressed and are, therefore, included features in the alerts summary.

Baseline self-management data and patient goals are personalized in the app’s settings. The co-design team members prioritized patient ownership, interactivity, and tracking as important for the user experience. In the app settings, the key measures to track [23-25] or goals to be set relate to weight, fluid restriction volume, blood pressure (BP), pulse, daily steps, and number of exercise videos to be viewed daily.

The appointments tab contains a calendar to add, review, and set reminders for medical appointments with the ability to add detail needed for the appointment. The HF self-management literature lists the importance of keeping track of clinic and doctor visits [23,25]. Locally, clinician’s critique of current self-management support is that follow-up care and connected care is not done well, and the co-design team prioritized scheduling and reminders as design priorities. From the patients’ perspective, there were reported challenges managing multiple medical appointments as some choose to take notes immediately after appointments to summarize the conversation to capture the complexity of care. Especially, necessary for those living in rural areas who need to travel for specialized medical care, careful coordination of appointments effectively could improve time away from loved ones, avoid early wake-ups, and missing meals or medication doses. Furthermore, some family caregivers reported feeling like project managers, regularly assisting with scheduling, and attending medical appointments causing feelings of being overwhelmed with caregiver responsibilities. These important patient- and family-centered considerations were incorporated in design improvements of the appointments section.

The My Docs (documents) section provides an opportunity to store, review, and share test results, letters, and referrals. Documenting health records [23,25] is important in managing one’s health, and the health service’s HF discharge checklist contains echocardiogram results (Appendix F [21]) for effective communication when moving between care settings. During workshops, the co-design team determined that it was relevant to the patient persona who want to know echocardiogram and pathology results but may periodically misplace this documentation. From the perspective of clinicians, a design priority was to include or track patient data for the purposes of reviewing this data later. The My Docs section was seen as a way for the patient to facilitate communication between the health care team, to better maximize and join care between health care providers and settings.

My Team lists the contact details of the user’s emergency contact person and the health professionals relevant to their care. The recommendations [7] and standards [21] for multidisciplinary care demonstrate the importance of patients engaging effectively with their care providers through, for example, communication with health professionals [24] and documenting their contact details [23-25]. The hospital’s discharge checklist contains specific details regarding the person(s) responsible for postdischarge care and follow-up in the community (Appendix F [21]). This section was considered relevant by all stakeholders throughout the app’s design. Patients may have an available and approachable multidisciplinary team, foster relationships with respect and trust with doctors and nurses in their health care team and seek care regularly. However, participants also reported poor information sharing between health care providers and may be unsure who else is providing care for them commonly relying on memory. The stakeholder map identified that the patient’s spouse and general practitioner are the most likely personal and professional involved in HF self-management. Other members of the family and the pharmacist were also frequently involved, followed by a person’s employer or friends and specialist. In terms of the relevance of the My Team section to health care providers, clinicians wanted a tailored care plan that includes the multidisciplinary care team to ensure that care was holistic, and the design brief emphasizes the importance of managing all stakeholders in care well. Clinicians communicated their concerns of health inequality as some patients have poor access to specific multidisciplinary team members. Finally, during design workshops, the co-design team prioritized team communication as a priority function. These factors resulted in a group decision to include a list of names and details of all persons involved in the care of a person with HF.

This subsection includes an infographic containing the common signs and symptoms of HF, information to assist in appropriate help seeking, and information about worsening HF. This subsection was an important inclusion in the app because patients frequently reported symptoms such as breathlessness, urinary frequency, sleep disturbance, fatigue, exhaustion and nighttime breathlessness, anxiety, and agitation. Patients said they were frustrated by multiple, interacting, and complex symptoms. Other patients lacked understanding of the treatment rationale in lessening symptom burden. During workshop activities, the co-design team decided it was a design priority to include information and self-help in a visual and simple format. The infographic representing common HF symptoms was sourced, with approval, from the St Vincent’s Heart Health website [22]. Hyperlinks to further information and advice pages are accessed through this infographic, and it was collated from patient information booklets [23,24], the St Vincent’s Heart Health website [22], the chronic HF action plan [24] as well as the multidisciplinary team members themselves based on their clinical experience and expertise.

The medication component includes a list of current medications, previous medications, an allergy list, medicine information, and the patient’s own diuretic plan. Clinicians thought it appropriate to facilitate improved medication management as a component that should be improved in current care. The pharmacist on the co-design team provided specific insight into the design of this subsection. Patients reported the disruption to their routine when medication prescriptions were changed and the inconsistent documenting of medication lists with some writing changes on scrap paper or even forgetting important changes in the reality of daily life. Family caregivers are sometimes involved in reminders, and patients reported taking tablets with them during outings; so, these realities of the daily management of medications were incorporated into the design of this subsection. During workshop activities where the subsection was further refined, the co-design team members prioritized medication information as an important design feature. The cardiac nurse consultant regularly caring for indigenous Australians saw value in including the color of the medication as a visual reminder. In regard to the literature, medication is a reported important component of HF self-management as per the information contained within the patient education booklets [23-25] which provides a written medication list template [23] and by the hospital literature with the flexible diuretic regime listed in the hospital’s HF discharge checklist (Appendix F [21]). The National Prescriber Scheme Medicine Wise website [26] was also reviewed for general medicine information.

This subsection comprises of the important fluid restriction guideline for HF. The page displays a visual representation of a measuring jug at the volume of fluid restriction tailored to the patient’s restriction volume in the settings (commonly 1200 mL or 1500 mL per day). The jug gradually fills as users enter oral fluid intake throughout the day. Restricting fluid intake is likely the most important method to prevent fluid congestion alongside taking diuretic medications; however, patients commonly reported challenges with maintaining fluid restrictions in daily life, especially with thirst. Clinicians wanted to include or track data, and during design workshops, the co-design team emphasized that user feedback and an interactive interface were important. Information and advice [24,25,27], local guidelines [22,27], and tools and guidelines regarding documenting fluid intake [23,25,27] were local and national literature sources considered during the design. Previous qualitative research conducted in the same clinical setting regarding fluid restriction adherence was also referred to [28].

The diet component includes information for healthy eating, low salt (sodium) eating, label reading, and foods to avoid. Patients reported that they were not necessarily interested in calorie counting, so general information and advice on healthy eating including reducing salt [23-25,29], recipe suggestions and the healthy eating section of Heart Foundation website [30] were consulted. These resources were deemed relevant to family caregivers who commonly prepare and/or assist with meal planning and cooking. Recommendations, advice, and insight regarding nutritional education were provided by the clinical dietitian on the co-design team.

Daily weight management in this subsection of the app gives the user the ability to record daily weight, view a 7-day weight trend on a bar graph, receive color-coded feedback based on this data and pop up alerts depending on stability of that day’s weight in comparison to the dry weight set in the settings tab. Information on fluid retention including documenting daily weight and guidelines for help seeking [23-25,27] throughout the literature was consulted, alongside specialist input from the 2 nurse practitioners on the co-design team who regularly assisted in managing the variations in weight due to fluid congestion in worsening HF. The patients interviewed had variable understandings regarding fluid management, reporting what they knew about dry weight and the concern about going 2 kg over their dry weight. Clinicians thought that the weight section was highly important to include in the apps design, specifically around tracking weight data over the longer term. The co-design team believed having an interactive and visual interface that was tailored to patient parameters improved its utility. The nurse consultant was particularly involved in the colorful design of the feedback alert system when weights varied from the dry weight.

For some, self-monitoring of BP and pulse is important in HF. This My Plan subsection provides the option to record and store BP and pulse measurements. Clinicians generally supported the inclusion of patient data to track them; however, the inclusion of recording BP and pulse specifically, was inconsistent. One patient initially suggested the inclusion and the cardiologist agreed to it; however, the other clinicians believed it was not important enough to include especially comparative to other daily measures to track in HF. A second patient who does not self-monitor this data did not see it necessary to include in the app. Through ongoing discussions, it was decided this subsection would be included in the final design as the literature supports the intermittent documentation of BP [23,25]. Furthermore, the hospital’s discharge checklist specifies recording a postural BP (measurements taken while sitting and standing) and nature of the pulse as either regular, irregular, or paced (Appendix F [21]).

This subsection relates to the long-term planning required for patients with HF. This section contains information and prompts to decide on a plan, discuss this with others, speak to their doctor, and plan what happens to their defibrillator (an implantable medical device) if they have one. The inclusion of this section was deemed relevant by clinicians, and patients on the co-design team agreed to its inclusion without providing specific input into its content. The team reviewed the local advance care planning website [31] and palliative care recommendations for the multidisciplinary care of people with HF [7] as key literature sources.

The well-being component represents the psychological aspect of self-management. It contains an interactive depression screening tool, at risk or low risk results screens and information and advice pages. This section was suggested by a patient on the co-design team during the second design workshop as they felt it necessary to address the emotional support needed for people living with HF. In the interviews, patients reported the frequency of anxiety and worry. Patient needs included family, nature, mindfulness, and happiness demonstrated in 1 patient persona who balances quality of life with safety in HF in her pursuit to maintain well-being. The co-design team then conducted a literature review of the psychological care recommendations for HF [7], and clinicians communicated their use of the depression screen tool (Patient Health Questionnaire-2, PHQ-2 score) [32,33] routinely used in current practice. The PHQ-2 store is a 2-item validated questionnaire designed for the initial assessment of depression and anxiety in the primary care setting [32,33] and precedes referral for specialized care in the local hospital setting.

The exercise component has a step counter with 7-day graphical representation of daily steps. There was an inclusion of 3 exercise videos demonstrated by the physiotherapist—balance, upper limb, and lower limb—with a 7-day graph. Patient interviews uncovered that patients were using their smartphone’s step counter, appreciate supervised physical exercise and set exercise goals, for example one patient setting a 2 km daily walk. Clinicians valued ability to track patient data in considering the relevance to the patient group, and physiotherapist on the co-design team designed the exercise program to the specific context. The Otago exercise program to prevent falls in older adults [34], a resource commonly referred to for this patient population, formed the basis of the content of the balance and lower-limb exercises.