Effectiveness of an Avatar application for teaching heart attack recognition and response: A pragmatic randomized control trial

Aims: To evaluate the effectiveness of an Avatar application for educating people with acute coronary syndrome (heart attack). Background: A lack of understanding of Acute Coronary Syndrome symptoms and appropriate responses often contribute to delay in seeking medical treatment. Design: A single-centre, non-blinded, pragmatic randomized controlled trial. Methods: Seventy Acute Coronary Syndrome patients were randomly assigned to the intervention (Avatar application) or usual care groups. Participants were followed up at 0, 1, and 6 months. Tobit Growth Curve Model was used to analyse the primary outcome—symptom knowledge; and the secondary outcomes—attitudes and beliefs. Heart attack action plan implementation and health care utilisation were analysed using Chi-square and Mann–Whitney U test. Results: Of the 70 participants, 63% were male and the mean age of the participants was 64.7 (SD 11.7) years. Sixty-six (94.2%) participants completed follow-up. Between group differences on acute coronary syndrome (ACS) Response Index scores were statistically significant at 1-month and 6-month follow-ups (p <.01). The intervention group had a significant improvement in symptom knowledge, attitudes, and beliefs over the 6-month period (p <.001, p =.009, p <.001 respectively); and no significant improvement in the usual care group participants (p =.152, p =.068, p =.228). For healthcare use, at follow-up, there was a significant difference in ambulance use, between the intervention group and the usual care group (33.33% vs. 18.18%, p =.008; cardiac: 88.89% vs. 42.86%; p =.049); 85.14% of participants reported that the application helped them to feel more confident in recognizing and responding to symptoms in the future. Conclusion: The education app was effective in improving individuals’ ACS knowledge, attitudes, and beliefs. A large multi-centre trial with a longer follow-up to evaluate the intervention's effectiveness on clinical outcomes will be our next step in evaluation. Impact: The content of AVATARS (Nurse Cora) app can be translated into different languages and evaluated for patients from different health settings and linguistic backgrounds.