# An accessible, scalable, patient-facing mHealth application for self-care of heart failure in LMIC

> **NIH NIH R21** · YALE UNIVERSITY · 2020 · $172,939

## Abstract

PROJECT SUMMARY
Heart failure (HF) affects more than 38 million people globally and is responsible for high rates of
hospitalization and premature mortality, especially in sub-Saharan Africa. HF causes multiple debilitating and
distressing symptoms. These can often be managed by patients themselves, but only when they are able to
identify symptoms and select appropriate actions. Self-care, a World Health Organization-endorsed
intervention for chronic conditions and a strong evidence base, is greatly underutilized in low- and middle-
income countries (LMIC). In Uganda, self-care is identified as one of the greatest unmet needs among patients
with HF. mHealth offers a promising platform to address this need gap in LMIC, by leveraging the widespread
penetration of mobile phones to offer individualized self-care tools such as education, healthy lifestyle prompts,
and decision support directly to patients with HF. Since 2016, our multidisciplinary, multi-national Research
Team has been collaborating to design a locally relevant mHealth application to improve self-care among
Ugandan patients with HF by adapting a smartphone-based app to the local context. Grounded in user-
centered design principles, we have developed Medly Uganda and conducted usability testing of this app and
an associated clinician dashboard. Medly Uganda is designed for low-cost feature phones and generates self-
care instructions based on patient-reported HF symptoms. The app features multiple innovations, including full
integration into a rapidly scaling, government-endorsed mHealth system and the use of both Unstructured
Supplementary Service Data (USSD) and Short Messaging Service (SMS), two universal mobile phone
platforms with complementary advantages.
Our current proposal has a strong scientific premise and is based on the rationale that an app that engages
patients with adaptive education and decision support can positively impact self-care and improve quality of life
and clinical outcomes of patients with HF in LMIC. We herein propose a comprehensive evaluation of both
implementation and clinical outcomes of Medly Uganda in a six month-long prospective cohort study of 72
patients and 10 clinicians at the Uganda Heart Institute in Kampala, Uganda. Alongside our two Specific Aims,
we propose an innovative Research Capacity Strengthening Plan that leverages the strengths of our
respective institutions. The proposed study lays the foundation for a multi-site randomized controlled trial of
Medly Uganda and will generate important insights into self-care of HF as well as the application of mHealth in
LMIC for chronic disease management.

## Key facts

- **NIH application ID:** 9984835
- **Project number:** 5R21TW010998-02
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Jeremy Ian Schwartz
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $172,939
- **Award type:** 5
- **Project period:** 2019-08-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9984835

## Citation

> US National Institutes of Health, RePORTER application 9984835, An accessible, scalable, patient-facing mHealth application for self-care of heart failure in LMIC (5R21TW010998-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9984835. Licensed CC0.

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