Mobile applications in surgical patient health education: an integrative review

An integrative literature review performed through consultation in the following portals and/or databases: VHL; PubMed; Web of Science; Scopus; LILACS and CINAHL. The search was guided by the question: “What is the evidence on the use of mobile applications in the health education of surgical patients?” conducted from July to September 2017, including articles published from the year 2000 to 2017.

RESULTS

Five articles published in international journals in English with varied methodological designs were selected. Among the studies found, 60% used an educational intervention through smartphone applications in the pre and postoperative periods, and 40% of the studies had an evidence level of 2B.

CONCLUSION

The studies showed that the use of smartphone applications in educating and guiding surgical patients was effective. However, there is still a gap in studies which demonstrate surgical patient education through smartphone applications.

Descriptors:
Perioperative Care; Health Education; Mobile Applications; Smartphone; Perioperative Nursing; Review

Database	Search structure
BVS	Patient education AND smartphone Education intervention AND mobile phone AND surgical patients (“Smartphone” OR “Mobile Phone”) AND (Orientation OR Advice) AND (“Pacientes Cirúrgicos” OR “Paciente Cirúrgico” OR “Surgical Patients” OR “Surgical Patient”)
PubMed	((“Mobile Applications”[Mesh] OR “Mobile Applications”[tiab])) AND surgery
Scopus	(Smartphone OR “Mobile Phone” OR “Cell Phone” OR Cellphone OR “Smart Phone”) AND (Patient* AND Surgery)
Web of Science	(Smartphone OR “Mobile Phone” OR “Cell Phone” OR Cellphone OR “Smart Phone”) AND (Patient* AND Surgery)
LILACS	(Smartphone OR “Mobile Phone” OR “Cell Phone” OR Cellphone OR “Smart Phone”) AND (Patient* AND Surgery)
CINAHL	(Smartphone OR “Mobile Phone” OR “Cell Phone” OR Cellphone OR “Smart Phone”) AND (Patient* AND Surgery)
Medline	(Smartphone OR “Mobile Phone” OR “Cell Phone” OR Cellphone OR “Smart Phone”) AND (Patient* AND Surgery)

Author	N	Objective	Intervention	Measuring instrument	Result	Evidence level
Mundi et al.(8)	30	Evaluate the acceptability and effectiveness of a mobile app in preparing patients for bariatric surgery.	Mobile application with videos and messages, preoperatively. Application of the knowledge test before the intervention and after 12 weeks. Physical activity and usability test applied after 12 weeks.	Knowledge Test International Physical Activity Short Form Questionnaire (IPAQ-SF)/Instrument developed by the researcher regarding usability.	Only 10 patients completed the study. There was an increase in nutritional knowledge, and greater engagement in a healthy lifestyle. Application adapted to the patient’s daily routine, was useful for surgery preparation, patients reported better connection with the surgical team.	2B
Cho, Lee(9)	123	To evaluate the knowledge acquired using the Safe patients mobile app in patients undergoing general, urological, orthopedic and neurological surgery.	Application usage for 3 days. Evaluation moment: before and after 3 days.	Instrument developed by the researcher with seven true and false questions about patient safety.	Average correct answers pre-test of 64.8% and post-test of 75.8% (p<0.001).	1C
Foley et al.(10)	39 IG=13 CG=26	Evaluate the effectiveness of using an iPad app to reduce anxiety and depression in patients undergoing mastectomy.	IPad app with information, animations and comfort messages. Time of assessment: one week before surgery, when they received iPad, and postoperatively after one week, in routine outpatient consultations.	Hospital Anxiety and Depression Scale (HADS)/ Mini-Mental Adjustment to Cancer (Mini-MAC)/ The Information Technology Familiarity Questionnaire/ Information Satisfaction Questionnaire.	Homogeneous groups in the preoperative HADS scale score and immediate postoperative, but significantly lower in the control group patients in the 7th postoperative period (p = 0.029 for anxiety and 0.022 for depression). There was no significant difference in 4 of the 5 domains of the Mini-MAC questionnaire. Satisfaction with the information received by the application was similar between the pre and postoperative groups.	1B
Scott et al.(11)	20	To evaluate the interest in using self-reporting mobile applications and warning sign screening in patients after colorectal surgery and to better understand the factors that affect postoperative use of the application at home.	Application presented to the patient upon admission and instructed to use daily for 2 weeks after hospital discharge. (There was a $10 incentive to use).	System Usability Scale (SUS)/Semi-structured interview.	Loss of five patients. SUS scale score of 95. Interview results: 75% daily use; frequency of use: 80% at least seven times and 26.7% over 25 times. Overall impression: The app serves as a second opinion or supplement to the information received previously.	2B
Kim et al.(12)	17	To evaluate the effectiveness of the mobile application with the iGetBetter (iGB) program as an alternative to support and encourage patients for better adherence to the preoperative and postoperative total knee arthroplasty (TKA) protocol.	Provided an iPad mini to the patients with internet to access the app. Patients used the app in self-preparation and perioperative recovery, with manual data recording on the iPad mini. Data to be recorded: execution of the care plan during the day; response to common reminders in pre- and postoperative TKA protocols received by the application.	IGB Clinical Dashboard, the system triggers alerts to the clinician if patients provide answers out of range of what the clinician considers acceptable.	In the 14 days before the operation, 92.3% of the patients participated in the education accesses (n=6), a necessary amount, with an average of 3.5 and a 59% reduction in adherence. Postoperatively there was an average of 17.8 accesses in 30 days (59.2%), with no significant difference between the number of accesses in the preoperative phase. 2,045 responses (157 answers per patient) were given to 3,984 specific instructions considering patient losses (307 questions per patient), involving consultations and follow-up, which resulted in a 51% response rate.	2C

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author:
Rafaela Cristina Gomes Machado. Av. Dr. Enéas de Carvalho, 419, Cerqueira César CEP 05403-000 - São Paulo, SP, Brazil. rafaela.cristina.machado@usp.br