Many adolescents living with heart disease face challenges when transitioning from
pediatric to adult care. There is little evidence on how use of smartphone technology
influences transition readiness. Just TRAC it! is a method of using existing features
on a smartphone, including the Notes, Calendar, and Contacts apps, as a way for adolescents
and adults to manage their health. We aimed to investigate the impact of nurse-led
teaching with vs. without Just TRAC it! on self-management skills in this population.
METHODS AND RESULTS
We conducted a randomized clinical trial of 16-18 year olds with congenital heart
disease (CHD) or acquired heart disease requiring surgery. Participants were randomly
allocated 1:1 to either usual care (control; 1-hour education session) or the smartphone
intervention (1-hour education session including Just TRAC it!). The primary outcome
was change in TRANSITION-Q score between baseline, 3 and 6 months. Secondary outcomes
were frequency of use and perceived usefulness of Just TRAC it! at 3 and 6 months
post intervention. Analysis was intention to treat. We enrolled 68 patients (41% female,
mean age 17.3 years). Cardiac diagnosis was simple CHD (34%), moderate CHD (49%),
complex CHD (13%), and acquired heart disease (4%). Sixty-eight percent had previous
cardiac surgery and 26% had a previous cardiac catheterization. TRANSITION-Q scores
were similar at baseline and increased over time in both groups (Figure) but were
not significantly different between groups at 6 months. On average, TRANSITION-Q score
at 6 months were 0.9 points higher than at 3 months (95% CI 0.1-1.7). Each additional
point at the baseline score brought, on average, a 0.7 point increase in TRANSITION-Q
score (95% CI 0.5-0.9) each at 3 months and at 6 months. Perceived usefulness of Just
TRAC it! is summarized (Table). Ninety-seven percent of participants indicated they
would recommend Just TRAC it! to others at 3 months and 100% at 6 months.
Nurse-led transition teaching with vs. without Just TRAC it! improved transition readiness
based on TRANSITION-Q scores over time, with no significant difference between groups.
The majority of participants found Just TRAC it! useful, with the camera, calendar
and notes apps reported as the most useful. Participants had a positive reception
to Just TRAC it! and would recommend it to others. Longer follow-up is needed to assess
how smartphone technology is used by young adults to facilitate their entry into the
adult healthcare system.