Smartphone-based mobile health impact on oral anticoagulation adherence, quality of life, and healthcare utilization in adult atrial fibrillation

Table 5 Mechanisms of action and feasibility of mobile health intervention

Ref.	Intervention/trial name	Process outcome domain	Key finding
Feasibility and engagement
Magnani et al[37], 2025	Rural AF intervention	Intervention fidelity: Median use of relational agent over 120 days	Excellent fidelity; participants used the agent a median of 84% of days
Guo et al., 2020[23]	mAFA-II (dynamic risk)	Communication fidelity: Frequency of patient/doctor messages	Significant, sustained message frequency over 12 months (P < 0.001)
Hsieh et al[35], 2021	Web-based program	Intervention delivery	Implemented via face-to-face training to ensure user competency
Patient activation and knowledge
Xu et al[36], 2024	Alfalfa app study	Anticoagulation knowledge (JAKQ)	Knowledge significantly higher in app group at 1 and 3 months (e.g., 78.1% vs 25.0% at 3 months; P < 0.001)
Hsieh et al[35], 2021	Web-based program	Coping strategies (brief COPE scale)	Significantly improved approach coping and reduced avoidance coping (P < 0.001)
Treatment optimization
Guo et al[23], 2020	mAFA-II (dynamic risk)	OAC treatment uptake/persistence	OAC use increased in intervention arm (63.4% to 70.2%) but decreased by 25% in usual care (P < 0.001)

AF: Atrial fibrillation; COPE scale: Coping orientation to problems experienced scale; OAC: Oral anticoagulant; COPE scale: Coping orientation to problems experienced scale; JAKQ: Japanese version of the anticoagulation knowledge questionnaire.