! What%is%Patient%Empowerment%(PEmp)?A"process"through"which"patients"gain"a"sense"of"control"""""""""""over"their"health"and"ability"to"manage"their"illness

! How%can%fertility%patients%benefit%from%PEmp?PEmp can"help"patients"to"feel"informed,"participate"in"decisions"about"their"fertility"care"and"better"manage"the"psychological"distress"associated"with"infertility,"which"involves"feelings"of"loneliness,"uncertainty"and"loss"of"control."

! Why%mHealth?Educational"resources"and"online"peer"support"have"been"shown"to"enhance"PEmpmHealth"provides"easily"accessible"information"that"is"simple"&"targeted"to"patients’"needs,"as"well"as"24/7"connection"with"peers"

INTRODUCTION

METHODS! A"pre:post%design%study%evaluating"a"new"mHealth"App

• Practical"information"about"infertility,"its"treatment"""and"associated"psychosocial"issues

• A"forum"where"users"can"share"lived"experiences"""""""and"emotional"support"with"peers.

! Participants:%men"and"women"undergoing"fertility"treatments"in"4"clinics"in"Montreal"and"Toronto"

! Google%Analyticswas"used"to"track"participant"activity"on"the"app"during"an"8Pweek"period

! Measures:

1. Demographic"characteristics"and"fertility"history

2. Patient%Empowerment%using"a"34Pitem"adapted"Patient'Empowerment'Questionnaire (van"UdenPKraan et"al."2009)• Responses"from"1"“completely"disagree”"to"5"“completely"agree”• 7"subscale"scores"and"a"total"score"(0P170),"with"higher"scores"

indicating"greater"PEmp

3. Perceived%stress%using"the"Perceived'Stress'Scale'(PSS74)(Cohen"et"al."1983)

• Responses"from"0"(“never”)"to"4"(“very"often”)• Total"score"between"0"and"16,"higher"="more"perceived"stress

4. Fertility:related%quality%of%life%using"the"36Pitem"FertiQoL(Boivin"et"al."2011)

• 4Ppoint"LikertPtype"scale• Final"scores"range"from"0P100,"higher"="better"QoL

! Sample%characteristics%(N =%152)

! Empowerment%scores

DISCUSSION! Promoting"PEmp is"becoming"increasingly"recognized"as"an"important"aspect"of"patientPcentered"care"and"patient"wellPbeing."PEmp may"help"fertility"patients"cope"with"the"

stress"of"treatment"and"impaired"quality"of"life."In"fact,"this"study"shows"that"those"who"felt"more"empowered"were"less"stressed"and"had"a"better"quality"of"life.

! People"with"lower"initial"PEmp were"more"engaged"with"the"app,"suggesting"that"Infotilitymay"be"a"helpful"resource"to"these"patients"as"it"provides"tools"to"better"understand"infertility,"navigate"treatment,"cope"and"feel"supported."

! Although"results"regarding"men"are"exploratory"due"to"small"sample"size,"this"study"demonstrate"the"potential"of"an"mHealth"forum"to"improve"patient"empowerment"in"men"under"stress."Stressed"men"may"be"especially"empowered"by"mobile"access"to"peers"as"it"offers"a"safe"and"anonymous"place"to"express"feelings,"and"obtain"validation,"emotional"support"and"knowledge."

Fertility%Patients’%Empowerment%and%Engagement%with%an%mHealth%AppFélicia'Brochu1'2,'Peter'Chan2'3,'Carolyn'Ells1'2'4,'Nancy'Feeley1'2'4,'Kirk'Lo5,'Neal'Mahutte6,'Sophia'Ouhilal6,'Togas'Tulandi1'2'3 &'Phyllis'Zelkowitz1'2'4

1Jewish"General"Hospital,"Montreal,"Quebec,"Canada;"2McGill"University,"Montreal,"Quebec,"Canada;"3McGill"University"Health"Centre,"Montreal,"Quebec,"Canada;"4Lady"Davis"Institute,"Montreal,"Quebec,"Canada;5Mount"Sinai"Hospital,"Toronto,"Ontario,"Canada;"6Montreal"Fertility"Centre,"Montreal,"Quebec,"Canada;"

The%objectives%were%to%investigate%in%fertility%patients:%1. How%PEmp relates%to%quality%of%life%and%stress2. How%PEmp relates%to%engagement%with%an%mHealth%app3. Whether%PEmp changed%during%the%study%and%in%

relation%to%use%of%an%mHealth%app

RESULTS

Women%(N =%122)

Men%(N =%30)

N % N %

LanguageFrench 44 36.1% 4 13.3%English 78 63.9% 26 86.7%Annual%household%Income≥ 100,000$ 73 60.3% 18 60.0%Highest%educational%degreeCEGEP,"technical"or"below

27 22.1% 11 36.7%

University 42 34.4% 10 33.3%Graduate 53 43.4% 9 30.0%Immigrant 42 35.0% 11 36.7%

Mean%age:%%♀ 35.23"(SD ="4.7)"""♂ 37.07"(SD ="5.6)Average%treatment%duration≥"1"year"for"58.2%"of"women"and"50.0%"of"men

Infertility%diagnosisMalePfactor:"20.4%" FemalePfactor:"34.9%MixedPfactor:"13.2%" Unexplained:"19.7%Undergoing testing:"11.2%

Empowerment%subscale Women MenBeing"informed 2.28"(0.08) 2.48"(0.22)Feeling"confident"with"my"physician 2.71"(0.05) 2.71"(0.12)Acceptance"of"fertility"problems 2.22"(0.08) 2.57"(0.16)Feeling"confident"about"my"treatment

2.91"(0.05) 2.91"(0.13)

Optimism"and"control"over"the"future

2.21"(0.06) 2.68"(0.14)

SelfPesteem 2.75"(0.08) 3.06"(0.13)Social"wellPbeing 2.78"(0.07) 3.13"(0.13)Total 86.76%(1.37) 93.42%(4.06)

Because"pairedPsamples"tPtests"revealed"that"PEmp scores"did"not"differ"between"Time"1"and"Time"2,"only"scores"from"Time"1"are"shown"below

8#weeksof#app#usage

Time%11st set"of"questionnaires

Time%22nd set"of"questionnaires

Infotility

In"both"women"and"men,"PEmp scores"were"negatively"related"to"perceived"stress"(r ="P.511"and"P.644,"both"p <".005)"and"positively"related"to"quality"of"life"(r =".593"and".612,"both"p <".005)"at"Time"1,"suggesting"that"those"with"greater"PEmp perceived"less"stress"

and"reported"a"better"quality"of"life.

1. How%does%PEmp relate%to%perceived%stress%and%quality%of%life?

2. How%does%PEmp relate%to%subsequent%engagement%with%the%app?PEmp scores"at"Time"1"were"explored"in"relation"to"3"engagement"indices"(EI)"developed"to"assess"overall"app"usage,"use"of"the"informational"content"of"the"app,"and"use"of"the"forum."These"EIs"were"created"by"summing"three"logPtransformed"and"standardized"indicators:"the"number"of"pages"viewed,"the"number"of"sessions"and"the"total"time"spent"on"pages."

3. Did%PEmp change%during%the%study%in%relation%to%engagement%with%the%app?

Women’s total%PEmp was%negatively%related%to%the%overall%app%EI%(r#=%:.195,%p#<%.05)%and%the%information%EI%(r#=%:.222,%p#<%.05),"suggesting"that"women"with"lower"PEmp at"Time"1"had"greater"engagement"with"the"app"overall,"and"in"particular"with"the"informational"section"of"the"app."

Men’s"PEmp was"not"related"to"overall"engagement"with"the"app."However,"a%significant%negative%association%was%found%between%men’s%PEmp and%the%forum%EI%(N#=%11,%r#=%:.759,%p#=%.005),"indicating"that"men"who"reported"lower"PEmp at"Time"1"showed"a"greater"subsequent"engagement"with"the"forum"than"those"with"higher"levels"of"PEmp."

Change"in"total"PEmp was"explored"in"relation"to"sociodemographic"characteristics,"fertility"history,"perceived"stress"and"quality"of"life"to"identify"subgroups"whose"levels"of"PEmp might"have"changed"during"the"study"in"relation"to"engagement.

Does#engagement#moderate#change#in#PEmp?

In"women%(N ="122),"positive"change"in"PEmp was"associated"with"higher"perceived"stress"at"Time"1"(r =".176,"p =".054)"and"seeking"psychological"counselling"during"treatment"(t ="P 3.151,"p <".005),"but"not"engagement"with"the"app.

In"men%(N ="30),"change"in"PEmp during"the"study"was"associated"with"perceived"stress"at"Time"1"(r =".470,"p <".01) and"engagement"with"the"forum"(r =".662,"p'<".05)."A"moderated"multiple"regression"revealed"a"significant"moderation"effect"of"the"forum"EI"on"the"relationship"between"stress"and"change"in"PEmp (N ="11,"β ="5.876,"SE ="2.701,"t ="2.176,"p <".05).

Moderation%modelF ="5.053,"p <".05,"R2"=".684

! Simple"slopes"analysis"indicated"that"men%who%were%highly%stressed%at%Time%1%and%who%engaged%with%the%forum%on%the%app%reported%a%greater%increase%in%PEmp post:intervention.%

Perceived"stress

Change"in"PEmp

Forum"EI

β ="5.515

β ="1.239