Perceived confidence for injury self‑management increases for young men with mild haemophilia with the use of the mobile app HIRT?

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Background: Young men with mild haemophilia have unique challenges pertaining to bleed management. They may not always identify musculoskeletal injury requiring medical attention as they do not bleed frequently, potentially resulting in significant health consequences. In response to these challenges, a team of clinicians, researchers and young men with mild haemophilia developed a self-assessment pathway which was converted into a mobile app. Aim: This study examined the influence of the mobile app, HIRT? (Hemophilia Injury Recognition Tool) on perceived injury self-management in young men with mild haemophilia in Canada. Methods: We used a mixed methods design. The quantitative data, through a self-report questionnaire, evaluated perceived injury self-management strategies and participant confidence levels. Non-parametric Wilcoxon signed-rank test and McNemar chi-square test were used to determine association between perceived self-management strategies when using and not using the app, with significant levels set at p<0.05. Qualitative data was created using interpretive description and inductive content analysis of recorded and transcribed interviews. Results: 12 young men, aged 18-35 years, participated. Perceived confidence levels significantly increased (p=0.004) with the use of the app. Five qualitative themes were identified: accessibility, credibility, the benefit of alarms, confidence and usefulness. Conclusion: This study provides promising evidence to support the feasibility and use of HIRT? as an injury self-management tool for young men with mild haemophilia. Future research should prospectively investigate the effect of the app on injury selfmanagement confidence.

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  • 1. World Federation of Hemophilia: Guidelines for the Management of Hemophilia. Available from: (accessed 11 April 2017).

  • 2. World Federation of Hemophilia: Annual Global Survey 2015. Available from: (accessed 11 April 2017).

  • 3. Blanchette VS Key NS Ljung LR et al. Definitions in hemophilia: communication from the SSC of the ISTH. J Thromb Haemost 2014;12: 1935-9.

  • 4. Canadian Hemophilia Assessment and Resource Management Information System (CHARMS). Report date 15 April 2014.

  • 5. Peerlinck K Jacquemin M. Mild haemophilia: a disease with many faces and many pitfalls. Haemophilia 2010; 16 (suppl. 5): 100-6.

  • 6. Lipton RA. I need to pay more attention to mild haemophilia patients. Haemophilia 2011; 17(4): 704. doi:

    • Crossref
    • Export Citation
  • 7. Kumar R Stain AM Hilliard P Carcao M. Consequences of delayed therapy for sports-related bleeds in patients with mild-to-moderate haemophilia and type 3 von Willebrand’s disease not on prophylaxis. Haemophilia 2013; 19: e256-69.

  • 8. Steele MJ Laudenbach L. Delay in treatment and increased morbidity in mild hemophilia. Haemophilia 2004; 10 (suppl. 3): 86.

  • 9. Price VE Hawes SA Bouchard A Vaughan A Jarock C Kuhle S. Unmeasured costs of haemophilia: the economic burden on families with children with haemophilia. Haemophilia 2015; 21 e294-9.

  • 10. Venkateswaran L Wilimas JA Jones DJ Nuss MD. Mild hemophilia in children: prevalence complications and treatment. J Pediatr Hematol Oncol 1998; 20: 32-5.

  • 11. Ekholm C Mattson E Astermark J Ljung R Berntorp E. Mild haemophilia in Sweden. Haemophilia 2010; 16 (suppl. 4): 90.

  • 12. Schulman S. Mild Hemophilia. Treatment of Hemophilia series-41. World Federation of Hemophilia. 2006. Accessed 1 Dec 2013.

  • 13. Jansen NWD Roosendaal G Lafeber FPJG. Understanding haemophilic arthropathy: an exploration of current open issues. Br J Haematol 2008; 143: 632-40.

  • 14. Tagliaferri A Di Perna C Riccardi F Pattacini C Rivolta GF. The natural history of mild haemophilia: a 30-year single centre experience. Haemophilia 2012; 18: 166-74. doi:

    • Crossref
    • Export Citation
  • 15. Franchini M Favaloro E J Lippi G. Mild Hemophilia A. J Thromb Haemost 2009; 8: 421-32. doi:

    • Crossref
    • Export Citation
  • 16. Chambost H Gaboulaud V Coatmelec B et al. What factors influence the age at diagnosis of hemophilia? Results of the French hemophilia cohort. J Pediatr 2002; 141: 548-52.

  • 17. Gamba G Lodo F Trinchero A Montani N Ghidelli N. Patterns of bleeding age at first bleeding episode and at diagnosis in severe and mild/moderate haemophilia. Haemophilia 2010; 16 (suppl.4): 91.

  • 18. Nilson J Schachter C Mulder K et al. A qualitative study identifying the knowledge attitudes and behaviours of young men with mild haemophilia. Haemophilia 2012; 18: e120-5.

  • 19. Lindvall K Colstrup L Loogna K Wollter IM Gronhaug S. Knowledge of disease and adherence in adult patients with hemophilia. Haemophlia 2010; 16 592-6.

  • 20. Smartphone definition accessed 15 Jan 2017.

  • 21. Nilson J Mulder K Schachter C. A new self-assessment pathway tool for young men with mild hemophilia A and B who experience musculoskeletal bleeds. Haemophilia 2012; 18 (suppl. 3): 106.

  • 22. Canadian Wireless Technology Association. CWTA Facts and Figures 2015. Available from: (accessed 17 October 2015).

  • 23. Future in Focus: Digital Canada. (2015). Available from: http:// (accessed 28 April 2017).

  • 24. Dicianno BE Parmanto B Fairman AD et al. Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitation. Phys Ther 2015; 95(3): 397-405.

  • 25. Free C Philips G Galli L et al. The effectiveness of mobilehealth technology-based health behaviour change or disease management interventions for health care consumers: A systematic review. PLoS Med 2013; 10(1): e1001362. doi:

    • Crossref
    • Export Citation
  • 26. Cummings E Hauser J Cameron-Tucker H et al. Enhancing self-efficacy for self-management in people with cystic fibrosis. Stud Health Technol Inform 2011; 169: 33-7.

  • 27. Steele Gray C Miller D Kuluski K Cott C. Tying eHealth tools to patient needs: Exploring the use of eHealth for communitydwelling patients with complex chronic disease and disability. JMIR Res Protoc 2014; 3(4): e67. doi:

    • Crossref
    • Export Citation
  • 28. Wayne N Ritvo P. Smartphone-enabled health coach intervention for people with diabetes from a modest socioeconomic strata: Single arm longitudinal feasibility study. J Med Internet Res 2014; 16(6): e149. doi:

    • Crossref
    • Export Citation
  • 29. Boulos MNK Wheeler S Tavares C Jones R. How smartphones are changing the face of mobile and participatory healthcare: an overview with example from eCAALYX. Biomedical Engineering OnLine 2011; 10: 24. doi:

    • Crossref
    • Export Citation
  • 30. Lomotey RK Mulder K Nilson J et al. Mobile selfmanagement guide for young men with mild hemophilia in cases of minor injuries. Netw Model Anal Health Inform Bioinforma 2014; 3: 64. doi:

    • Crossref
    • Export Citation
  • 31. Richard L Morse JM. README FIRST for a User’s Guide to Qualitative Methods. 3rd edn. Los Angeles London: Sage Publications Inc; 2013.

  • 32. Andrew S Halcomb EJ. Mixed Methods Research for Nursing and Health Sciences. Oxford: Blackwell Publishing Ltd; 2009.

  • 33. Keller VF White MK. Choices and changes: A new model for influencing patient behaviour. J Clin Outcomes Manag 1997; 4(6): 33-6.

  • 34. Apache CouchDB Futon Browse Database. Available from: (accessed 15 December 2015).

  • 35. IBM; SPSS software. Available from: (accessed 3 March 2015).

  • 36. Dawson B Trapp RG (eds.). Basic and Clinical Biostatistics. (Ch.5). 4th edn. McGraw-Hill Companies; 2004.

  • 37. Thorne S. Interpretive Description. Walnut Creek CA: Left Coast Press; 2008.

  • 38. QRS International. NVivo for Windows. Available from: (accessed 3 March 2015).

  • 39. Braun V Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.

  • 40. Canadian Society for Exercise Physiology. Canadian Physical Activity Guidelines for Adults 18-64 Years. Available from: (accessed 28 April 2017).

  • 41. Nilson J. Are you HIRT? (Hemophilia Injury Recognition Tool): Perceptions from young men with mild hemophilia in Canada on the use of the mobile app for injury self-management (Master’s thesis University of Saskatchewan). 2016. Available from:

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