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Baptista S, Wadley G, Bird D, Oldenburg B, Speight J. Acceptability of an Embodied Conversational Agent for Type 2 Diabetes Self-Management Education and Support via a Smartphone App: Mixed Methods Study. JMIR Mhealth Uhealth 2020; 8:e17038. [PMID: 32706734 PMCID: PMC7407258 DOI: 10.2196/17038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/18/2020] [Accepted: 03/29/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Embodied conversational agents (ECAs) are increasingly used in health care apps; however, their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated. OBJECTIVE This study aimed to evaluate the acceptability of the ECA (Laura) used to deliver diabetes self-management education and support in the My Diabetes Coach (MDC) app. METHODS A sequential mixed methods design was applied. Adults with T2D allocated to the intervention arm of the MDC trial used the MDC app over a period of 12 months. At 6 months, they completed questions assessing their interaction with, and attitudes toward, the ECA. In-depth qualitative interviews were conducted with a subsample of the participants from the intervention arm to explore their experiences of using the ECA. The interview questions included the participants' perceptions of Laura, including their initial impression of her (and how this changed over time), her personality, and human character. The quantitative and qualitative data were interpreted using integrated synthesis. RESULTS Of the 93 intervention participants, 44 (47%) were women; the mean (SD) age of the participants was 55 (SD 10) years and the baseline glycated hemoglobin A1c level was 7.3% (SD 1.5%). Overall, 66 of the 93 participants (71%) provided survey responses. Of these, most described Laura as being helpful (57/66, 86%), friendly (57/66, 86%), competent (56/66, 85%), trustworthy (48/66, 73%), and likable (40/66, 61%). Some described Laura as not real (18/66, 27%), boring (26/66, 39%), and annoying (20/66, 30%). Participants reported that interacting with Laura made them feel more motivated (29/66, 44%), comfortable (24/66, 36%), confident (14/66, 21%), happy (11/66, 17%), and hopeful (8/66, 12%). Furthermore, 20% (13/66) of the participants were frustrated by their interaction with Laura, and 17% (11/66) of the participants reported that interacting with Laura made them feel guilty. A total of 4 themes emerged from the qualitative data (N=19): (1) perceived role: a friendly coach rather than a health professional; (2) perceived support: emotional and motivational support; (3) embodiment preference acceptability of a human-like character; and (4) room for improvement: need for greater congruence between Laura's words and actions. CONCLUSIONS These findings suggest that an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing ongoing, friendly, nonjudgmental, emotional, and motivational support is well received. Nevertheless, the ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry CTRN12614001229662; https://tinyurl.com/yxshn6pd.
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Affiliation(s)
- Shaira Baptista
- The University of Melbourne, Melbourne, Australia.,The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
| | - Greg Wadley
- The University of Melbourne, Melbourne, Australia
| | | | | | - Jane Speight
- The University of Melbourne, Melbourne, Australia.,The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
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- see Authors' Contributions,
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Baptista S, Wadley G, Bird D, Oldenburg B, Speight J. User Experiences With a Type 2 Diabetes Coaching App: Qualitative Study. JMIR Diabetes 2020; 5:e16692. [PMID: 32706649 PMCID: PMC7395244 DOI: 10.2196/16692] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/08/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diabetes self-management apps have the potential to improve self-management in people with type 2 diabetes (T2D). Although efficacy trials provide evidence of health benefits, premature disengagement from apps is common. Therefore, it is important to understand the factors that influence engagement in real-world settings. OBJECTIVE This study aims to explore users' real-world experiences with the My Diabetes Coach (MDC) self-management app. METHODS We conducted telephone-based interviews with participants who had accessed the MDC self-management app via their smartphone for up to 12 months. Interviews focused on user characteristics; the context within which the app was used; barriers and facilitators of app use; and the design, content, and delivery of support within the app. RESULTS A total of 19 adults with T2D (8/19, 42% women; mean age 60, SD 14 years) were interviewed. Of the 19 interviewees, 8 (42%) had T2D for <5 years, 42% (n=8) had T2D for 5-10 years, and 16% (n=3) had T2D for >10 years. In total, 2 themes were constructed from interview data: (1) the moderating effect of diabetes self-management styles on needs, preferences, and expectations and (2) factors influencing users' engagement with the app: one size does not fit all. CONCLUSIONS User characteristics, the context of use, and features of the app interact and influence engagement. Promoting engagement is vital if diabetes self-management apps are to become a useful complement to clinical care in supporting optimal self-management. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry CTRN126140012296; URL https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366925&isReview=true.
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Affiliation(s)
- Shaira Baptista
- Melbourne School of Population and Global Health, Melbourne, Australia.,Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
| | - Greg Wadley
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - Dominique Bird
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, Melbourne, Australia
| | - Jane Speight
- Melbourne School of Population and Global Health, Melbourne, Australia.,Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
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- See Authors' Contributions section,
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Omar MA, Hasan S, Palaian S, Mahameed S. The impact of a self-management educational program coordinated through WhatsApp on diabetes control. Pharm Pract (Granada) 2020; 18:1841. [PMID: 32477434 PMCID: PMC7243744 DOI: 10.18549/pharmpract.2020.2.1841] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/26/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Social media can effectively mediate digital health interventions and thus,
overcome barriers associated with face-to-face interaction. Objective: To assess the impact of patient-centered diabetes education program
administered through WhatsApp on glycosylated hemoglobin (HbA1c) values,
assess the correlation, if any, between health literacy and numeracy on
intervention outcomes Methods: During an ‘intervention phase’ spread over six months, target
diabetic patients (N=109) received structured education through WhatsApp as
per the American Association of Diabetes Educators Self-Care Behaviors
recommendations. The control group with an equal number of participants
received ‘usual care’ provided by health professionals void of
the social media intervention. Changes in HbA1c levels were recorded thrice
(at baseline, 3 and 6 months) for the test group and twice (baseline and 6
months) for the control group. Change in HbA1c values were compared and
statistical significance was defined at p<0.05. Baseline health
literacy and diabetes numeracy were assessed for both groups (N=218) using
the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test
(DNT), respectively, and values were correlated with HbA1c change
p<0.05. Participants’ satisfaction with the intervention was
also assessed. Results: The average age of respondents was 41.98 (SD 15.05) years, with a diabetes
history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the
control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively.
After six months, a significant drop in HbA1c value was noticed in
intervention group (7.7; SD 1.35; p= 0.001); with no significance in the
control group (8.4; SD 1.32; p=0.032, paired t-test). Moreover, the
reduction in HbA1c was more in the test group (0.7%) than the control
group (0.1%) with a difference of 0.6% which is considered
clinically significant. There was no significant correlation between LAD
score and HbA1c at baseline (r=-0.203, p=0.064), 3 months (r=-0.123,
p=0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar
result was observed with DNT, where DNT score and HbA1c at baseline, 3
months and 6 months showed no correlation (r=0.112, 0.959 and 0.886;
respectively) with HbA1c levels. Eighty percent of the respondents found the
social media intervention ‘beneficial’ and suggested it be
used long term. Conclusions: Diabetes education via WhatsApp showed promising outcomes regardless of the
level of patients’ health literacy or numeracy.
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Affiliation(s)
- Muaed Al Omar
- PhD. Associate Professor. Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University. Ajman (United Arab Emirates).
| | - Sanah Hasan
- PhD. Associate Professor. Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University. Ajman (United Arab Emirates).
| | - Subish Palaian
- PhD. Associate Professor. Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University. Ajman (United Arab Emirates).
| | - Shrouq Mahameed
- MSc. Research Assistant. Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University. Ajman (United Arab Emirates).
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Prinjha S, Ricci-Cabello I, Newhouse N, Farmer A. British South Asian Patients' Perspectives on the Relevance and Acceptability of Mobile Health Text Messaging to Support Medication Adherence for Type 2 Diabetes: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e15789. [PMID: 32310150 PMCID: PMC7199132 DOI: 10.2196/15789] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/01/2019] [Accepted: 01/26/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes (T2D) is greater in South Asian populations and health outcomes are poorer compared with other ethnic groups. British South Asians are up to six times more likely to have T2D than the general population, to develop the condition at a younger age, and to experience diabetes-related complications. Interventions to support people in managing their condition can potentially reduce debilitating complications. Evidence to support the use of digital devices in T2D management, including mobile phones, has shown positive impacts on glycemic control. There is increasing recognition that health interventions that are culturally adapted to the needs of specific groups are more likely to be relevant and acceptable, but evidence to support the effectiveness of adapted interventions is limited and inconclusive. OBJECTIVE This formative study aimed to explore the perceptions and views of British South Asian patients with T2D on mobile health SMS text messaging to support medication adherence, aimed at the general UK population. METHODS Eight exploratory focus groups were conducted in Leicester, the United Kingdom, between September 2017 and March 2018. A diverse sample of 67 adults took part. RESULTS British South Asian people with T2D who use digital devices, including mobile phones, felt that short messages to support medication adherence would be acceptable and relevant, but they also wanted messages that would support other aspects of self-management too. Participants were particularly interested in content that met their information needs, including information about South Asian foods, commonly used herbs and spices, natural and herbal approaches used in the United Kingdom and in South Asia, and religious fasting. Short messages delivered in English were perceived to be acceptable, often because family members could translate for those unable to read or understand the messages. Suggestions to support patients unable to understand short messages in English included having them available in different formats, and disseminated in face-to-face groups for those who did not use digital devices. CONCLUSIONS Exploring the views of British South Asian patients about SMS text messaging aimed at the general UK population is important in maximizing the potential of such an intervention. For such a digital system to meet the needs of UK South Asian populations, it may also have to include culturally relevant messages sent to those who opt to receive them. It is equally important to consider how to disseminate message content to patients who do not use digital devices to help reduce health inequalities.
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Affiliation(s)
- Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ignacio Ricci-Cabello
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, Palma de Mallorca, Illes Balears, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Illes Balears, Spain
- Ciber de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Patients' Perspective on Digital Technologies in Advanced Genitourinary Cancers. Clin Genitourin Cancer 2020; 19:76-82.e6. [PMID: 32527682 DOI: 10.1016/j.clgc.2020.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Digital technologies allow for the remote monitoring of cancer patients and thereby close an important care gap. Despite a variety of upcoming digital health-tech solutions, there is little knowledge on uro-oncologic patients' perception of digital technologies in clinical care and cancer trials. PATIENTS AND METHODS A questionnaire was developed to evaluate patients' current use, preferences, and expectations of digital health technology. Patients receiving systemic treatment for urothelial, prostate, and renal-cell carcinoma were included during outpatient visits. RESULTS Ninety-seven patients undergoing systemic therapy for metastatic renal-cell, urothelial, or prostate cancer were included in the final analysis. Internet, smartphone, and wearable user rates were significantly higher in younger patients (100% user rate in age group 40-49 years vs. 38% in age group 80-89 years). Patients were more likely to use wearables in clinical trials when they received the generated data (2.9/5) than when they did not (2.3/5, P < .0001). Interest in activity data (3.7/5) was higher than sleeping data (2.7/5, P < .0001), but desire for sleeping data increases with advancement of treatment lines (3.9, P = .008). Patients prefer a digital follow-up every 2.6 days; younger patients and those receiving advanced therapy lines prefer less frequent follow-up (respectively, every 3.3 days, P = .050, and every 4.0 days, P = .0001). Patients allow a maximum of an average of 2.2 minutes daily for digital follow-up. CONCLUSION We observed high engagement in digital technologies and interest in the data generated by digital devices. However, for the development of future health care applications, aspects such as patient age, gender, and therapy line need to be considered in uro-oncologic patients.
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Zhang Y, Liu C, Luo S, Huang J, Li X, Zhou Z. Effectiveness of Lilly Connected Care Program (LCCP) App-Based Diabetes Education for Patients With Type 2 Diabetes Treated With Insulin: Retrospective Real-World Study. JMIR Mhealth Uhealth 2020; 8:e17455. [PMID: 32141838 PMCID: PMC7084288 DOI: 10.2196/17455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 02/06/2023] Open
Abstract
Background Diabetes poses heavy economic and social burdens worldwide. Mobile apps show great potential for diabetes self-management education. However, there is limited evidence for the effectiveness of providing general diabetes education through mobile apps. Objective The aim of this study was to clarify the effectiveness of Lilly Connected Care Program (LCCP) app-based diabetes education for glycemic control. Methods This retrospective cohort study included patients with diabetes recruited to the LCCP platform from September 1, 2018, to May 31, 2019. Each patient was followed for 12 weeks. According to the number of diabetes education courses they had completed, the patients were divided into the following three groups: group A (0-4 courses), group B (5-29 courses), and group C (≥30 courses). The main outcomes were the change in blood glucose at the 12th week compared with baseline and the differences in blood glucose at the 12th week among the three groups. The associations of the number of diabetes education courses completed with the average blood glucose and frequency of self-monitoring of blood glucose (SMBG) at the 12th week were assessed by multivariate linear regression analyses controlling for other confounding covariates. Univariate and multivariate linear regression analyses were used to assess factors influencing patients’ engagement in the diabetes education courses. Results A total of 5011 participants were enrolled. Their mean fasting blood glucose (FBG) and postprandial blood glucose (PBG) were significantly lower at the 12th week than at baseline (FBG, 7.46 [standard deviation (SD) 1.95] vs 7.79 [SD 2.18] mmol/L, P<.001; PBG, 8.94 [SD 2.74] vs 9.53 [SD 2.81] mmol/L, P<.001). The groups that completed more diabetes education courses had lower FBG (group B, β=−0.14, 95% CI −0.26 to −0.03; group C, β=−0.29, 95% CI −0.41 to −0.16; P for trend <.001) and PBG (group B, β=−0.29, 95% CI −0.46 to −0.11; group C, β=−0.47, 95% CI −0.66 to −0.28; P for trend <.001) and a higher frequency of SMBG at the 12th week (group B, β=1.17, 95% CI 0.81-1.53; group C, β=4.21, 95% CI 3.81-4.62; P for trend <.001) when compared with the findings in group A. Age and education were related to patients’ engagement in the diabetes education courses. Middle-aged patients (35-59 years old) and elderly patients (≥60 years old) completed more diabetes education courses (middle-aged group, β=2.22, P=.01; elderly group, β=2.42, P=.02) than young patients (18-34 years old). Conclusions LCCP app-based diabetes education is effective for glycemic control and SMBG behavior improvement in patients with type 2 diabetes receiving insulin therapy. Young patients’ engagement in the education courses was relatively low. We need to conduct in-depth interviews with users to further improve the curriculum.
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Affiliation(s)
- Yiyu Zhang
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuoming Luo
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Jin Huang
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
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Young HM, Miyamoto S, Dharmar M, Tang-Feldman Y. Nurse Coaching and Mobile Health Compared With Usual Care to Improve Diabetes Self-Efficacy for Persons With Type 2 Diabetes: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e16665. [PMID: 32130184 PMCID: PMC7076411 DOI: 10.2196/16665] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a growing public health problem amenable to prevention and health promotion. As healthy behaviors have an impact on disease outcomes, approaches to support and sustain diabetes self-management are vital. OBJECTIVE This study aimed to evaluate the effectiveness of a nurse coaching program using motivational interviewing paired with mobile health (mHealth) technology on diabetes self-efficacy and self-management for persons with type 2 diabetes. METHODS This randomized controlled trial compared usual care with an intervention that entailed nurse health coaching and mHealth technology to track patient-generated health data and integrate these data into an electronic health record. The inclusion criteria were as follows: (1) enrolled at 1 of 3 primary care clinics, (2) aged 18 years or above, (3) living with type 2 diabetes, and (4) English-speaking. We collected outcome measures at baseline, 3 months, and 9 months. The primary outcome was diabetes self-efficacy; secondary outcomes were depressive symptoms, perceived stress, physical functioning, and emotional distress and anxiety. Linear regression mixed modeling estimated the population trends and individual differences in change. RESULTS We enrolled 319 participants; 287 participants completed the study (155 control and 132 intervention). The participants in the intervention group had significant improvements in diabetes self-efficacy (Diabetes Empowerment Scale, 0.34; 95% CI -0.15,0.53; P<.01) and a decrease in depressive symptoms compared with usual care at 3 months (Patient Health Questionnaire-9; 0.89; 95% CI 0.01-1.77; P=.05), with no differences in the other outcomes. The differences in self-efficacy and depression scores between the 2 arms at 9 months were not sustained. The participants in the intervention group demonstrated a significant increase in physical activity (from 23,770 steps per week to 39,167 steps per week at 3 months and 32,601 per week at 9 months). CONCLUSIONS We demonstrated the short-term effectiveness of this intervention; however, by 9 months, although physical activity remained above the baseline, the improvements in self-efficacy were not sustained. Further research should evaluate the minimum dose of coaching required to continue progress after active intervention and the potential of technology to provide effective ongoing automated reinforcement for behavior change. TRIAL REGISTRATION ClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176.
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Affiliation(s)
- Heather M Young
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Sheridan Miyamoto
- College of Nursing, The Pennsylvania State University, University Park, PA, United States
| | - Madan Dharmar
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Yajarayma Tang-Feldman
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
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Matricardi PM, Dramburg S, Alvarez‐Perea A, Antolín‐Amérigo D, Apfelbacher C, Atanaskovic‐Markovic M, Berger U, Blaiss MS, Blank S, Boni E, Bonini M, Bousquet J, Brockow K, Buters J, Cardona V, Caubet J, Cavkaytar Ö, Elliott T, Esteban‐Gorgojo I, Fonseca JA, Gardner J, Gevaert P, Ghiordanescu I, Hellings P, Hoffmann‐Sommergruber K, Fusun Kalpaklioglu A, Marmouz F, Meijide Calderón Á, Mösges R, Nakonechna A, Ollert M, Oteros J, Pajno G, Panaitescu C, Perez‐Formigo D, Pfaar O, Pitsios C, Rudenko M, Ryan D, Sánchez‐García S, Shih J, Tripodi S, Van der Poel L, Os‐Medendorp H, Varricchi G, Wittmann J, Worm M, Agache I. The role of mobile health technologies in allergy care: An EAACI position paper. Allergy 2020; 75:259-272. [PMID: 31230373 DOI: 10.1111/all.13953] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/12/2019] [Indexed: 12/24/2022]
Abstract
Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the "Be He@lthy, Be Mobile" WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the "General Data Protection Regulation" and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed.
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Affiliation(s)
- Paolo Maria Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité ‐ University Medicine Berlin Berlin Germany
| | - Stephanie Dramburg
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité ‐ University Medicine Berlin Berlin Germany
| | - Alberto Alvarez‐Perea
- Allergy Service Hospital General Universitario Gregorio Marañón Madrid Spain
- Gregorio Marañón Health Research Institute Madrid Spain
| | | | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine University of Regensburg Regensburg Germany
| | | | - Uwe Berger
- Department of Oto‐Rhino‐Laryngology Medical University of Vienna Vienna Austria
| | - Michael S. Blaiss
- Medical College of Georgia at Augusta University Augusta Georgia USA
| | - Simon Blank
- Center of Allergy and Environment (ZAUM), School of Medicine and Helmholtz Center Munich Technical University of Munich Munich Germany
| | - Elisa Boni
- Allergy Unit Santo Spirito Hospital Alessandria Italy
| | - Matteo Bonini
- National Heart and Lung Institute Royal Brompton Hospital & Imperial College London London UK
- Fondazione Policlinico Universitario A. Gemelli – IRCCS Rome Italy
- Universita’ Cattolica del Sacro Cuore Rome Italy
| | - Jean Bousquet
- University Hospital Montpellier France
- Contre les MAladies Chronique spour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site MACVIA‐France Montpellier France
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine Technical University of Munich Munich Germany
| | - Jeroen Buters
- Center of Allergy and Environment (ZAUM), School of Medicine and Helmholtz Center Munich Technical University of Munich Munich Germany
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine Hospital Vall d'Hebron Barcelona
- ARADyAL Research Network Barcelona Spain
| | - Jean‐Christoph Caubet
- Department of the Child and Adolescent, Pediatric Allergy Unit Geneva University Hospital Geneva Switzerland
| | - Özlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Goztepe Training and Research Hospital Istanbul Medeniyet University Istanbul Turkey
| | - Tania Elliott
- New York University Medical Center New York New York USA
| | | | - Joao A. Fonseca
- CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine University of Porto Porto Portugal
- MEDIDA, Lda Porto Portugal
- MEDCIDS, Dpt. of Community Medicine, Information, and Health Sciences, Faculty of Medicine University of Porto Portugal
| | - James Gardner
- Great North Children's Hospital Newcastle UK
- Newcastle University Newcastle UK
| | - Philippe Gevaert
- Department of Otorhinolaryngology Ghent University Ghent Belgium
| | | | - Peter Hellings
- Euforea Brussels Belgium
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | | | - A. Fusun Kalpaklioglu
- Department of Immunology and Allergic Diseases Kirikkale University School of Medicine Kırıkkale Turkey
| | | | | | - Ralph Mösges
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology University of Cologne Cologne Germany
- CRI ‐ Clinical Research International Ltd. Cologne Germany
| | - Alla Nakonechna
- Department of Allergy Broadgreen Hospital Liverpool UK
- Liverpool Hope University Liverpool UK
| | - Markus Ollert
- Department of Infection and Immunity Luxembourg Institute of Health Esch‐sur‐Alzette Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis University of Southern Denmark Odense C Denmark
| | - José Oteros
- Center of Allergy and Environment (ZAUM), School of Medicine and Helmholtz Center Munich Technical University of Munich Munich Germany
| | - Giovanni Pajno
- Allergy Unit‐ Department of Pediatrics University of Messina Messina Italy
| | - Catalina Panaitescu
- Family Medicine Solo Practice RespiRO – Romanian Primary Care Respiratory Group Bucharest Romania
| | - Daniel Perez‐Formigo
- Department of Ophthalmology Hospital Universitario de Torrejon Madrid Spain
- Faculty of Medicine University of Francisco de Vitoria (UFV) Pozuelo de Alarcon, Madrid Spain
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | | | | | - Dermot Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK
- Optimum Patient Care Cambridge UK
| | - Silvia Sánchez‐García
- Allergy Unit Hospital Infantil Universitario Niño Jesús Madrid Spain
- Spanish Research Network on Allergy (ARADyAL: Red Nacional de Alergia ‐Asma, Reacciones Adversas y Alérgicas‐) of the Carlos III Health Institute Madrid Spain
| | - Jennifer Shih
- Emory University and Children's Healthcare of Atlanta Atlanta Georgia USA
| | | | | | - Harmieke Os‐Medendorp
- Department of Dermatology and Allergology University Medical Center Utrecht The Netherlands
| | - Gilda Varricchi
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI) University of Naples Federico II Naples Italy
| | - Jörn Wittmann
- Selbstregulierung Informationswirtschaft eV Berlin Germany
| | - Margitta Worm
- Department of Dermatology and Allergology, Allergy‐Center‐Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
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Yasmin F, Ali L, Banu B, Rasul FB, Sauerborn R, Souares A. Understanding patients' experience living with diabetes type 2 and effective disease management: a qualitative study following a mobile health intervention in Bangladesh. BMC Health Serv Res 2020; 20:29. [PMID: 31918704 PMCID: PMC6953219 DOI: 10.1186/s12913-019-4811-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2017, 425 million adults worldwide had diabetes; 80% were living in low and middle-income countries. Bangladesh had 6.9 million adults with diabetes; death from diabetes comprised 3% of the country's total mortality. This study looked at different factors (personal, familial, social, and financial) affecting both the life of patients with diabetes type 2 and the management of the disease. It also explored patient's perception of the mobile health intervention in the context of disease management and helped to explain the findings obtained from the quantitative part of this study. METHOD The study was a mixed-method, sequential explanatory design. A mobile health project (interactive voice call and call center) was implemented in Dhaka district, Bangladesh from January to December, 2014. Patients received treatment at the outpatient department of Bangladesh Institute of Health Science Hospital, Dhaka, Bangladesh, were included in intervention and control groups of the main study following a Randomized Control Trial. Among them, a total of 18 patients (9 + 9) were selected purposefully for the qualitative study, which was conducted in July, 2015. The sample was selected purposefully considering the age, sex, socio-economic status and proximity of living due to the political instability of the country during the data collection period. The interviews were transcribed and analyzed applying investigator triangulation. RESULTS Most patients stated that diabetes has affected their lives. In general, both groups´ evaluation of mobile health services were good and both regarded the recommendations for medication, diet, physical exercise, and other lifestyle behaviors (use of tobacco and betel nuts) as helpful. The cost of overall treatment (medications, physician consultations, laboratory investigations), the lack of availability of safe public places for physical exercise and unfavorable weather conditions (heat, rainfall) were mentioned as barriers to the overall management of the disease. CONCLUSION A patient-centered mobile health intervention supported by a collaborative patient-provider relationship, a strong family support system, available public spaces for exercise and the introduction of a functional public health insurance system could be beneficial for the better management of diabetes.
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Affiliation(s)
- F Yasmin
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany.
- Faculty of Health/Department of Human Medicine, University Witten/Herdecke, 58448, Witten, Germany.
| | - L Ali
- Bangladesh University of Health Sciences (BUHS), Mirpur-1, Dhaka, 1216, Bangladesh
| | - B Banu
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - F B Rasul
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
- BRAC James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, 1212, Bangladesh
| | - R Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - A Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
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Öberg U, Orre CJ, Hörnsten Å, Jutterström L, Isaksson U. Using the Self-Management Assessment Scale for Screening Support Needs in Type 2 Diabetes: Qualitative Study. JMIR Nurs 2020; 3:e16318. [PMID: 34345780 PMCID: PMC8279441 DOI: 10.2196/16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 05/10/2020] [Accepted: 08/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses' experiences using a digitalized scale for measuring patients' needs for self-management support in primary health care settings has been found. OBJECTIVE This paper describes diabetes specialist nurses' (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support. METHODS This qualitative study is based on observations and interviews analyzed using qualitative content analysis. RESULTS From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient's term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration. CONCLUSIONS Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalized care. Using a screening instrument in a patient meeting may also contribute to a role change in the work and practice of DSNs.
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Affiliation(s)
- Ulrika Öberg
- Department of Nursing Umeå University Umeå Sweden
| | - Carl Johan Orre
- Department of Computer Science and Media Technology DVMT, Malmö University Malmö Sweden
| | - Åsa Hörnsten
- Department of Nursing Umeå University Umeå Sweden
| | | | - Ulf Isaksson
- Department of Nursing Umeå University Umeå Sweden
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Torbjørnsen A, Ribu L, Rønnevig M, Grøttland A, Helseth S. Users' acceptability of a mobile application for persons with type 2 diabetes: a qualitative study. BMC Health Serv Res 2019; 19:641. [PMID: 31492176 PMCID: PMC6729081 DOI: 10.1186/s12913-019-4486-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/28/2019] [Indexed: 02/02/2023] Open
Abstract
Background The use of mobile health apps is now common in diabetes self-management and acceptability of such tools could help predict further use. There is limited research on the acceptability of such apps: use over time, the factors and features that influence self-management, how to overcome barriers, and how to use an app in relation to health-care personnel. In this study, we aimed to obtain an in-depth understanding of users’ acceptability of a mobile app for diabetes self-management, and to explore their communication with health-care personnel concerning the app. Methods The study had a qualitative descriptive design. Two researchers conducted 24 semi-structured in-depth interviews with adults with type 2 diabetes who had used a digital diabetes diary app for 1 year, during participation in the Norwegian Study in the EU project RENEWING HeALTH. We recruited the participants in a primary health-care setting. The transcripts of the interviews were analyzed using qualitative content analysis on developing themes, which we interpreted according to a theory of acceptability. We used NVivo 11 Pro during the process. Results The users’ acceptability of the app diverged. Overall, the responses indicated that the use of a digital diabetes diary requires hard work, but could also ease the effort involved in following a healthy lifestyle and better-controlled levels of blood glucose. Crucial to the acceptability was that a routine use could give an overview of diabetes registration and give new insights into self-management. In addition, support from health-care personnel with diabetes knowledge was described as necessary, either to confirm the decisions made based on use of the app, or to get additional self-management support. There were gradual transitions between practical and social acceptability, where utility of the app seems to be necessary for both practical and social acceptability. Lack of acceptability could cause both digital and clinical distress. Conclusions Both practical and social acceptability were important at different levels. If the users found the utility of the app to be acceptable, they could tolerate some lack of usability. We need to be aware of both digital and clinical distress when diabetes apps form a part of relevant health-care. Trial registrations Self-management in Type 2 Diabetes Patients Using the Few Touch Application, NCT01315756, https://clinicaltrials.gov/show/NCT01315756 March 15, 2011.
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Affiliation(s)
- Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway. .,General Practice Research Unit, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Lis Ribu
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Marit Rønnevig
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | | | - Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Yingling L, Allen NA, Litchman ML, Colicchio V, Gibson BS. An Evaluation of Digital Health Tools for Diabetes Self-Management in Hispanic Adults: Exploratory Study. JMIR Diabetes 2019; 4:e12936. [PMID: 31313657 PMCID: PMC6664655 DOI: 10.2196/12936] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background Although multiple self-monitoring technologies for type 2 diabetes mellitus (T2DM) show promise for improving T2DM self-care behaviors and clinical outcomes, they have been understudied in Hispanic adult populations who suffer disproportionately from T2DM. Objective The objective of this study was to evaluate the acceptability, feasibility, and potential integration of wearable sensors for diabetes self-monitoring among Hispanic adults with self-reported T2DM. Methods We conducted a pilot study of T2DM self-monitoring technologies among Hispanic adults with self-reported T2DM. Participants (n=21) received a real-time continuous glucose monitor (RT-CGM), a wrist-worn physical activity (PA) tracker, and a tablet-based digital food diary to self-monitor blood glucose, PA, and food intake, respectively, for 1 week. The RT-CGM captured viewable blood glucose concentration (mg/dL) and PA trackers collected accelerometer-based data, viewable on the device or an associated tablet app. After 1 week of use, we conducted a semistructured interview with each participant to understand experiences and thoughts on integration of the data from the devices into a technology-facilitated T2DM self-management intervention. We also conducted a brief written questionnaire to understand participants’ self-reported T2DM history and past experience using digital health tools for T2DM self-management. Feasibility was measured by device utilization and objective RT-CGM, PA tracker, and diet logging data. Acceptability and potential integration were evaluated through thematic analysis of verbatim interview transcripts. Results Participants (n=21, 76% female, 50.4 [SD 11] years) had a mean self-reported hemoglobin A1c of 7.4 [SD 1.8] mg/dL and had been diagnosed with T2DM for 7.4 [SD 5.2] years (range: 1-16 years). Most (89%) were treated with oral medications, whereas the others self-managed through diet and exercise. Nearly all participants (n=20) used both the RT-CGM and PA tracker, and 52% (11/21) logged at least one meal, with 33% (7/21) logging meals for 4 or more days. Of the 8 possible days, PA data were recorded for 7.1 [SD 1.8] days (range: 2-8), and participants averaged 7822 [SD 3984] steps per day. Interview transcripts revealed that participants felt most positive about the RT-CGM as it unveiled previously unknown relationships between lifestyle and health and contributed to changes in T2DM-related thoughts and behaviors. Participants felt generally positive about incorporating the wearable sensors and mobile apps into a future intervention if support were provided by a health coach or health care provider, device training were provided, apps were tailored to their language and culture, and content were both actionable and delivered on a single platform. Conclusions Sensor-based tools for facilitating T2DM self-monitoring appear to be a feasible and acceptable technology among low-income Hispanic adults. We identified barriers to acceptability and highlighted preferences for wearable sensor integration in a community-based intervention. These findings have implications for the design of T2DM interventions targeting Hispanic adults.
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Affiliation(s)
- Leah Yingling
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Nancy A Allen
- College of Nursing, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Michelle L Litchman
- College of Nursing, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Vanessa Colicchio
- College of Nursing, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Bryan S Gibson
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
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Baptista S, Trawley S, Pouwer F, Oldenburg B, Wadley G, Speight J. What Do Adults with Type 2 Diabetes Want from the "Perfect" App? Results from the Second Diabetes MILES: Australia (MILES-2) Study. Diabetes Technol Ther 2019; 21:393-399. [PMID: 31166804 DOI: 10.1089/dia.2019.0086] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: We investigated what Australian adults with type 2 diabetes (T2D) want from the "perfect" diabetes self-management application. Methods: Adults with T2D completed a national online survey including an open-ended question: "If you were describing the perfect app to help you manage your diabetes, what would it do?" Qualitative responses were subjected to thematic analysis. Results: Of the 339 participants who provided usable responses, 153 (45%) were women, the mean age was 58 ± 10 years, and 139 participants (41%) managed their diabetes with insulin. Two primary themes emerged. First, participants expressed a desire for assistance with practical aspects of diabetes self-management to improve, and reduce the cognitive burden of, self-management; this included tracking and visualizing multiple sources of data, using data to inform automated, personalized coaching, reminders, and alarms, and automating upload and linking of data through connected devices. Second, they desired assistance with psychological and emotional aspects of diabetes self-management; this included ongoing encouragement and motivation, help with stress management or negative emotions, and complementing existing health care by facilitating interconnectivity with health professionals. Conclusions: Our findings suggest that the clear desire of people with type 2 diabetes is for the "perfect app" to reduce not only the practical, but also the cognitive and emotional burden of diabetes self-management. They provide further evidence that understanding the desires of people living with diabetes needs to be the first step in app development to ensure that apps provide features, support, and benefits that people with diabetes value.
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Affiliation(s)
- Shaira Baptista
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- 2 The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Steven Trawley
- 2 The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- 3 Cairnmillar Institute, Hawthorn East, VIC, Australia
| | - Frans Pouwer
- 4 School of Psychology, Deakin University, Geelong, VIC, Australia
- 5 Department of Psychology, University of Southern Denmark, Odense, Denmark
- 6 STENO Diabetes Center Odense, Odense, Denmark
| | - Brian Oldenburg
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Greg Wadley
- 7 School of Computing and Information Systems, The University of Melbourne, Melbourne, VIC, Australia
| | - Jane Speight
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- 2 The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- 4 School of Psychology, Deakin University, Geelong, VIC, Australia
- 5 Department of Psychology, University of Southern Denmark, Odense, Denmark
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64
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Lester R, Park JJ, Bolten LM, Enjetti A, Johnston JC, Schwartzman K, Tilahun B, Delft AV. Mobile phone short message service for adherence support and care of patients with tuberculosis infection: Evidence and opportunity. J Clin Tuberc Other Mycobact Dis 2019; 16:100108. [PMID: 31720432 PMCID: PMC6830136 DOI: 10.1016/j.jctube.2019.100108] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To attain the Global End Tuberculosis (TB) goals, the treatment of persons with TB requires advancements in coordinated approaches that are low-cost and highly accessible. Treating TB successfully requires prolonged medication regimens with good adherence, which in turn requires patients to be adequately supported. Furthermore, TB care-providers often wish to monitor treatment-taking by patients in order to track the success of their programs and ensure adequate completion of therapies by individuals. The standard-of-care for treatment monitoring in TB programs often includes directly observed therapy (DOT). Video observed therapy (VOT) has emerged as a method to mimic in-person visits or observations, especially in the smartphone era with internet data connections, but remains simply inaccessible to patients in areas where TB is most endemic. Both approaches may be considered more intensive than necessary for many patients, leaving an opportunity for more affordable and acceptable approaches. The rapid increase in mobile phone penetration provides an opportunity to reach patients between clinical visits. Short message services (SMS) are available on almost every mobile phone and are supported by first generation cellular communication networks, thus providing the farthest reach and penetration globally. Evidence from non-TB conditions suggests SMS, used in a variety of ways, may support outpatients for better medication adherence and quality of care but the evidence in TB remains limited. In this paper, we discuss how basic mobile phones and SMS-related services may be used in supporting global care of persons with TB, with a focus on patient-centered approaches.
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Affiliation(s)
| | - Jay Jh Park
- University of British Columbia, Vancouver, Canada
| | | | | | - James C Johnston
- University of British Columbia, Vancouver, Canada.,Provincial TB Services, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Kevin Schwartzman
- Respiratory Division, Montreal Chest Institute, Respiratory Epidemiology and Clinical Research Unit, and McGill International Tuberculosis Centre, McGill University, Montreal, Quebec, Canada
| | | | - Arne von Delft
- TB Proof, 29 Almond Drive, Somerset West, Western Cape 7130, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Abstract
If we were to create the diabetes care experience anew, there is little doubt that it would not resemble the current bricks-and-mortar way we do things currently. For however a future model of care is designed, it would assume a digital-first approach, whereby the modern conveniences of digitally-mediated services we have experienced in other industries would be reflected in our diabetes care. To this end, our diabetes data would be liberated, transparent to those that need it, but safe and secure otherwise. We would have access to new tools that create insights that lower the burden, not add to it. And access to care would be just in time, convenient, and from a distance when needed. What is stopping a digital-first model is complex and deeply seated, but not insurmountable with engagement from industry, regulators, and care providers that are all willing to modernize the way care is delivered. Personal human interaction will continue to play an important part in the care for millions of people living with diabetes, no matter the sophistication of these digital services. What these technologies will provide is the human capacity to deal with the higher need, vulnerable people for whom access to timely care is an issue. Moreover, it will provide choice for an increasingly diverse population that seeks options for the form, and the delivery, of their personalized care.
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Affiliation(s)
- Joseph A Cafazzo
- 1 Centre for Global eHealth Innovation, and the Wolfond Chair in Digital Health, Techna Institute, University Health Network, Toronto, Ontario, Canada
- 2 Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, Toronto, Ontario, Canada
- 3 Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Bond KT, Ramos SR. Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey. JMIR Form Res 2019; 3:e9995. [PMID: 31144667 PMCID: PMC6658301 DOI: 10.2196/formative.9995] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/30/2018] [Accepted: 04/29/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format. OBJECTIVE The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women. METHODS A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants' perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video. RESULTS Overall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=-.814; P=.004), not having unprotected sex in the last 3 months (beta=-.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=-.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=-.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women. CONCLUSIONS Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women.
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Affiliation(s)
- Keosha T Bond
- Department of Public Health, New York Medical College, Valhalla, NY, United States
| | - S Raquel Ramos
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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A digital self-management intervention for adults with type 2 diabetes: Combining theory, data and participatory design to develop HeLP-Diabetes. Internet Interv 2019; 17:100241. [PMID: 31372349 PMCID: PMC6660456 DOI: 10.1016/j.invent.2019.100241] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 02/03/2019] [Accepted: 02/18/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Digital health interventions have potential to contribute to better health outcomes, better healthcare and lower costs. However, evidence for their effectiveness is variable. The development and content of digital health interventions are often not described in enough detail to enable others to replicate the research or improve on previous interventions. This has led to a call for transparent reporting of intervention content and development. PURPOSE To describe the development process and content of a digital self-management intervention for people with type 2 diabetes (HeLP-Diabetes) that has been found to achieve its target clinical outcome, the reduction of HbA1c, a measure of glycaemic control. METHOD We synthesised theory, data from existing research evidence and international guidelines, and new qualitative data from target users to identify the determinants of self-management and the content to be included in HeLP-Diabetes. Using an ongoing iterative participatory design approach the content of the intervention was written, produced, reviewed and changed. CONCLUSION It is possible to develop and transparently report self-management programmes for long-term conditions, which reflect current best evidence, theoretical underpinning and user involvement. We intend that reporting the development process and content will inform future digital intervention development.
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Key Words
- CBT, Cognitive Behaviour Therapy
- Diabetes mellitus, type 2
- Digital intervention development
- HCPs, Health Care Professionals
- HeLP Diabetes, Healthy Living for People with Type 2 Diabetes
- HealthTalk Online, HTO
- Internet
- LLTTF, Living Life to the Full
- MRC, Medical Research Council
- NICE, National Institute for Health Care Excellence
- NPT, Normalisation Process Theory
- Participatory design
- Patient education as topic
- RNIB, Royal National Institute of Blind People
- Self-management
- T2DM, Type 2 diabetes mellitus
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Lie SS, Karlsen B, Graue M, Oftedal B. The influence of an eHealth intervention for adults with type 2 diabetes on the patient-nurse relationship: a qualitative study. Scand J Caring Sci 2019; 33:741-749. [PMID: 30866066 DOI: 10.1111/scs.12671] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 01/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND A constructive patient-nurse relationship is beneficial in self-management support approaches. Research indicates eHealth interventions hold a potential for self-management support for adults with type 2 diabetes. However, eHealth may change the patient-nurse relationship. No studies to date have addressed how eHealth self-management support interventions with written asynchronous communication can influence the relationship between patients and nurses. AIM The aim of this study was to explore how an eHealth intervention based on the Guided Self-Determination program (eGSD) influences the patient-nurse relationship from the perspective of patients participating and the nurses conducting the intervention. METHODS A qualitative approach with individual semi-structured interviews was used. Ten patients with type 2 diabetes who completed the eGSD and four nurses who delivered the intervention participated. The data were transcribed verbatim, and qualitative content analysis was used to analyse the text. RESULTS The findings revealed two themes: 'eGSD facilitates a reciprocal understanding and a flexibility in the relationship' and 'eGSD creates a more fragile relationship', reflecting ambiguous experiences with the eGSD. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE The findings indicate that eGSD influences the patient-nurse relationship by facilitating reciprocal understanding and flexibility. Both patients and RNs acknowledged these outcomes as beneficial. Nevertheless, familiar in-person consultations were expressed as integral for the patient-nurse relationship. As written communication in eHealth is a novelty, it demands new knowledge and expertise that RNs must master. Findings from this study may therefore be acknowledged when developing and implementing eHealth interventions. Education programs in written eHealth communication, as well as guidelines and frameworks on how to professionally and effectively conduct eHealth services while maintaining supportive patient-nurse relationships, should be a priority for institutions that educate healthcare personnel, health institutions and other stakeholders.
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Affiliation(s)
- Silje S Lie
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Faculty of Health Studies, VID Specialized University, Sandnes, Norway
| | - Bjørg Karlsen
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Marit Graue
- Centre for Evidence-based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bjørg Oftedal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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den Braber N, Vollenbroek-Hutten MMR, Oosterwijk MM, Gant CM, Hagedoorn IJM, van Beijnum BJF, Hermens HJ, Laverman GD. Requirements of an Application to Monitor Diet, Physical Activity and Glucose Values in Patients with Type 2 Diabetes: The Diameter. Nutrients 2019; 11:nu11020409. [PMID: 30781348 PMCID: PMC6413029 DOI: 10.3390/nu11020409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/22/2022] Open
Abstract
Adherence to a healthy diet and regular physical activity are two important factors in sufficient type 2 diabetes mellitus management. It is recognized that the traditional treatment of outpatients does not meet the requirements for sufficient lifestyle management. It is hypothesised that a personalized diabetes management mHealth application can help. Such an application ideally measures food intake, physical activity, glucose values, and medication use, and then integrates this to provide patients and healthcare professionals insight in these factors, as well as the effect of lifestyle on glucose values in daily life. The lifestyle data can be used to give tailored coaching to improve adherence to lifestyle recommendations and medication use. This study describes the requirements for such an application: the Diameter. An iterative mixed method design approach is used that consists of a cohort study, pilot studies, literature search, and expert meetings. The requirements are defined according to the Function and events, Interactions and usability, Content and structure and Style and aesthetics (FICS) framework. This resulted in 81 requirements for the dietary (n = 37), activity and sedentary (n = 15), glycaemic (n = 12), and general (n = 17) parts. Although many applications are currently available, many of these requirements are not implemented. This stresses the need for the Diameter as a new personalized diabetes application.
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Affiliation(s)
- Niala den Braber
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
- Biomedical Signals and Systems (BSS), University of Twente, 7522 NB Enschede, The Netherlands.
| | - Miriam M R Vollenbroek-Hutten
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
- Biomedical Signals and Systems (BSS), University of Twente, 7522 NB Enschede, The Netherlands.
| | - Milou M Oosterwijk
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
| | - Christina M Gant
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
| | - Ilse J M Hagedoorn
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
| | - Bert-Jan F van Beijnum
- Biomedical Signals and Systems (BSS), University of Twente, 7522 NB Enschede, The Netherlands.
| | - Hermie J Hermens
- Biomedical Signals and Systems (BSS), University of Twente, 7522 NB Enschede, The Netherlands.
- Roessingh Research and Development (RRD), 7522 AH Enschede, The Netherlands.
| | - Gozewijn D Laverman
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
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70
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Zhang Y, Li X, Luo S, Liu C, Xie Y, Guo J, Liu F, Zhou Z. Use, Perspectives, and Attitudes Regarding Diabetes Management Mobile Apps Among Diabetes Patients and Diabetologists in China: National Web-Based Survey. JMIR Mhealth Uhealth 2019; 7:e12658. [PMID: 30735147 PMCID: PMC6384538 DOI: 10.2196/12658] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/01/2019] [Accepted: 01/20/2019] [Indexed: 12/19/2022] Open
Abstract
Background The diabetes disease burden in China is heavy, and mobile apps have a great potential for diabetes management. However, there is a lack of investigation of diabetes app use among Chinese diabetes patients and diabetologists. The perspectives and attitudes of diabetes patients and diabetologists regarding diabetes apps are also unclear. Objective Our objectives were to investigate diabetes patients’ and diabetologists’ use, attitudes, and perspectives, as well as patients’ needs, with respect to diabetes apps to provide information regarding the optimal design of diabetes apps and the best strategies to promote their use. Methods Diabetes patients and diabetologists across China were surveyed on the WeChat (Tencent Corp) network using Sojump (Changsha ran Xing InfoTech Ltd) from January 23, 2018, to July 30, 2018. In total, 2 survey links were initially sent to doctors from 46 Latent Autoimmune Diabetes of Adults Study collaborative hospitals in China in 25 major cities and were spread on their WeChat contacts network. We also published the patient survey link on 3 WeChat public accounts and requested diabetes patients to fill out questionnaires. A multivariate regression analysis was used to identify associations of demographic and basic disease information with app usage among adult patients. Results Overall, 1276 individuals from 30 provincial regions responded to the patient survey; among them, the overall app awareness rate was 29.94% (382/1276) and usage was 15.44% (197/1276). The usage was higher among patients with type 1 diabetes (T1DM) than among patients with type 2 diabetes (T2DM; 108/473, 22.8% vs 79/733, 10.8%; P<.001). The multivariate regression analysis showed that diabetes type, age, education, family income, and location were associated with app use in adult patients (P<.05). The need for and selection of diabetes apps differed slightly between patients with T1DM and patients with T2DM. The reasons why patients discontinued the use of an app included limited time (59/197, 29.9%), complicated operations (50/197, 25.4%), ineffectiveness for glycemic control (48/197, 24.4%), and cost (38/197, 19.3%). Of the 608 responders to the diabetologist survey, 40.5% (246/608) recommended diabetes apps to patients and 25.2% (153/608) used diabetes apps to manage patients. The greatest obstacles to the diabetologists’ use of apps to manage diabetes patients include limited time (280/608, 46.1%), legal issues (129/608, 21.2%), patients’ distrust (108/608, 17.8%), and billing issues (66/608, 10.9%). Conclusions The awareness and use of diabetes apps in Chinese people with diabetes and the proportion of diabetologists using diabetes apps to manage patients are low. Designing apps targeting different patient needs and conducting high-quality randomized controlled trials will improve the effectiveness of the apps, provide evidence for patients to choose suitable apps, and be conducive to the promotion of app use.
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Affiliation(s)
- Yiyu Zhang
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Shuoming Luo
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuting Xie
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Fang Liu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
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71
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Jeffrey B, Bagala M, Creighton A, Leavey T, Nicholls S, Wood C, Longman J, Barker J, Pit S. Mobile phone applications and their use in the self-management of Type 2 Diabetes Mellitus: a qualitative study among app users and non-app users. Diabetol Metab Syndr 2019; 11:84. [PMID: 31636719 PMCID: PMC6794726 DOI: 10.1186/s13098-019-0480-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/09/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mobile phone applications (apps) have been shown to successfully facilitate the self-management of chronic disease. This study aims to evaluate firstly the experiences, barriers and facilitators to app usage among people with Type 2 Diabetes Mellitus (T2DM) and secondly determine recommendations to improve usage of diabetes apps. METHODS Participants were aged ≥ 18 years with a diagnosis of T2DM for ≥ 6 months. Semi-structured phone-interviews were conducted with 16 app and 14 non-app users. Interviews were based on the Technology Acceptance Model, Health Information Technology Acceptance Model (HITAM) and the Mobile Application Rating Scale. Data were analysed using deductive content analysis. RESULTS Most app-users found apps improved their T2DM self-management and health. The recommendation of apps by health professionals, as well as positive interactions with them, improved satisfaction; however, only a minority of patients had practitioners involved in their app use. All non-app users had never had the concept discussed with them by a health professional. Facilitators to app use included the visual representation of trends, intuitive navigation and convenience (for example, discretion and portability). Barriers to app use were participant's lack of knowledge and awareness of apps as healthcare tools, perceptions of disease severity, technological and health literacy or practical limitations such as rural connectivity. Factors contributing to app use were classified into a framework based on the Health Belief Model and HITAM. Recommendations for future app design centred on educational features, which were currently lacking (e.g. diabetes complications, including organ damage and hypoglycaemic episodes), monitoring and tracking features (e.g. blood glucose level monitoring with trends and dynamic tips and comorbidities) and nutritional features (e.g. carbohydrate counters). Medication reminders were not used by participants. Lastly, participants felt that receiving weekly text-messaging relating to their self-management would be appropriate. CONCLUSIONS The incorporation of user-centred features, which engage T2DM consumers in self-management tasks, can improve health outcomes. The findings may guide app developers and entrepreneurs in improving app design and usability. Given self-management is a significant factor in glycaemic control, these findings are significant for GPs, nurse practitioners and allied health professionals who may integrate apps into a holistic management plan which considers strategies outside the clinical environment.
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Affiliation(s)
| | | | | | | | | | | | - Jo Longman
- University of Sydney, University Centre for Rural Health, Sydney, Australia
| | - Jane Barker
- University of Sydney, University Centre for Rural Health, Sydney, Australia
| | - Sabrina Pit
- Western Sydney University, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480 Australia
- School of Medicine, University of Sydney, Sydney, Australia
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72
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Sahin C, Courtney KL, Naylor PJ, E Rhodes R. Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis. Digit Health 2019; 5:2055207619845279. [PMID: 31041110 PMCID: PMC6481002 DOI: 10.1177/2055207619845279] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/28/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to identify, assess and summarize available scientific evidence on tailored text messaging interventions focused on type 2 diabetes self-management. The systematic review concentrated on message design and delivery features, and tailoring strategies. The meta-analysis assessed the moderators of the effectiveness of tailored text messaging interventions. METHODS A comprehensive search strategy included major electronic databases, key journal searches and reference list searching for related studies. PRISMA and Cochrane Collaboration's guidelines and recommended tools for data extraction, quality appraisal and data analysis were followed. Data were extracted on participant characteristics (age, gender, ethnicity), and interventional and methodological characteristics (study design, study setting, study length, choice of modality, comparison group, message type, format, content, use of interactivity, message frequency, message timing, message delivery, tailoring strategies and theory use). Outcome measures included diet, physical activity, medication adherence and glycated hemoglobin data (HbA1C). Where possible, a random effects meta-analysis was performed to pool data on the effectiveness of the tailored text messaging interventions and moderator variables. RESULTS The search returned 13 eligible trials for the systematic review and 11 eligible trials for the meta-analysis. The majority of the studies were randomized controlled trials, conducted in high-income settings, used multi-modalities, and mostly delivered informative, educational messages through an automated message delivery system. Tailored text messaging interventions produced a substantial effect (g = 0.54, 95% CI = 0.08-0.99, p < 0.001) on HbA1C values for a total of 949 patients. Subgroup analyses revealed the importance of some moderators such as message delivery (Q B = 18.72, df = 1, p = 0.001), message direction (Q B = 5.26, df = 1, p = 0.022), message frequency (Q B = 18.72, df = 1, p = 0.000) and using multi-modalities (Q B = 6.18, df = 1, p = 0.013). CONCLUSIONS Tailored mobile text messaging interventions can improve glycemic control in type 2 diabetes patients. However, more rigorous interventions with larger samples and longer follow-ups are required to confirm these findings and explore the effects of tailored text messaging on other self-management outcomes.
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Affiliation(s)
- Cigdem Sahin
- Cigdem Sahin, University of Victoria, Social
Dimensions of Health Program, P.O. Box 3050, STN CSC Victoria, BC V8W 3P5,
Canada.
| | - Karen L Courtney
- Social Dimensions of Health Program, University of Victoria,
Victoria, BC, Canada
- School of Health Information Science, University of Victoria,
Victoria, BC, Canada
- School of Exercise Science, Physical and Health Education,
University of Victoria, Victoria, BC, Canada
- Behavioural Medicine Laboratory, School of Exercise Science,
Physical and Health Education, University of Victoria, BC, Canada
| | - PJ Naylor
- Social Dimensions of Health Program, University of Victoria,
Victoria, BC, Canada
- School of Health Information Science, University of Victoria,
Victoria, BC, Canada
- School of Exercise Science, Physical and Health Education,
University of Victoria, Victoria, BC, Canada
- Behavioural Medicine Laboratory, School of Exercise Science,
Physical and Health Education, University of Victoria, BC, Canada
| | - Ryan E Rhodes
- Social Dimensions of Health Program, University of Victoria,
Victoria, BC, Canada
- School of Health Information Science, University of Victoria,
Victoria, BC, Canada
- School of Exercise Science, Physical and Health Education,
University of Victoria, Victoria, BC, Canada
- Behavioural Medicine Laboratory, School of Exercise Science,
Physical and Health Education, University of Victoria, BC, Canada
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Zhang Y, Li X, Luo S, Liu C, Liu F, Zhou Z. Exploration of Users' Perspectives and Needs and Design of a Type 1 Diabetes Management Mobile App: Mixed-Methods Study. JMIR Mhealth Uhealth 2018; 6:e11400. [PMID: 30249580 PMCID: PMC6231832 DOI: 10.2196/11400] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022] Open
Abstract
Background With the popularity of mobile phones, mobile apps have great potential for the management of diabetes, but the effectiveness of current diabetes apps for type 1 diabetes mellitus (T1DM) is poor. No study has explored the reasons for this deficiency from the users’ perspective. Objective The aims of this study were to explore the perspectives and needs of T1DM patients and diabetes experts concerning a diabetes app and to design a new T1DM management mobile app. Methods A mixed-methods design combining quantitative surveys and qualitative interviews was used to explore users’ needs and perspectives. Experts were surveyed at 2 diabetes conferences using paper questionnaires. T1DM patients were surveyed using Sojump (Changsha ran Xing InfoTech Ltd) on a network. We conducted semistructured, in-depth interviews with adult T1DM patients or parents of child patients who had ever used diabetes apps. The interviews were audio-recorded, transcribed, and coded for theme identification. Results The expert response rate was 63.5% (127/200). The respondents thought that the reasons for app invalidity were that patients did not continue using the app (76.4%, 97/127), little guidance was received from health care professionals (HCPs; 73.2%, 93/127), diabetes education knowledge was unsystematic (52.8%, 67/127), and the app functions were incomplete (44.1%, 56/127). A total of 245 T1DM patient questionnaires were collected, of which 21.2% (52/245) of the respondents had used diabetes apps. The reasons for their reluctance to use an app were limited time (39%, 20/52), complicated operations (25%, 13/52), uselessness (25%, 13/52), and cost (25%, 13/52). Both the experts and patients thought that the most important functions of the app were patient-doctor communication and the availability of a diabetes diary. Two themes that were useful for app design were identified from the interviews: (1) problems with patients’ diabetes self-management and (2) problems with current apps. In addition, needs and suggestions for a diabetes app were obtained. Patient-doctor communication, diabetes diary, diabetes education, and peer support were all considered important by the patients, which informed the development of a prototype multifunctional app. Conclusions Patient-doctor communication is the most important function of a diabetes app. Apps should be integrated with HCPs rather than stand-alone. We advocate that doctors follow up with their patients using a diabetes app. Our user-centered method explored comprehensively and deeply why the effectiveness of current diabetes apps for T1DM was poor and what T1DM patients needed for a diabetes app and provided meaningful guidance for app design.
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Affiliation(s)
- Yiyu Zhang
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Shuoming Luo
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fang Liu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
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Wang J, Chu CF, Li C, Hayes L, Siminerio L. Diabetes Educators' Insights Regarding Connecting Mobile Phone- and Wearable Tracker-Collected Self-Monitoring Information to a Nationally-Used Electronic Health Record System for Diabetes Education: Descriptive Qualitative Study. JMIR Mhealth Uhealth 2018; 6:e10206. [PMID: 30049667 PMCID: PMC6085552 DOI: 10.2196/10206] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/29/2018] [Accepted: 06/16/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diabetes educators are integral to a clinical team in providing diabetes self-management education and support; however, current mobile and Web-based self-management tools are not integrated into clinical diabetes care to support diabetes educators' education efforts. OBJECTIVE The objective of our study was to seek diabetes educators' insights regarding the development of an interface within the Chronicle Diabetes system, a nationally used electronic health record (EHR) system for diabetes education documentation with behavioral goal-setting functions, to transfer mobile phone- and wearable tracker-collected self-monitoring information from patients to diabetes educators to facilitate behavioral goal monitoring. METHODS A descriptive qualitative study was conducted to seek educators' perspectives on usability and interface development preferences in developing a connected system. Educators can use the Chronicle Diabetes system to set behavioral goals with their patients. Individual and group interviews were used to seek educators' preferences for viewing mobile phone- and wearable tracker-collected information on diet, physical activity, and sleep in the Chronicle Diabetes system using open-ended questions. Interview data were transcribed verbatim and analyzed for common themes. RESULTS Five common themes emerged from the discussion. First, educators expressed enthusiasm for and concerns about viewing diet and physical activity data in Chronicle Diabetes system. Second, educators valued viewing detailed dietary macronutrients and activity data; however, they preferred different kinds of details depending on patients' needs, conditions, and behavioral goals and educators' training background. Third, all educators liked the integration of mobile phone-collected data into Chronicle Diabetes system and preferably with current EHR systems. Fourth, a need for a health care team and a central EHR system to be formed was realized for educators to share summaries of self-monitoring data with other providers. Fifth, educators desired advanced features for the mobile app and the connected interface that can show self-monitoring data. CONCLUSIONS Flexibility is needed for educators to track the details of mobile phone- and wearable tracker-collected diet and activity information, and the integration of such data into Chronicle Diabetes and EHR systems is valuable for educators to track patients' behavioral goals, provide diabetes self-management education and support, and share data with other health care team members to faciliate team-based care in clinical practice.
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Affiliation(s)
- Jing Wang
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Chin-Fun Chu
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Chengdong Li
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Laura Hayes
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Linda Siminerio
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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