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Natale P, Chen S, Chow CK, Cheung NW, Martinez‐Martin D, Caillaud C, Scholes‐Robertson N, Kelly A, Craig JC, Strippoli G, Jaure A. Patient experiences of continuous glucose monitoring and sensor-augmented insulin pump therapy for diabetes: A systematic review of qualitative studies. J Diabetes 2023; 15:1048-1069. [PMID: 37551735 PMCID: PMC10755613 DOI: 10.1111/1753-0407.13454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/31/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023] Open
Abstract
AIMS Blood glucose control is central to the management of diabetes, and continuous glucose monitoring (CGM) improves glycemic control. We aimed to describe the perspectives of people with diabetes using CGM. MATERIALS AND METHODS We performed a systematic review of qualitative studies. RESULTS Fifty-four studies involving 1845 participants were included. Six themes were identified: gaining control and convenience (reducing pain and time, safeguarding against complications, achieving stricter glucose levels, and sharing responsibility with family); motivating self-management (fostering ownership, and increasing awareness of glycemic control); providing reassurance and freedom (attaining peace of mind, and restoring social participation); developing confidence (encouraged by the endorsement of others, gaining operational skills, customizing settings for ease of use, and trust in the device); burdened with device complexities (bewildered by unfamiliar technology, reluctant to rely on algorithms, overwhelmed by data, frustrated with malfunctioning and inaccuracy, distressed by alerts, and bulkiness of machines interfering with lifestyle); and excluded by barriers to access (constrained by cost, lack of suppliers). CONCLUSIONS CGM can improve self-management and confidence in patients managing diabetes. However, the technical issues, uncertainty in readings, and cost may limit the uptake. Education and training from the health professionals may help to reduce the practical and psychological burden for better patient outcomes.
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Affiliation(s)
- Patrizia Natale
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE‐J)University of Bari Aldo MoroBariItaly
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Sharon Chen
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyAustralia
| | - Clara K. Chow
- Westmead Applied Research CentreWestmead HospitalSydneyAustralia
- Sydney Medical SchoolThe University of SydneySydneyAustralia
| | - Ngai Wah Cheung
- Westmead Applied Research CentreWestmead HospitalSydneyAustralia
- Sydney Medical SchoolThe University of SydneySydneyAustralia
- Westmead Clinical SchoolWestmead HospitalSydneyAustralia
| | - David Martinez‐Martin
- The University of Sydney Nano Institute (Sydney Nano)The University of SydneySydneyAustralia
- School of Biomedical EngineeringThe University of SydneySydneyAustralia
| | - Corinne Caillaud
- Charles Perkins CentreThe University of SydneySydneyAustralia
- School of Medical SciencesThe University of SydneySydneyAustralia
| | - Nicole Scholes‐Robertson
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyAustralia
| | - Ayano Kelly
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyAustralia
- School of Health and Medicine, South Western Sydney CampusUniversity of New South WalesSydneyAustralia
- Rheumatology DepartmentLiverpool HospitalSydneyAustralia
- Ingham Institute of Applied Medical ResearchSydneyAustralia
| | - Jonathan C. Craig
- College of Medicine and Public HealthFlinders UniversityAdelaideAustralia
| | - Giovanni Strippoli
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE‐J)University of Bari Aldo MoroBariItaly
| | - Allison Jaure
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyAustralia
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[Mobile health technologies, social justice and population-based vulnerabilities : A public health ethics perspective on mHealth using the example of type 2 diabetes mellitus]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:168-175. [PMID: 36695833 PMCID: PMC9892162 DOI: 10.1007/s00103-022-03650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/16/2022] [Indexed: 01/26/2023]
Abstract
Mobile health technologies (mHealth) promote the trend towards personal responsibility and self-management. By using the example of type 2 diabetes mellitus (T2DM), the article aims to deepen the discussion on mHealth, personal responsibility and justice-which has so far only been rudimentary-from a public health ethical perspective. It shows that in the field of T2DM, mHealth can on the one hand improve social health justice, but on the other hand can also exacerbate social health injustices. From a justice-focused, public health ethical perspective on T2DM mHealth, it is necessary to better understand whether and how vulnerable population groups are considered in mHealth development and implementation, how these groups experience the use of the technology, what social-epidemiological impacts the increasing use of mHealth can have, which health inequalities in the area of T2DM are unfair, to what extent personal responsibility should be placed in the hands of the users, and where the limits of personal responsibility lie. Considering social diversity and the social determinants of health is an ongoing process and must permeate all phases of mHealth development and implementation.
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Anugu P, Ansari MAY, Min YI, Benjamin EJ, Murabito J, Winters K, Turner E, Correa A. Digital Connectedness in the Jackson Heart Study: Cross-sectional Study. J Med Internet Res 2022; 24:e37501. [DOI: 10.2196/37501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/26/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background
Although new approaches for data collection, such as mobile technology and teleresearch, have demonstrated new opportunities for the conduct of more timely and less costly surveys in community-based studies, literature on the feasibility of conducing cardiovascular disease research using mobile health (mHealth) platforms among middle-aged and older African Americans has been limited.
Objective
The purpose of this study was to contribute to the knowledge regarding the penetrance of internet and mobile technologies, such as cellphones or smartphones in existing large cohort studies of cardiovascular disease.
Methods
A digital connectedness survey was conducted in the Jackson Heart Study (JHS), a Mississippi-based African American cohort study, as part of the annual follow-up calls with participants from July 2017 to February 2019.
Results
Of the 4024 participants contacted, 2564 (63.7%) completed the survey. Among survey respondents, 2262 (88.2%) reported use of internet or cellphone, and 1593 (62.1%) had a smartphone. Compared to nonusers (n=302), internet or cellphone users (n=2262) were younger (mean age 80.1, SD 8.0 vs 68.2, SD 11.3 years), more likely to be affluent (n=778, 40.1% vs n=39, 15.4%), and had greater than high school education (n=1636, 72.5% vs n=85, 28.1%). Internet or cellphone users were less likely to have cardiovascular disease history compared to nonusers (136/2262, 6.6% vs 41/302, 15.8%). The prevalence of current smoking and average BMI were similar between internet or cellphone users and nonusers. Among internet or cellphone users, 1316 (58.3%) reported use of email, 504 (22.3%) reported use of apps to track or manage health, and 1269 (56.1%) expressed interest in using JHS-developed apps.
Conclusions
Our findings suggest that it is feasible to use mHealth technologies to collect survey data among African Americans already enrolled in a longitudinal study. Our findings also highlight the need for more efforts to reduce the age and education divide in access and use of internet and smartphones for tracking health and research in African American communities.
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Stephen DA, Nordin A, Nilsson J, Persenius M. Using mHealth applications for self-care - An integrative review on perceptions among adults with type 1 diabetes. BMC Endocr Disord 2022; 22:138. [PMID: 35614419 PMCID: PMC9131554 DOI: 10.1186/s12902-022-01039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individually designed interventions delivered through mobile health applications (mHealth apps) may be able to effectively support diabetes self-care. Our aim was to review and synthesize available evidence in the literature regarding perception of adults with type 1 diabetes on the features of mHealth apps that help promote diabetes self-care, as well as facilitators and barriers to their use. An additional aim was to review literature on changes in patient reported outcome measures (PROMs) in the same population while using mHealth apps for diabetes self-care. METHODS Quantitative and qualitative studies focusing on adults aged 18 years and over with type 1 diabetes in any context were included. A systematic literature search using selected databases was conducted. Data was synthesised using narrative synthesis. RESULTS We found that features of mHealth apps designed to help promote and maintain diabetes self-care could be categorized into self-care data monitoring, app display, feedback & reminders, data entry, data sharing, and additional features. Factors affecting the use of mHealth apps reported in the literature were personal factors, app design or usability factors, privacy and safety factors, or socioeconomic factors. Quality of life and diabetes distress were the most commonly reported PROMs in the included studies. CONCLUSION We are unable to reach a conclusive result due to the heterogeneity of the included studies as well as the limited number of studies reporting on these areas among adults with type 1 diabetes. We therefore recommend further large-scale studies looking into these areas that can ultimately improve mHealth app use in type 1 diabetes self-care. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42020157620 .
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Affiliation(s)
- Divya Anna Stephen
- Department of Health Sciences, Faculty for Health, Science And Technology, Karlstad University, Karlstad, Sweden.
| | - Anna Nordin
- Department of Health Sciences, Faculty for Health, Science And Technology, Karlstad University, Karlstad, Sweden
- Department of Health, Learning and Technology, Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden
| | - Jan Nilsson
- Department of Health Sciences, Faculty for Health, Science And Technology, Karlstad University, Karlstad, Sweden
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Mona Persenius
- Department of Health Sciences, Faculty for Health, Science And Technology, Karlstad University, Karlstad, Sweden
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Hjelm K, Hedlund L. Internet-of-Things (IoT) in healthcare and social services – experiences of a sensor system for notifications of deviant behaviours in the home from the users’ perspective. Health Informatics J 2022; 28:14604582221075562. [DOI: 10.1177/14604582221075562] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies on use of IT in residential care are limited; thus, there is a need for investigations to understand both older people’s and nursing staff’s perspectives on experiences of new technology. ‘Smart homes’ provide home automation solutions, making life easier for those residing there. The aim was to explore, from the users’ perspective, experiences of a sensor system installed in the home. The sensors are meant to provide notifications of deviations in behaviours or routines by the resident, requiring healthcare staff or relatives to do a supervisory visit. The sensor notification system made the users feel secure by being monitored, having control over the situation, and allowing them to become more independent in their daily lives; furthermore, they emphasised the importance of having well-functioning systems. Further development of the technology and use, in co-creation with the users, is needed. Careful preparation in installing/starting the system and repeated information about its aim are needed.
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Affiliation(s)
- Katarina Hjelm
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Hedlund
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Pan J, Dong H, Bryan-Kinns N. Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation. JMIR Aging 2021; 4:e30420. [PMID: 34807836 PMCID: PMC8663706 DOI: 10.2196/30420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 01/22/2023] Open
Abstract
Background Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective The aims of this study are to understand older adults’ perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults’ perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults’ perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults’ adoption of mHealth services. Conclusions The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults.
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Affiliation(s)
- Jing Pan
- College of Art and Design, Nanjing Tech University, Nanjing, China
| | - Hua Dong
- Brunel Design School, Brunel University London, London, United Kingdom
| | - Nick Bryan-Kinns
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, United Kingdom
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Artificial Pancreas Control Strategies Used for Type 1 Diabetes Control and Treatment: A Comprehensive Analysis. APPLIED SYSTEM INNOVATION 2020. [DOI: 10.3390/asi3030031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This paper presents a comprehensive survey about the fundamental components of the artificial pancreas (AP) system including insulin administration and delivery, glucose measurement (GM), and control strategies/algorithms used for type 1 diabetes mellitus (T1DM) treatment and control. Our main focus is on the T1DM that emerges due to pancreas’s failure to produce sufficient insulin due to the loss of beta cells (β-cells). We discuss various insulin administration and delivery methods including physiological methods, open-loop, and closed-loop schemes. Furthermore, we report several factors such as hyperglycemia, hypoglycemia, and many other physical factors that need to be considered while infusing insulin in human body via AP systems. We discuss three prominent control algorithms including proportional-integral- derivative (PID), fuzzy logic, and model predictive, which have been clinically evaluated and have all shown promising results. In addition, linear and non-linear insulin infusion control schemes have been formally discussed. To the best of our knowledge, this is the first work which systematically covers recent developments in the AP components with a solid foundation for future studies in the T1DM field.
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Kubiak T, Priesterroth L, Barnard-Kelly KD. Psychosocial aspects of diabetes technology. Diabet Med 2020; 37:448-454. [PMID: 31943354 DOI: 10.1111/dme.14234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 12/14/2022]
Abstract
AIM To identify key psychosocial research in the domain of diabetes technology. RESULTS Four trajectories of psychosocial diabetes technology research are identified that characterize research over the past 25 years. Key evidence is reviewed on psychosocial outcomes of technology use as well as psychosocial barriers and facilitating conditions of diabetes technology uptake. Psychosocial interventions that address modifiable barriers and psychosocial factors have proven to be effective in improving glycaemic and self-reported outcomes in diabetes technology users. CONCLUSIONS Psychosocial diabetes technology research is essential for designing interventions and education programmes targeting the person with diabetes to facilitate optimized outcomes associated with technology uptake. Psychosocial aspects of diabetes technology use and related research will be even more important in the future given the advent of systems for automated insulin delivery and the increasingly widespread digitalization of diabetes care.
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Affiliation(s)
- T Kubiak
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - L Priesterroth
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - K D Barnard-Kelly
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
- BHR Limited, Fareham, UK
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White ND, Knezevich E. Flash Glucose Monitoring Technology Impact on Diabetes Self-Care Behavior. Am J Lifestyle Med 2019; 14:130-132. [PMID: 32231476 DOI: 10.1177/1559827619890955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Individuals with diabetes play a significant role in the control of their condition by participating in their own care. Self-monitoring of blood glucose is of particular importance in maintaining adequate glycemic control but when obtained using traditional fingerstick methods, is often limited with by cost, fear of needles or pain and inconvenience. Flash glucose monitoring is an innovative technology available to address these barriers and help people with diabetes better manage their blood glucose levels. Data demonstrating increased frequency in glucose monitoring, patient perspectives related to self-care behaviors, and implications for practice and future research are described.
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Affiliation(s)
- Nicole D White
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
| | - Emily Knezevich
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
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