The Use of Mobile Health to Deliver Self-Management Support to Young People With Type 1 Diabetes: A Cross-Sectional Survey

Text messaging to enhance glucose monitoring and self-care in teens with type 1 diabetes: Teens' perceptions predict outcomes

AIMS

We assessed association between how teens with type 1 diabetes (T1D) perceived a text-messaging (TM) reminder system to check glucose levels and how their perceptions related to their responsiveness to TM reminders to check glucose levels.

METHODS

Teens received TM reminders 1-4 times daily to check glucose levels and to reply with the result. Qualitative assessments were performed quarterly. Teens were categorized by perceptions expressed at the majority of the visits and their TM responsiveness over 18 months.

RESULTS

There were 135 teens (51 % male), with a mean age of 14.8 ± 1.2 years, receiving TM reminders. Distribution of participants' perceptions was 37 % positive (POS), 35 % neutral (with both positive and negative responses (POS/NEG)), and 28 % negative (NEG). Teens with POS perceptions about TM reminders were more likely to respond with a glucose value to the TM reminders than teens with NEG or POS/NEG perceptions (p = 0.002). Youth with POS perceptions and TM responsiveness on ≥ 50 % of days had an 0.81 % improvement in their HbA1c (p = 0.004) over 18 months.

CONCLUSIONS

Teens with POS perceptions to TM reminders were likely to respond and their responsiveness yielded glycemic benefit, suggesting need to consider opinions of teens with T1D to maximize their intervention engagement and resulting benefits.

Young Adults with Type 1 Diabetes

Young adults experience multiple developmental transitions across social, educational, vocational, residential, and financial life domains. These transitions are potential competing priorities to managing a chronic condition such as type 1 diabetes and can contribute to poor psychosocial and medical outcomes. In this narrative review, we describe population outcomes of young adult populations and the unique considerations associated with managing type 1 diabetes in young adulthood. We provide an overview of the current evidence-based strategies to improve care for young adults with type 1 diabetes and recommendations for future directions in the field.

A study investigating user adoptive behavior and the continuance intention to use mobile health applications during the COVID-19 pandemic era: Evidence from the telemedicine applications utilized in Indonesia

During the COVID-19 pandemic era that began in 2020, there has been a growing trend in the literature to tackle the problem of health stress (HS) for promoting a sense of public health. In turn, this developing area of research has a high level of relevancy linked to business and economic recovery (Čvirik, 2020). Since HS has increased sharply during the COVID-19 pandemic era, there has been a need to further investigate the balance between coping with HS and the positive continuous intention to use mobile health applications (mHealth apps) among the public. This is the first study that takes the Asia-Pacific region as its case study and empirically investigates the validity of extensions based on the theories of expectation confirmation theory (ECT) (Bhattacherjee, 2001) on user continuous behavior relating to mHealth apps during the COVID-19 pandemic. Results reveal that HS as an emotion can positively affect perceived usefulness and satisfaction in relation to the continuous intention to use mHealth apps. The differences between new and frequent users are confirmed. Discussion and implications for practices are provided in the end.

Accessibility and Openness to Diabetes Management Support via Mobile Phones: A Survey of People with Type 1 Diabetes Using Advanced Diabetes Technologies (Preprint)

Background

Little is known about the feasibility of mobile health (mHealth) support among people with type 1 diabetes (T1D) using advanced diabetes technologies including continuous glucose monitoring (CGM) systems and hybrid closed-loop insulin pumps (HCLs).

Objective

This study aims to evaluate patient access and openness to receiving mHealth diabetes support in people with T1D using CGM systems or HCLs.

Methods

We conducted a cross-sectional survey among patients with T1D using CGM systems or HCLs managed in an academic medical center. Participants reported information regarding their mobile device use; cellular call, SMS text message, or internet connectivity; and openness to various channels of mHealth communication (smartphone apps, SMS text messages, and interactive voice response [IVR] calls). Participants’ demographic characteristics and CGM data were collected from medical records. The analyses focused on differences in openness to mHealth and mHealth communication channels across groups defined by demographic variables and measures of glycemic control.

Results

Among all participants (N=310; female: n=198, 63.9%; mean age 45, SD 16 years), 98.1% (n=304) reported active cellphone use and 80% (n=248) were receptive to receiving mHealth support to improve glucose control. Among participants receptive to mHealth support, 98% (243/248) were willing to share CGM glucose data for mHealth diabetes self-care assistance. Most (176/248, 71%) were open to receiving messages via apps, 56% (139/248) were open to SMS text messages, and 12.1% (30/248) were open to IVR calls. Older participants were more likely to prefer SMS text messages (P=.009) and IVR calls (P=.03) than younger participants.

Conclusions

Most people with T1D who use advanced diabetes technologies have access to cell phones and are receptive to receiving mHealth support to improve diabetes control.

Perceptions on mobile health use for health education in an Indigenous population

Introduction

Indigenous peoples in Canada face numerous health needs and challenges and often have poor health status due to inequitable access to care. Providing culturally appropriate support for health conditions, particularly chronic conditions that require self-management, can assist in averting complications and morbidity. Mobile health is a useful medium for delivering health education across different populations. However, meaningful user involvement is necessary because mobile health interventions suitable for one population may not be appropriate for another. Indigenous people’s views will inform the use of mobile health interventions in Indigenous communities.

Objective

The study explored the perception of Indigenous women on using mobile health as a tool for receiving health information.

Methods

This was a qualitative study, and participants comprised of 22 Indigenous women (First Nations and Métis) with or at risk of diabetes, aged 18–69 years in Saskatoon, Canada. After 12 weeks of disseminating diabetic eye care information via text messaging, data were collected via sharing circle discussions and analyzed using thematic analysis.

Results

Participants indicated that the nature of messages such as the use of Indigenous languages, the message content, frequency of messages, group activities, and delivery formats such as voice messages, mobile applications, Internet, two-way messaging, and text messages were essential considerations in using mobile health as a tool for receiving health information.

Conclusion

Different factors need to be considered in using mobile health as a tool for health education among Indigenous peoples. These factors could be applicable in implementing mobile health solutions in other populations for the management of health conditions.

A Text Messaging Intervention With Financial Incentive for Adolescents With Type 1 Diabetes

BACKGROUND

Adolescents with type 1 diabetes (T1D) have higher hemoglobin A1C (HbA1c) levels than others. In general, adolescents engage with text messaging (TM) and financial incentives, both associated with improved diabetes outcomes. This study aimed to assess the impact of a TM intervention with financial incentives on self-care behaviors and HbA1c.

METHODS

A six-month randomized controlled trial compared MyDiaText™, a TM education and support application, with standard care. The sample included 166 teens with T1D, 12-18 years old, attending a diabetes clinic. The intervention group received one daily TM and were instructed to respond. Participants who responded to TMs for the most consecutive days were eligible for a financial reward biweekly via lottery. All participants received prompts to complete the self-care inventory (SCI) at baseline, 90, and 180 days. HbA1c was collected at clinic visits. Changes in SCI and HbA1c were analyzed using a multilevel mixed-effects linear regression model. Intention-to-treat and per-protocol analyses were performed.

RESULTS

The median TM response rate was 59% (interquartile range 40.1%-85.2%) and decreased over time. After adjustment for baseline characteristics, in per-protocol analysis, there was a statistically significant difference in SCI score increase in those receiving one TM per day vs control (P = .035). HbA1c decreased overall, without significant difference between groups (P = .786).

CONCLUSIONS

A TM intervention with financial incentives for adolescents with T1D in suboptimal control was associated with increasing self-care report; however, glycemic control did not differ from controls. Further research is needed to develop digital health interventions that will impact glycemic control.

Translating strategies for promoting engagement in mobile health: A proof-of-concept microrandomized trial

OBJECTIVE

Mobile technologies allow for accessible and cost-effective health monitoring and intervention delivery. Despite these advantages, mobile health (mHealth) engagement is often insufficient. While monetary incentives may increase engagement, they can backfire, dampening intrinsic motivations and undermining intervention scalability. Theories from psychology and behavioral economics suggest useful nonmonetary strategies for promoting engagement; however, examinations of the applicability of these strategies to mHealth engagement are lacking. This proof-of-concept study evaluates the translation of theoretically-grounded engagement strategies into mHealth, by testing their potential utility in promoting daily self-reporting.

METHOD

A microrandomized trial (MRT) was conducted with adolescents and emerging adults with past-month substance use. Participants were randomized multiple times daily to receive theoretically-grounded strategies, namely reciprocity (the delivery of inspirational quote prior to self-reporting window) and nonmonetary reinforcers (e.g., the delivery of meme/gif following self-reporting completion) to improve proximal engagement in daily mHealth self-reporting.

RESULTS

Daily self-reporting rates (62.3%; n = 68) were slightly lower than prior literature, albeit with much lower financial incentives. The utility of specific strategies was found to depend on contextual factors pertaining to the individual's receptivity and risk for disengagement. For example, the effect of reciprocity significantly varied depending on whether this strategy was employed (vs. not employed) during the weekend. The nonmonetary reinforcement strategy resulted in different outcomes when operationalized in various ways.

CONCLUSIONS

While the results support the translation of the reciprocity strategy into this mHealth setting, the translation of nonmonetary reinforcement requires further consideration prior to inclusion in a full scale MRT. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Developing an Adaptive Mobile Intervention to Address Risky Substance Use Among Adolescents and Emerging Adults: Usability Study

BACKGROUND

Substance use among adolescents and emerging adults continues to be an important public health problem associated with morbidity and mortality. Mobile health (mHealth) provides a promising approach to deliver just-in-time adaptive interventions (JITAIs) to prevent escalation of use and substance use-related consequences.

OBJECTIVE

This pilot study aims to describe the iterative development and initial feasibility and acceptability testing of an mHealth smartphone app, called MiSARA, designed to reduce escalation in substance use.

METHODS

We used social media advertisements to recruit youth (n=39; aged 16-24 years, who screened positive for past-month binge drinking or recreational cannabis use) with a waiver of parental consent. Participants used the MiSARA app for 30 days, with feasibility and acceptability data reported at a 1-month follow-up. We present descriptive data regarding behavior changes over time.

RESULTS

The results show that most participants (31/39, 79%) somewhat liked the app at least, with most (29/39, 74%) rating MiSARA as 3 or more stars (out of 5). Almost all participants were comfortable with self-reporting sensitive information within the app (36/39, 92%); however, most participants also desired more interactivity (27/39, 69%). In addition, participants' substance use declined over time, and those reporting using the app more often reported less substance use at the 1-month follow-up than those who reported using the app less often.

CONCLUSIONS

The findings suggest that the MiSARA app is a promising platform for JITAI delivery, with future trials needed to optimize the timing and dose of messages and determine efficacy.

A Fun Way to Learn About Diabetes: Using Therapeutic Play in a Brazilian Camp

PURPOSE

Understanding disease mechanisms inside the body is crucial to engage youth with type 1 diabetes (T1D) in self-care behaviors. This study describes how Instructional Therapeutic Play (ITP) group sessions held by nurses in a Brazilian camp can enhance youth's understanding about T1D.

DESIGN AND METHODS

Youth with T1D participated in video recorded ITP group sessions guided by the Sensitive Creative Method. First, participants were asked to create an artistic production based upon the query "What happens in the body of a young person who has diabetes?". They described their drawings and shared information, providing opportunities to discuss T1D pathophysiology. Second, campers were told a story about a child who had T1D onset using a rag doll and illustrative figures. Participants were asked to create a second artistic production based upon the same initial query. Finally, campers had another presentation of the drawings, discussion, and sharing through the question "How did the story told help you understand your diabetes?" Transcriptions of ITP sessions were submitted to thematic analysis.

RESULTS

Twenty participants (9-17yo) were assigned to age/gender matched groups. Four themes were built: Designing insulin production; Experiencing the glycemic vigilance in diabetes management; The ITP session as a safe space to share challenges with nurses and peers; and Unraveling the myths of diabetes with the ITP session.

CONCLUSION

Therapeutic play sessions enhanced youth's knowledge and unraveled myths of T1D pathophysiology.

PRACTICE IMPLICATIONS

ITP sessions can be developed by nurses in order to deliver age-appropriate diabetes education to pediatric patients.

A Facilitated Web-Based Self-Management Tool for People With Type 1 Diabetes Using an Insulin Pump: Intervention Development Using the Behavior Change Wheel and Theoretical Domains Framework

BACKGROUND

Type 1 diabetes (T1D) requires intensive self-management (SM). An insulin pump is designed to better support personal T1D management, but at the same time, it exacerbates the complexity and requirements of SM. Research shows that people with diabetes are likely to benefit from navigating and connecting to local means of social support and resources through web-based interventions that offer flexible, innovative, and accessible SM. However, questions remain as to which behavior change mechanisms within such resources benefit patients most and how to foster engagement with and endorsement of SM interventions.

OBJECTIVE

The aim of this study was to evaluate the perspectives and experiences of people with T1D using an insulin pump and specialist health care professionals (HCPs) and determine what behavior change characteristics and strategies are required to inform the optimization of an existing web-based social network (SN) intervention to support SM.

METHODS

Focus groups with insulin pump users (n=19) and specialist HCPs (n=20) in 6 National Health Service (NHS) trusts across the south of England examined the barriers and enablers to incorporating and self-managing an insulin pump. An analysis was undertaken using the Behavior Change Wheel and Theoretical Domains Framework, followed by a taxonomy of behavior change techniques (BCTs) to identify the contents of and strategies for the implementation of a complex health intervention.

RESULTS

A total of 4 themes represent the SM perspectives and experiences of stakeholders: (1) a desire for access to tailored and appropriate resources and information-the support and information required for successful SM are situational and contextual, and these vary according to time and life circumstances, and therefore, these need to be tailored and appropriate; (2) specific social support preferences-taking away isolation as well as providing shared learnings and practical tips, but limitations included the fear of judgment from others and self-pity from peers; (3) the environmental context, that is, capacity and knowledge of pump clinic HCPs-HCPs acknowledge the patient's need for holistic support but lack confidence in providing it; and (4) professional responsibility and associated risks and dangers, whereas HCPs are fearful of the consequences of promoting non-NHSSM support, and they question whether SM support fits into their role. BCTs were identified to address these issues.

CONCLUSIONS

The use of behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers and enablers of self-managing T1D with an insulin pump. A web-based SN intervention appears to offer additional forms of SM support while complementing NHS services. However, for intervention implementation, HCPs' apprehensions about responsibility when signposting to non-NHS SM support would need to be addressed, and opportunistic features would need to be added, through which pump users could actively engage with other people living with T1D.

Impact of mobile health in diabetic retinopathy awareness and eye care behavior among Indigenous women

BACKGROUND

Diabetes is increasingly widespread among Indigenous people, and diabetic retinopathy (DR) is a diabetes eye complication and a common cause of vision loss among adults in Canada. Indigenous women have a high risk of diabetes which increases their risk for DR. This study explored utilizing mobile health (mHealth) via text messages to provide DR awareness and improve diabetic-eye care behavior. This study identified the changes in DR awareness and eye care behavior due to a mHealth education intervention among Indigenous women with or at risk of diabetes.

METHODS

A pre-post study which adopted an embedded concurrent mixed methods approach guided by self-determination theory and the medicine wheel. Study participants were First Nations and Métis women living with or at risk of diabetes in Saskatoon, Canada. Data was collected via sharing circles and a DR knowledge, attitude, and practice survey. Pre-intervention participants' baseline information on DR knowledge and behavior were obtained from participants. After that, participants received daily text messages on diabetes-eye related information for 12 weeks. Post-intervention, the impact of the mHealth intervention on DR awareness and eye care behavior was assessed.

RESULTS

Following the intervention, the DR knowledge, attitude, and practice scores significantly improved. Individuals living with diabetes had increased DR attitude and practice post-scores compared to those at risk of diabetes. Older women had a lower pre-post change in practice scores compared to younger women. The mHealth intervention provided a holistic approach to support diabetes-eye care and empowered the study participants to eat healthily, take medication as prescribed, and have regular medical and eye check-ups.

CONCLUSIONS

The mHealth education intervention increased DR awareness and fostered a change in diabetes-eye care behavior. Health information via text messaging can motivate, provide support, and empower individuals as well as prevent and manage chronic conditions and reduce the risk of complications.

Effectiveness of Smartphone App-Based Interactive Management on Glycemic Control in Chinese Patients With Poorly Controlled Diabetes: Randomized Controlled Trial

BACKGROUND

In recent years, the rapid development of mobile medical technology has provided multiple ways for the long-term management of chronic diseases, especially diabetes. As a new type of management model, smartphone apps are global, convenient, cheap, and interactive. Although apps were proved to be more effective at glycemic control, compared with traditional computer- and Web-based telemedicine technologies, how to gain a further and sustained improvement is still being explored.

OBJECTIVE

The objective of this study was to investigate the effectiveness of an app-based interactive management model by a professional health care team on glycemic control in Chinese patients with poorly controlled diabetes.

METHODS

This study was a 6-month long, single-center, prospective randomized controlled trial. A total of 276 type 1 or type 2 diabetes patients were enrolled and randomized to the control group (group A), app self-management group (group B), and app interactive management group (group C) in a 1:1:1 ratio. The primary outcome was the change in glycated hemoglobin (HbA_1c) level. Missing data were handled by multiple imputation.

RESULTS

At months 3 and 6, all 3 groups showed significant decreases in HbA_1c levels (all P<.05). Patients in the app interactive management group had a significantly lower HbA_1clevel than those in the app self-management group at 6 months (P=.04). The average HbA_1c reduction in the app interactive management group was larger than that in the app self-management and control groups at both months 3 and 6 (all P<.05). However, no differences in HbA_1c reduction were observed between the app self-management and control groups at both months 3 and 6 (both P>.05). Multivariate line regression analyses also showed that the app interactive management group was associated with the larger reduction of HbA_1c compared with groups A and B at both months 3 and 6 (all P>.05). In addition, the app interactive management group had better control of triglyceride and high-density lipoprotein cholesterol levels at both months 3 and 6 compared with baseline (both P<.05).

CONCLUSIONS

In Chinese patients with poorly controlled diabetes, it was difficult to achieve long-term effective glucose improvement by using app self-management alone, but combining it with interactive management can help achieve rapid and sustained glycemic control.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02589730; https://clinicaltrials.gov/ct2/show/NCT02589730.

Appropriation of Mobile Health for Diabetes Self-Management: Lessons From Two Qualitative Studies

BACKGROUND

To achieve clarity on mobile health's (mHealth's) potential in the diabetes context, it is necessary to understand potential users' needs and expectations, as well as the factors determining their mHealth use. Recently, a few studies have examined the user perspective in the mHealth context, but their explanatory value is constrained because of their limitation to adoption factors.

OBJECTIVE

This paper uses the mobile phone appropriation model to examine how individuals with type 1 or type 2 diabetes integrate mobile technology into their everyday self-management. The study advances the field beyond mere usage metrics or the simple dichotomy of adoption versus rejection.

METHODS

Data were gathered in 2 qualitative studies in Singapore and Germany, with 21 and 16 respondents, respectively. Conducting semistructured interviews, we asked respondents about their explicit use of diabetes-related apps, their general use of varied mobile technologies to manage their disease, and their daily practices of self-management.

RESULTS

The analysis revealed that although some individuals with diabetes used dedicated diabetes apps, most used tools across the entire mobile-media spectrum, including lifestyle and messaging apps, traditional health information websites and forums. The material indicated general barriers to usage, including financial, technical, and temporal restrictions.

CONCLUSIONS

In sum, we find that use patterns differ regarding users' evaluations, expectancies, and appropriation styles, which might explain the inconclusive picture of effects studies in the diabetes mHealth context.

Comparing Real-Time Self-Tracking and Device-Recorded Exercise Data in Subjects with Type 1 Diabetes

BACKGROUND

Insulin therapy, medical nutrition therapy, and physical activity are required for the treatment of type 1 diabetes (T1D). There is a lack of studies in real-life environments that characterize patient-reported data from logs, activity trackers, and medical devices (e.g., glucose sensors) in the context of exercise.

OBJECTIVE

The objective of this study was to compare data from continuous glucose monitor (CGM), wristband heart rate monitor (WHRM), and self-tracking with a smartphone application (app), iDECIDE, with regards to exercise behaviors and rate of change in glucose levels.

METHODS

Participants with T1D on insulin pump therapy tracked exercise for 1 month with the smartphone app while WHRM and CGM recorded data in real time. Exercise behaviors tracked with the app were compared against WHRM. The rate of change in glucose levels, as recorded by CGM, resulting from exercise was compared between exercise events documented with the app and recorded by the WHRM.

RESULTS

Twelve participants generated 277 exercise events. Tracking with the app aligned well with WHRM with respect to frequency, 3.0 (2.1) and 2.5 (1.8) days per week, respectively (p = 0.60). Duration had very high agreement, the mean duration from the app was 65.6 (55.2) and 64.8 (54.9) minutes from WHRM (p = 0.45). Intensity had a low concordance between the data sources (Cohen's kappa = 0.2). The mean rate of change of glucose during exercise was -0.27 mg/(dL*min) and was not significantly different between data sources or intensity (p = 0.21).

CONCLUSION

We collated and analyzed data from three heterogeneous sources from free-living participants. Patients' perceived intensity of exercise can serve as a surrogate for exercise tracked by a WHRM when considering the glycemic impact of exercise on self-care regimens.

Users' preferences and design recommendations to promote engagements with mobile apps for diabetes self-management: Multi-national perspectives

Background

Mobile phone applications (apps) offer motivation and support for self-management of diabetes mellitus (DM), but their use is limited by high attrition due to insufficient consideration of end-users perspectives and usability requirements. This study aimed to examine app usage and feature preferences among people with DM, and explore their recommendations for future inclusions to foster engagement with diabetes apps.

Methods

The study was conducted internationally on adults with type 1 or type 2 DM using online questionnaire (quantitative) to investigate usage and preferences for app features that support diabetes self-management and semi structured telephone interview (qualitative) to explore suggestions on fostering engagement and specific educational information for inclusion into diabetes apps. Survey and interview data were analysed using descriptive/ inferential statistics and inductive thematic analysis respectively.

Results

A total of 217 respondents with type 1 DM (38.25%) or type 2 DM (61.8%), from 4 continents (Australia, Europe, Asia and America) participated in the survey. About half of the respondents (48%) use apps, mainly with features for tracking blood glucose (56.6%), blood pressure (51.9%) and food calories (48.1%). Preferred features in future apps include nutrient values of foods (56.7%), blood glucose (54.8%), physical exercise tracker (47%), health data analytics (42.9%) and education on diabetes self-management (40.6%). Irrespective of the type of DM, participants proposed future apps that are user friendly, support healthy eating, provide actionable reminders and consolidate data across peripheral health devices. Participants with type 1 DM recommended customised features with news update on developments in the field of diabetes. Nominated specific educational topics included tips on problem solving, use of insulin pump therapy, signs of diabetes complication and transitioning from paediatric into adult care.

Conclusions

The study has highlighted patients’ perspectives on essential components for inclusion in diabetes apps to promote engagement and foster better health outcomes.

The Use of Mobile Applications Among Adults with Type 1 and Type 2 Diabetes: Results from the Second MILES-Australia (MILES-2) Study

BACKGROUND

While the number of diabetes-specific mobile applications (apps) continues to grow, there is a lack of knowledge about their actual use.

METHODS

The second MILES (Management and Impact for Long-term Empowerment and Success)-Australia study was a national cross-sectional survey of the psychological, behavioral, and social aspects of diabetes for adults with type 1 diabetes (T1D) and type 2 diabetes (T2D). Associations between diabetes-specific app usage and demographic, clinical, and psychosocial variables were examined.

RESULTS

Of the 1589 respondents responding to the diabetes-specific app questions, 795 had T1D (mean ± standard deviation age 43 ± 14 years; 61% women; diabetes duration 19 ± 14 years) and 794 had T2D (age 60 ± 9 years; 40% women; diabetes duration 11 ± 7 years). Among adults with T1D, 24% (n = 188) reported using apps, with carbohydrate counting (74%; n = 139) as the most common cited purpose. App usage was significantly associated with shorter diabetes duration, more frequent glucose monitoring, and lower self-reported HbA1c. Among adults with T2D, 8% (n = 64) reported using apps, with glucose monitoring (62%; n = 39) as the most common purpose. For all respondents, the most commonly reported reason for not using apps was a belief that they could not help with diabetes self-management.

CONCLUSIONS

A minority of adults with T1D and T2D use apps to support their self-management. App use among adults with T1D is associated with a more recent T1D diagnosis, more frequent glucose monitoring, and lower self-reported HbA1c. Future efforts should focus on this association and determine the mechanisms by which app use is related to better clinical outcomes.

A Novel Approach to Identifying Barriers and Facilitators in Raising a Child With Type 1 Diabetes: Qualitative Analysis of Caregiver Blogs

BACKGROUND

With rising incidence of type 1 diabetes (T1D) diagnoses among children and the high levels of distress experienced by the caregivers of these children, caregiver support is becoming increasingly important. Historically, relatively few support resources have existed. Increasing use of the Internet, and blogs in particular, has seen a growth of peer support between caregivers of children with T1D. However, little is known about the type and quality of information shared on T1D caregiver blogs. At the same time, the information on such blogs offers a new window into what challenges and successes caregivers experience in helping to manage their children's T1D.

OBJECTIVE

The purpose of this study was to (1) analyze blogs of caregivers to children with T1D to better understand the challenges and successes they face in raising a child with T1D, and (2) assess the blogs for the presence of unsafe or inaccurate clinical information or advice.

METHODS

An inductive thematic qualitative study was conducted of three blogs authored by caregivers of children living with T1D, which included 140 unique blog posts and 663 associated comments. Two physician investigators evaluated the blogs for presence of clinical or medical misinformation.

RESULTS

Five major themes emerged: (1) the impact of the child's diagnosis, (2) the burden of intense self-management experienced in caring for a child with T1D, (3) caregivers' use of technology to ease their fear of hypoglycemia and impacts that device alarms associated with this technology have on caregiver burden, (4) caregivers' perceptions of frequently missed or delayed diagnosis of T1D and the frustration this causes, and (5) the resilience that caregivers develop despite the burdens they experience. Misinformation was exceedingly rare and benign when it did occur.

CONCLUSIONS

Blog analysis represents a novel approach to understand the T1D caregiver's experience. This qualitative study found many challenges that caregivers face in raising a child with T1D. Despite the many barriers caregivers face in managing their children's T1D, they find support through advocacy efforts and peer-to-peer blogging. Blogs provide a unique avenue for support, with only rare and benign findings of medical misinformation, and may be a resource that diabetes care providers can consider offering to families for support.

Toward Predicting Social Support Needs in Online Health Social Networks

Background

While online health social networks (OHSNs) serve as an effective platform for patients to fulfill their various social support needs, predicting the needs of users and providing tailored information remains a challenge.

Objective

The objective of this study was to discriminate important features for identifying users’ social support needs based on knowledge gathered from survey data. This study also provides guidelines for a technical framework, which can be used to predict users’ social support needs based on raw data collected from OHSNs.

Methods

We initially conducted a Web-based survey with 184 OHSN users. From this survey data, we extracted 34 features based on 5 categories: (1) demographics, (2) reading behavior, (3) posting behavior, (4) perceived roles in OHSNs, and (5) values sought in OHSNs. Features from the first 4 categories were used as variables for binary classification. For the prediction outcomes, we used features from the last category: the needs for emotional support, experience-based information, unconventional information, and medical facts. We compared 5 binary classifier algorithms: gradient boosting tree, random forest, decision tree, support vector machines, and logistic regression. We then calculated the scores of the area under the receiver operating characteristic (ROC) curve (AUC) to understand the comparative effectiveness of the used features.

Results

The best performance was AUC scores of 0.89 for predicting users seeking emotional support, 0.86 for experience-based information, 0.80 for unconventional information, and 0.83 for medical facts. With the gradient boosting tree as our best performing model, we analyzed the strength of individual features in predicting one’s social support need. Among other discoveries, we found that users seeking emotional support tend to post more in OHSNs compared with others.

Conclusions

We developed an initial framework for automatically predicting social support needs in OHSNs using survey data. Future work should involve nonsurvey data to evaluate the feasibility of the framework. Our study contributes to providing personalized social support in OHSNs.