1
|
Bonet-Olivencia S, Carrillo-Leal J, Rao A, Sasangohar F. User-Centered Design of a Diabetes Self-Management Tool for Underserved Populations. J Diabetes Sci Technol 2024; 18:22-29. [PMID: 37978811 PMCID: PMC10899832 DOI: 10.1177/19322968231212220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND User-centered design (UCD) or user experience design (UXD) methods have gained recent popularity for the design of mobile health (mHealth) interventions. However, there is a gap in application of these methods for diabetes self-management. This study aims to document the UCD process for a self-management mobile application aimed for patients with diabetes in underserved communities. METHODS A UCD mixed-methods approach including interviews with patients and providers, a review of literature, and a technology landscape analysis were used to define the app functional information requirements that informed the user experience/user interface design process. Usability studies with the app designers and developers, intended users, and a focus group of nurse educators and dieticians were used to test and improve the design. RESULTS An mHealth app was developed with health-tracking features for stress, blood sugar, food, exercise, medications, weight, and blood pressure. We tackled a range of usability and user experience challenges, which encompassed addressing issues like low health literacy by employing a combination of user interface design principles, intuitive visualizations, customizable icons, seamless database integration, and automated data input features. Special attention was given to the design of educational content accounting for the intended users' cultural background and literacy levels. CONCLUSIONS User-centered design approach contributed to a better understanding of the intended users' needs, limitations, mental models, and expectations, facilitating the design of a comprehensive mobile app for patients with diabetes in underserved communities that includes essential features for self-management while providing a strong educational component, addressing an important gap in the literature.
Collapse
Affiliation(s)
- Samuel Bonet-Olivencia
- Department of Industrial and Systems
Engineering, Texas A&M University, College Station, TX, USA
| | - Jesus Carrillo-Leal
- Department of Industrial and Systems
Engineering, Texas A&M University, College Station, TX, USA
| | - Arjun Rao
- Department of Industrial and Systems
Engineering, Texas A&M University, College Station, TX, USA
| | - Farzan Sasangohar
- Department of Industrial and Systems
Engineering, Texas A&M University, College Station, TX, USA
| |
Collapse
|
2
|
Wang B, Asan O, Zhang Y. Shaping the future of chronic disease management: Insights into patient needs for AI-based homecare systems. Int J Med Inform 2024; 181:105301. [PMID: 38029700 DOI: 10.1016/j.ijmedinf.2023.105301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The rising demand for healthcare resources, especially in chronic disease management, has elevated the importance of Artificial Intelligence (AI) in healthcare. While AI-based homecare systems are being developed, the perspectives of chronic patients, who are one of the primary beneficiaries and risk bearers of these technologies, remain largely under-researched. While recent research has highlighted the importance of AI-based homecare systems, the current understanding of patients' desired designs and features is still limited. OBJECTIVE This paper explores chronic patients' perspectives regarding AI-based homecare systems, an area currently underrepresented in research. We aim to identify the factors influencing their decision to use such systems, elucidate the potential roles of government and other concerned authorities, and provide feedback to AI developers to enhance adoption, system design, and usability and improve the overall healthcare experiences of chronic patients. METHOD A web-based open-ended questionnaire was designed to gather the perspectives of chronic patients about AI-based homecare systems. In total, responses from 181 participants were collected. Using Krippendorff's clustering technique, an inductive thematic analysis was performed to identify the main themes and their respective subthemes. RESULT Through rigorous coding and thematic analysis of the collected responses, we identified four major themes further segmented into thirteen subthemes. These four primary themes were: 1) "Personalized Design", emphasizing the need for patients to manage their health condition better through personalized and educational resources and user-friendly interfaces; 2) "Emotional & Social Support", underscoring the desire for AI systems to facilitate social connectivity and provide emotional support to improve the well-being of chronic patients at home; 3) "System Integration & Proactive Care", addressing the importance of seamless communication, proactive patient monitoring and integration with existing healthcare platforms; and 4) "Ethics & Regulation", prioritizing ethical guidelines, regulatory compliance, and affordability in the design. CONCLUSION This study has offered significant insights into the needs and expectations of chronic patients regarding AI-based home care systems. 'The findings highlight the importance of personalized and accessible care, emotional and social support, seamless system integration, proactive care, and ethical considerations in designing and implementing such systems. By aligning the design and operation of these systems with the lived experiences and expectations of patients, we can better ensure their acceptance and effectiveness.
Collapse
Affiliation(s)
- Bijun Wang
- Department of Business Analytics and Data Science, Florida Polytechnic University, Lakeland, FL 33805, USA
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ 07047, USA.
| | - Yiqi Zhang
- Department of Industrial and Manufacturing Engineering, Penn State University, State College, PA 16801, USA
| |
Collapse
|
3
|
Mavragani A, Ramos AK, Trinidad N, Quintero S, Johnson Beller R, Struwe L, Pozehl B. Feasibility, Usability and Acceptability of a mHealth Intervention to Reduce Cardiovascular Risk in Rural Hispanic Adults: Descriptive Study. JMIR Form Res 2022; 6:e40379. [PMID: 36563025 PMCID: PMC9823566 DOI: 10.2196/40379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/07/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) technology using apps or devices to self-manage health behaviors is an effective strategy to improve lifestyle-related health problems such as hypertension, obesity, and diabetes. However, few studies have tested an mHealth intervention with Hispanic/Latino adults, and no studies were found testing mHealth with rural Hispanic/Latino adults, the fastest-growing population in rural areas. OBJECTIVE The purpose of this study was to evaluate the feasibility, usability, and acceptability of an mHealth cardiovascular risk self-management intervention with rural Hispanic/Latino adults. METHODS A descriptive study using quantitative and qualitative methods was used to evaluate the feasibility, usability, and acceptability of delivering a 12-week mHealth self-management intervention to reduce cardiovascular risk with rural Hispanic/Latino adults who were randomized to 1 of 2 groups. Both groups were asked to use MyFitnessPal to self-monitor daily steps, weight, and calories. The intervention group received support to download, initiate, and troubleshoot technology challenges with MyFitnessPal (Under Armour) and a smart scale, while the enhanced usual care group received only a general recommendation to use MyFitnessPal to support healthy behaviors. The usability of MyFitnessPal and the smart scale was measured using an adapted Health Information Technology Usability EvaluationScale (Health-ITUES). Adherence data in the intervention group (daily steps, weight, and calories) were downloaded from MyFitnessPal. Acceptability was evaluated using semistructured interviews in a subsample (n=5) of intervention group participants. RESULTS A sample of 70 eligible participants (enhanced usual care group n=34; intervention group n=36) were enrolled between May and December 2019. The overall attrition was 28% at 12 weeks and 54% at 24 weeks. mHealth usability in the intervention group increased at each time point (6, 12, and 24 weeks). Adherence to self-monitoring using mHealth in the intervention group after week 1 was 55% for steps, 39% for calories, and 35% for weights; at the end of the 12-week intervention, the adherence to self-monitoring was 31% for steps, 11% for weight, and 8% for calories. Spikes in adherence coincided with scheduled in-person study visits. Structured interviews identified common technology challenges including scale and steps not syncing with the app and the need for additional technology support for those with limited mHealth experience. CONCLUSIONS Recruitment of rural Hispanic/Latino adults into the mHealth study was feasible using provider and participant referrals. The use of MyFitnessPal, the smart scale, and SMS text messages to self-monitor daily steps, weights, and calories was acceptable and feasible if technology support was provided. Future research should evaluate and support participants' baseline technology skill level, provide training if needed, and use a phone call or SMS text message follow-ups as a strategy to minimize attrition. A wearable device, separate from the smartphone app, is recommended for activity tracking.
Collapse
Affiliation(s)
| | - Athena K Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Natalia Trinidad
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Sophia Quintero
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | | | - Leeza Struwe
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE, United States
| | - Bunny Pozehl
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, United States
| |
Collapse
|
4
|
Barengo NC, Apolinar LM, Estrada Cruz NA, Fernández Garate JE, Correa González RA, Diaz Valencia PA, Gonzalez CAC, Rodriguez JAG, González NC, Arellano Flores ML, Ledesma Muñoz ME, Gonzalez Sotelo DA, Davila Maldonado OM, Gomez Garcia JG, Laureano Hernandez FJ, Jimenez JEZ, Pulido Garcia BA, Vazquez HR, Ramirez Dorantes AA, Gonzalez Fierro LA, Hernandez Hernandez JC, Perez JZ. Development of an information system and mobile application for the care of type 2 diabetes patients at the primary care level for the health sector in Mexico: study protocol for a randomized controlled, open-label trial. Trials 2022; 23:253. [PMID: 35379298 PMCID: PMC8981629 DOI: 10.1186/s13063-022-06177-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
Background Providing optimal care for type 2 diabetes (DM2) patients remains a challenge for all healthcare systems. Patients often encounter various barriers in adhering to self-management programs due to lack of knowledge and understanding of self-care activities, lack of individualized and coordinated care, inconvenient and costly education sessions, and poor patient-provider communication. Mobile technologies such as cell phones/smartphones, handheld tablets, and other wireless devices offer new and exciting opportunities for addressing some of these challenges. The purpose of this study is to compare a diabetes management strategy using an information board and a mobile application versus standard care in patients with uncontrolled DM2. Method The SANENT (Sistema de Análisis de Enfermedades No Transmisibles) trial is a primary care-based, prospective, two-arm, randomized controlled, open-label, blinded-endpoint study. We aim to recruit 1440 DM2 patients during a period of 6 months until the requested number of participants has been achieved. The total length of the intervention will be 1 year. Both men and women treated for DM2 with an HbA1c > 8.5% and ≥ 20 years of age are eligible to participate in the study. The primary outcome of the study is improved diabetes control measured by changes in HbA1c in the study participants. HbA1c will be measured at baseline, 3-month, 6-month, 9-month, and 12-month follow-up visits in all participants. The main analysis will be based on the intention-to-treat principle. The primary endpoint of the study will be the change in HbA1C within the groups and the differences between the groups. This will be assessed by a repeated measurement approach based on mixed models which contain both fixed effects and random effects. Discussion The overall goal of this project is to contribute to the evidence for the use of mobile technology to improve the treatment and regulation of poorly controlled DM2 patients living in Mexico. Our proposed project will show how mobile health technology tools can be used in the treatment of patients with uncontrolled DM2 in primary health care in a Latin American population, and particularly how they could help diabetes patients take better care of themselves. Trial registration ClinicalTrials.gov, US National Institutes of Health NCT04974333. Prospectively registered on July 13, 2021. Protocol version number 1, dated August 15th, 2021.
Collapse
|
5
|
Enyioha C, Hall M, Voisin C, Jonas D. Effectiveness of Mobile Phone and Web-Based Interventions for Diabetes and Obesity Among African American and Hispanic Adults in the United States: Systematic Review. JMIR Public Health Surveill 2022; 8:e25890. [PMID: 35119368 PMCID: PMC8857702 DOI: 10.2196/25890] [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: 11/19/2020] [Revised: 02/05/2021] [Accepted: 10/14/2021] [Indexed: 11/14/2022] Open
Abstract
Background Mobile health (mHealth) and web-based technological advances allow for new approaches to deliver behavioral interventions for chronic diseases such as obesity and diabetes. African American and Hispanic adults experience a disproportionate burden of major chronic diseases. Objective This paper reviews the evidence for mHealth and web-based interventions for diabetes and obesity in African American and Hispanic adults. Methods Literature searches of PubMed/Medline, The Cochrane Library, EMBASE, CINAHL Plus, Global Health, Scopus, and Library & Information Science Source were conducted for relevant English-language articles. Articles identified through searches were reviewed by 2 investigators and, if they met the inclusion criteria, were extracted and assessed for risk of bias. Findings were summarized in tabular and narrative format. The overall strength of the evidence was assessed as high, moderate, low, or insufficient on the basis of risk of bias, consistency of findings, directness, precision, and other limitations. Results Searches yielded 2358 electronic publications, 196 reports were found to be eligible for inclusion, and 7 studies met the eligibility criteria. All 7 included studies were randomized control trials. Five studies evaluated the effectiveness of an mHealth intervention for weight loss, including one that evaluated the effectiveness for diabetes and two studies focused on diabetes. Of all the studies that focused on weight loss, 3 reported significant differences in weight loss in participants in the intervention group compared with those in the usual care group. Although all studies on diabetes control showed greater improvement in glycemic control for the intervention group compared to that in the control group, only one study showed a significant difference between the 2 groups. Conclusions This analysis indicates that there are few published studies that assessed mHealth interventions among minority populations and focused on weight or diabetes. Although the overall strength of evidence was low for diabetes control, it was moderate for weight loss, and our findings suggest that mHealth and web-based interventions may provide a promising approach for interventions among African American and Hispanic adults who have obesity or diabetes.
Collapse
Affiliation(s)
- Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew Hall
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christiane Voisin
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel Jonas
- Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
6
|
Bults M, van Leersum CM, Olthuis TJJ, Bekhuis REM, den Ouden MEM. Barriers and Drivers Regarding the Use of Mobile Health Apps Among Patients With Type 2 Diabetes Mellitus in the Netherlands: Explanatory Sequential Design Study. JMIR Diabetes 2022; 7:e31451. [PMID: 35084357 PMCID: PMC8832276 DOI: 10.2196/31451] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/01/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
Background Self-monitoring of blood glucose levels, food intake, and physical activity supports self-management of patients with type 2 diabetes mellitus (T2DM). There has been an increase in the development and availability of mobile health apps for T2DM. Objective The aim of this study is to explore the actual use of mobile health apps for diabetes among patients with T2DM and the main barriers and drivers among app users and nonusers. Methods An explanatory sequential design was applied, starting with a web-based questionnaire followed by semistructured in-depth interviews. Data were collected between July and December 2020. Questionnaire data from 103 respondents were analyzed using IBM SPSS Statistics (version 25.0). Descriptive statistics were performed for the actual use of apps and items of the Unified Theory of Acceptance and Use of Technology (UTAUT). The UTAUT includes 4 key constructs: performance expectancy (the belief that an app will help improve health performance), effort expectancy (level of ease associated with using an app), social influence (social support), and facilitating conditions (infrastructural support). Differences between users and nonusers were analyzed using chi-square tests for individual items. Independent 2-tailed t tests were performed to test for differences in mean scores per the UTAUT construct. In total, 16 respondents participated in the interviews (10 users and 6 nonusers of apps for T2DM). We performed content analysis using a deductive approach on all transcripts, guided by the UTAUT. Results Regarding actual use, 55.3% (57/103) were nonusers and 44.7% (46/103) were users of apps for T2DM. The main driver for the use of apps was the belief that using apps for managing diabetes would result in better personal health and well-being. The time and energy required to keep track of the data and understand the app were mentioned as barriers. Mean scores were significantly higher among users compared with nonusers of apps for T2DM for the constructs performance expectancy (4.06, SD 0.64 vs 3.29, SD 0.89; P<.001), effort expectancy (4.04, SD 0.62 vs 3.50, SD 0.82; P<.001), social influence (3.59, SD 0.55 vs 3.29, SD 0.54; P=.007), and facilitating conditions (4.22, SD 0.48 vs 3.65, SD 0.70; P<.001). On the basis of 16 in-depth interviews, it was recognized that health care professionals play an important role in supporting patients with T2DM in using apps. However, respondents noticed that their health care professionals were often not supportive of the use of apps for managing diabetes, did not show interest, or did not talk about apps. Reimbursement by insurance companies was mentioned as a missing facilitator. Conclusions Empowering health care professionals’ engagement is of utmost importance in supporting patients with T2DM in the use of apps. Insurance companies can play a role in facilitating the use of diabetes apps by ensuring reimbursement.
Collapse
Affiliation(s)
- Marloes Bults
- Technology, Health & Care Research Group, Saxion University of Applied Sciences, Enschede, Netherlands
| | - Catharina Margaretha van Leersum
- Science, Technology, and Policy Studies, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | | | | | | |
Collapse
|
7
|
Barengo NC, Diaz Valencia PA, Apolina LM, Estrada Cruz NA, Fernández Garate JE, Correa González RA, Cinco Gonzalez CA, Gómez Rodriguez JA, González NC. Mobile Health Technology in the Primary Prevention of Type 2 Diabetes: a Systematic Review. Curr Diab Rep 2022; 22:1-10. [PMID: 35113334 DOI: 10.1007/s11892-021-01445-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The objective of this review was to summarize the current scientific evidence of mobile health technology in the primary prevention of type 2 diabetes in patients with prediabetes derived from randomized clinical trials. RECENT FINDINGS Few randomized clinical trials are available using mobile health technologies in the prevention of type 2 diabetes. There is heterogeneity in regard to the main study outcomes, duration of interventions, and study findings. Inconsistent findings have been reported whether mobile health technologies are effective in reducing HbA1C levels or the incidence of type 2 diabetes in patients with prediabetes. However, results are promising that mobile health interventions may decrease body weight. Future study may consistently measure changes in glycemic indicators as well as develop elements that better address behavior changes.
Collapse
Affiliation(s)
- Noël C Barengo
- Department of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
- Division of Medical and Population Health Sciences Education and Research, Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
| | - Paula A Diaz Valencia
- Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
| | - Leticia Manuel Apolina
- Unidad de Investigación Médica en Enfermedades Endocrinas, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - José E Fernández Garate
- Unidad de Investigación Médica en Enfermedades Endocrinas, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | | |
Collapse
|
8
|
Bonet Olivencia S, Rao AH, Smith A, Sasangohar F. Eliciting Requirements for a Diabetes Self-Management Application for Underserved Populations: A Multi-Stakeholder Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:127. [PMID: 35010385 PMCID: PMC8751044 DOI: 10.3390/ijerph19010127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
Medically underserved communities have limited access to effective disease management resources in the U.S. Mobile health applications (mHealth apps) offer patients a cost-effective way to monitor and self-manage their condition and to communicate with providers; however, current diabetes self-management apps have rarely included end-users from underserved communities in the design process. This research documents key stakeholder-driven design requirements for a diabetes self-management app for medically underserved patients. Semi-structured survey interviews were carried out on 97 patients with diabetes and 11 healthcare providers from medically underserved counties in South Texas, to elicit perspectives and preferences regarding a diabetes self-management app, and their beliefs regarding such an app's usage and utility. Patients emphasized the need for accessible educational content and for quick access to guidance on regulating blood sugar, diet, and exercise and physical activity using multimedia rather than textual forms. Healthcare providers indicated that glucose monitoring, educational content, and the graphical visualization of diabetes data were among the top-rated app features. These findings suggest that specific design requirements for the underserved can improve the adoption, usability, and sustainability of such interventions. Designers should consider health literacy and numeracy, linguistic barriers, data visualization, data entry complexity, and information exchange capabilities.
Collapse
Affiliation(s)
- Samuel Bonet Olivencia
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
| | - Arjun H. Rao
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
| | - Alec Smith
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
| | - Farzan Sasangohar
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
- Center for Outcomes Research, Houston Methodist, Houston, TX 77030, USA
| |
Collapse
|
9
|
Shetty VB, Soon WHK, Roberts AG, Fried L, Roby HC, Smith GJ, Fournier PA, Jones TW, Davis EA. A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study. JMIR Diabetes 2021; 6:e29739. [PMID: 34647896 PMCID: PMC8554675 DOI: 10.2196/29739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. OBJECTIVE Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. METHODS A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA1c, 54 mmol/mol, SD 5.5 mmol/mol [7.1%, SD 0.5%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. RESULTS The main themes arising from the interview analysis were "increased knowledge," "increased confidence to exercise," and "suitability" for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). CONCLUSIONS The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373.
Collapse
Affiliation(s)
- Vinutha B Shetty
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Division of Pediatrics, The University of Western Australia, Perth, Australia
| | - Wayne H K Soon
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Alison G Roberts
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Leanne Fried
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Heather C Roby
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Grant J Smith
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Paul A Fournier
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Exercise and Health, School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Division of Pediatrics, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Division of Pediatrics, The University of Western Australia, Perth, Australia
| |
Collapse
|
10
|
Siti Zuhaida H, Chung HC, Mohd Said F, Tumingan K, Sahar Shah N, Hanim S, Bakar A. The Best Online Tools Based on Media Preference Reflected by Health Information Received on Social Media amongst Diabetic Patients in Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia. Malays J Med Sci 2021; 28:118-128. [PMID: 34285650 PMCID: PMC8260067 DOI: 10.21315/mjms2021.28.3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Diabetes mellitus has become a major public health problem globally. Social media could be useful in assisting clinical practice and sharing health-related information to improve self-management and to promote a positive behavioural change. This study aims to develop a guide on the best online tools by determining the media preference reflected by health-related information received from social media amongst diabetic patients in Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia, Kuala Lumpur. Methods This study was conducted cross-sectional on 174 respondents, who were selected by using a simple random sampling method. Socio-demographic data and the use of the internet and media for health-related information were obtained via questionnaires. Results The most preferred social media used for searching and sharing health-related information was WhatsApp (73.6%), followed by Facebook (67.8%), Instagram (18.4%) and Twitter (17.2%). The social media preference related to socio-demographic data of age was statistically significant (P < 0.002), which had a medium effect. Furthermore, the media preference was not significantly related to health-related information searched or shared on social media and the frequency of usage. Conclusion Indeed, the social media have been an essential media platform to enhance public awareness concerning public health. This calls for evolution to further enhance the use of social media amongst healthcare practitioners to emphasise health promotion and empower the patients to play an active role in their healthcare. This study provides a guideline for the medical researchers, practitioners or healthcare providers in choosing WhatsApp as an online medium to communicate with diabetic patients in the future, specifically in Malaysia.
Collapse
Affiliation(s)
- Hussein Siti Zuhaida
- Nursing Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hong Chuo Chung
- Nursing Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Fawwaz Mohd Said
- Nursing Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Khairunnisa Tumingan
- Nursing Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurshalin Sahar Shah
- Nursing Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suraya Hanim
- Nursing Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Abu Bakar
- Nursing Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
11
|
Baek J, Lin S, Bolin JN, Ory M, Flores S, Kash BA. Factors Affecting Adoption of a Technology-Based Tool for Diabetes Self-Management Education and Support Among Adult Patients with Type 2 Diabetes in South Texas. Sci Diabetes Self Manag Care 2021; 47:189-198. [PMID: 34000914 DOI: 10.1177/26350106211004885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to describe a novel computerized diabetes education tool and explore factors influencing self-selection and use among primarily Hispanic patients diagnosed with type 2 diabetes in south Texas. METHODS Study participants included 953 adult patients with type 2 diabetes enrolled in a diabetes education program between July 1, 2016, and June 30, 2017. Participants were asked to choose either a new technology-based diabetes education tool with a touch-screen device or a traditional face-to-face education method. Multivariate logistic regression analysis was applied to identify factors associated with adopting the computerized diabetes education tool among the patients. RESULTS When comparing technology-based tool adopters and nonadopters, several demographic and health-related factors differentiated technology use in bivariate analyses. The multivariate logistic regression model showed that Hispanic patients were less likely to choose a technology-based tool. Patients who perceived their health status as excellent/good were more likely to adopt the technologic education method than those with fair/poor perceived health status. A1C level was negatively associated with self-selection of technology. CONCLUSIONS Specific demographic and health-related characteristics are significant contributing factors to patients' adoption of a technology-based diabetes education tool. Health care providers can utilize these findings to target and refer specific patients to a computerized diabetes education tool for more effective diabetes care and to optimize technology adoption success.
Collapse
Affiliation(s)
- Juha Baek
- Center for Outcomes Research, Houston Methodist, Houston, Texas
| | - Sherry Lin
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Jane N Bolin
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas.,College of Nursing, Texas A&M University, College Station, Texas
| | - Marcia Ory
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas.,Center for Population Health and Aging, Texas A&M University, College Station, Texas
| | - Starr Flores
- Coastal Bend Health Education Center, Texas A&M University, Corpus Christi, Texas
| | - Bita A Kash
- Center for Outcomes Research, Houston Methodist, Houston, Texas.,Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
| |
Collapse
|
12
|
Faria LF, Reis ST, Leite KR, da Cruz JAS, Pimenta R, Viana NI, Amaral GQ, Santos GAGD, Ilias D, Fakhouri F, Xavier G, Srougi M, Passerotti CC. Digital application developed to evaluate functional results following robot-assisted radical prostatectomy: App for prostate cancer. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 197:105683. [PMID: 32777664 DOI: 10.1016/j.cmpb.2020.105683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Mobile applications ("apps") developed for smartphones and tablets are increasingly used in healthcare, allowing remote patient support or promoting self-health care. Prostate cancer (PC) screening allows for early-stage PC diagnosis, resulting in high rates of curative procedures such as radical prostatectomy. The main complications following surgery are urinary incontinence and erectile dysfunction. However, the exact numbers related to these morbidities are often missing due to brief interviews during consultations in the medical office. Therefore, the aim of this study was to create an app to determine whether response rates to pre- and post-surgical PC questionnaires will increase. METHODS The app was built using the IONIC framework system and provided to patients through a prospective randomized study. We included 100 patients divided into two groups: 1. first group used the app (n = 50); and 2. second group responded via validated printed questionnaires (control group) (n = 50). All patients received discharge counseling to respond to the questionnaires 1, 3, 6 and 12 months after the procedure. The app group received verbal guidance on how monitoring would occur, received an SMS containing a username and password providing access to the system and received reminder alerts to respond to the questionnaires. RESULTS The new app is called UroHealth and is available for download in the Apple App Store or at www.urohealth.com.br. When we evaluated the response rates, we found that 42.9% of the patients answered the preoperative questionnaire in the app group, while 16% responded in the control group (p = 0.003). By the end of the follow-up, we found that 24.5% of the patients answered the questionnaire in the app group, while 4% responded in the control group (p = 0.003). CONCLUSION This app enabled almost 6 times more patients to answer long-term follow-up questions after surgical procedures, providing high-quality information regarding morbidity related to treatment. Although our initial results indicate that this app may become a useful tool in obtaining more frequent and realistic answers, thus helping to improve surgical techniques, other ways of reaching the patient should be tested to achieve higher response rates.
Collapse
Affiliation(s)
- Leandro F Faria
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Sabrina T Reis
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil; Faculdade Atenas - Campus Passos, Minas Gerais, 37900-380, Brazil.
| | - Katia R Leite
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | | | - Ruan Pimenta
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Nayara I Viana
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Gabriela Q Amaral
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Gabriel A G D Santos
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Daniel Ilias
- Center for Robotic Surgery, Hospital Alemão Oswaldo Cruz, São Paulo 01327-001, Brazil.
| | - Felipe Fakhouri
- Center for Robotic Surgery, Hospital Alemão Oswaldo Cruz, São Paulo 01327-001, Brazil.
| | - Geraldo Xavier
- Center for Robotic Surgery, Hospital Alemão Oswaldo Cruz, São Paulo 01327-001, Brazil.
| | - Miguel Srougi
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Carlo Camargo Passerotti
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil; Center for Robotic Surgery, Hospital Alemão Oswaldo Cruz, São Paulo 01327-001, Brazil.
| |
Collapse
|
13
|
A systematic review into the assessment of medical apps: motivations, challenges, recommendations and methodological aspect. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00451-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
14
|
Kabeza CB, Harst L, Schwarz PE, Timpel P. A qualitative study of users' experiences after 3 months: the first Rwandan diabetes self-management Smartphone application "Kir'App". Ther Adv Endocrinol Metab 2020; 11:2042018820914510. [PMID: 32523670 PMCID: PMC7236575 DOI: 10.1177/2042018820914510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/03/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Owing to the increasing popularity of smartphones in Rwanda, almost 75% of the entire population currently has access to the internet. Although it has been shown that smartphone applications can support diabetes self-management, there was no diabetes self-management application available in Rwanda until April 2019. Based on the findings of a prior study assessing the needs and expectations of potential users, 'Kir'App' was developed to fill that void. The aim of this study was to evaluate users' experiences after 3 months of use of the first Kir'App prototype. METHODS The participants of the previous study were recruited to take part in the current study. Semi-structured, in-depth, face-to-face interviews were conducted. Findings were analysed thematically using Mayring's method of qualitative content analysis. Both deductive and inductive approaches were used to analyse transcripts according to the original categories and subcategories of the previous study. RESULTS A total of 14 people with either type 1 or type 2 diabetes participated in the study. Age of participants ranged from 19 to 70 years, with a mean age of 34.4 years. Seven of the eight original themes and one additional theme were subjoined: diabetes education and desired information provision; increased diabetes knowledge and awareness; monitoring and reminder functions; nutrition; physical activity; coping with burden of disease; app features; use behaviour and usability. Overall, participants stated that the app increased their diabetes knowledge and assisted them with their diabetes self-management. CONCLUSIONS We found that the first prototype of Kir'App meets the overall needs and expectations of participating Rwandan diabetics. Having followed a strict user-centred design process, their qualitative insights will help to further improve the app.
Collapse
Affiliation(s)
| | - Lorenz Harst
- Research Association Public Health Saxony, Centre for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Peter E.H. Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland Germany German Centre for Diabetes Research (DZD e.V.), Neuherberg, Germany Paul Langerhans Institute Dresden of the Helmholtz Centre Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland Germany
| |
Collapse
|
15
|
Krishnan G, Selvam G. Factors influencing the download of mobile health apps: Content review-led regression analysis. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
16
|
Abstract
PURPOSE OF REVIEW To review the current state of diabetes technology adoption and describe impact on outcomes in the context of age, gender, and ethnicity. We will discuss barriers and propose solutions that may help facilitate the adoption. RECENT FINDINGS We are witnessing rapid evolution and increase in adoption of diabetes technology in all its forms, including insulin delivery and glucose monitoring devices, mobile medical applications, and telemedicine. This technology has a great potential to improve diabetes-related outcomes, including acute and chronic complications as well as quality of life for people living with diabetes. However, currently available outcome data are showing modest efficacy and evidence for disparities when it comes to age, gender, and ethnicity. Despite multiple barriers, the adoption of technology is steadily increasing. It is clear that disparities exist in terms of access to and use of technology, but they may be at least in part driven by unmet needs of end users and as such are not unsurmountable. While more research is needed to identify the specific causes for the disparities, future development of diabetes technology that is based on adaptation of behavioral theories has a potential to address the gaps. The disparities can be lessened by understanding the needs of end users and with improvement in personalization of technology, allowing the right device to be used by the right patient. Targeted interventions to increase awareness and education and help navigate the processes involved in currently available technology may help diminish the gaps in health equity.
Collapse
Affiliation(s)
- Leslie Eiland
- Department of Internal medicine, Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA
| | - Thiyagarajan Thangavelu
- Department of Internal medicine, Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA
| | - Andjela Drincic
- Department of Internal medicine, Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA.
| |
Collapse
|
17
|
Zhang Y, Liu C, Luo S, Xie Y, Liu F, Li X, Zhou Z. Factors Influencing Patients' Intentions to Use Diabetes Management Apps Based on an Extended Unified Theory of Acceptance and Use of Technology Model: Web-Based Survey. J Med Internet Res 2019; 21:e15023. [PMID: 31411146 PMCID: PMC6711042 DOI: 10.2196/15023] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetes poses heavy social and economic burdens worldwide. Diabetes management apps show great potential for diabetes self-management. However, the adoption of diabetes management apps by diabetes patients is poor. The factors influencing patients' intention to use these apps are unclear. Understanding the patients' behavioral intention is necessary to support the development and promotion of diabetes app use. OBJECTIVE This study aimed to identify the determinants of patients' intention to use diabetes management apps based on an integrated theoretical model. METHODS The hypotheses of our research model were developed based on an extended Unified Theory of Acceptance and Use of Technology (UTAUT). From April 20 to May 20, 2019, adult patients with diabetes across China, who were familiar with diabetes management apps, were surveyed using the Web-based survey tool Sojump. Structural equation modeling was used to analyze the data. RESULTS A total of 746 participants who met the inclusion criteria completed the survey. The fitness indices suggested that the collected data fit well with the research model. The model explained 62.6% of the variance in performance expectancy and 57.1% of the variance in behavioral intention. Performance expectancy and social influence had the strongest total effects on behavioral intention (β=0.482; P=.001). Performance expectancy (β=0.482; P=.001), social influence (β=0.223; P=.003), facilitating conditions (β=0.17; P=.006), perceived disease threat (β=0.073; P=.005), and perceived privacy risk (β=-0.073; P=.012) had direct effects on behavioral intention. Additionally, social influence, effort expectancy, and facilitating conditions had indirect effects on behavioral intention that were mediated by performance expectancy. Social influence had the highest indirect effects among the three constructs (β=0.259; P=.001). CONCLUSIONS Performance expectancy and social influence are the most important determinants of the intention to use diabetes management apps. Health care technology companies should improve the usefulness of apps and carry out research to provide clinical evidence for the apps' effectiveness, which will benefit the promotion of these apps. Facilitating conditions and perceived privacy risk also have an impact on behavioral intention. Therefore, it is necessary to improve facilitating conditions and provide solid privacy protection. Our study supports the use of UTAUT in explaining patients' intention to use diabetes management apps. Context-related determinants should also be taken into consideration.
Collapse
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
| | - 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
| | - Fang Liu
- 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
| |
Collapse
|
18
|
Salari R, Niakan Kalhori SR, Fatehi F, Ghazisaeedi M, Nazari M. Determining minimum set of features for diabetes mobile apps. J Diabetes Metab Disord 2019; 18:333-340. [PMID: 31890658 DOI: 10.1007/s40200-019-00417-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/30/2019] [Indexed: 12/25/2022]
Abstract
Purpose Interest in mobile health applications (apps) for diabetes self-care is growing. Mobile health is a promising new treatment modality for diabetes, though few smartphone apps have been designed based on a proper study and prioritization. The aim of this study was to determine a minimum set of features for diabetes mobile apps. Methods This study was conducted in three steps: 1.A review of the literature to collect all available features, 2. Assessing the validity of suggested features by Content Validity Index (CVI) and Content Validity Ratio (CVR), 3. Examining the importance of features by Friedman test. Results We retrieved all features of available mobile apps for type 2 diabetes, which are suggested and discussed in literature and compiled as a single list comprising of 33 features. Then, a survey of expert's opinion produced a set of 23 final minimum features which includes all types of tracking, mealtime tagging, food database, diet management, educational materials, healthy coping, reducing risks, problem solving, Email, color coding, alerts, reminder, target range setting, trend chart view, logbook view, numerical indicators view, customizable theme, preset notes, and custom notes. According to the mean rank which indicates the priority of each feature, the most important one was blood glucose tracking (with 16.71 mean rank) and the least important feature was the numerical indicators like such as standard deviation or average (with 6.50 mean rank). Conclusions The present study is the first step towards the development of our mobile apps for people with type II diabetes, and highest the essential features that are required for an optimal self-care comprehensively.
Collapse
Affiliation(s)
- Raheleh Salari
- 1Department of Health Information Management, Tehran University of Medical Sciences, Floor 3, No. 17, Faredanesh Alley, Ghods St, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- 1Department of Health Information Management, Tehran University of Medical Sciences, Floor 3, No. 17, Faredanesh Alley, Ghods St, Tehran, Iran
| | - Farhad Fatehi
- 2Australian e-Health Research Centre, CSIRO, Brisbane, Australia.,3Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Marjan Ghazisaeedi
- 1Department of Health Information Management, Tehran University of Medical Sciences, Floor 3, No. 17, Faredanesh Alley, Ghods St, Tehran, Iran
| | - Mahin Nazari
- 4Department of Health Education and Health Promotion, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
19
|
Kebede MM, Pischke CR. Popular Diabetes Apps and the Impact of Diabetes App Use on Self-Care Behaviour: A Survey Among the Digital Community of Persons With Diabetes on Social Media. Front Endocrinol (Lausanne) 2019; 10:135. [PMID: 30881349 PMCID: PMC6407478 DOI: 10.3389/fendo.2019.00135] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/13/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction: This study aimed to identify popular diabetes applications (apps) and to investigate the association of diabetes app use and other factors with cumulative self-care behaviour. Methods: From November 2017 to March 2018, we conducted a web-based survey with persons 18 years of age and above. We recruited respondents via diabetes Facebook groups, online patient-forums and targeted Facebook advertisements (ads). Data on participants' demographic, clinical, and self-management characteristics, as well as on self-care behaviour and characteristics of the diabetes apps use were collected. Self-care behaviour was measured using a licensed version of the Summary of Diabetes Self-care Activities (SDSCA) questionnaire. The cumulative self-care score was calculated by summing up scores for "general diet," "specific diet," "exercise," "blood glucose testing," "foot care" and "smoking." To identify popular diabetes apps, users were requested to list all apps they use for diabetes self-management. Two sample t-test and multiple linear regression stratified by type of diabetes were performed to examine associations between app use and self-care behaviour, by controlling for key confounders. Results: One thousand fifty two respondents with type 1 and 630 respondents with type 2 diabetes mellitus (DM) entered the survey. More than half, 549 (52.2%), and one third, 210 (33.3%), of respondents with type 1 and 2 DM, respectively, reported using diabetes apps for self-management. "mySugr" and continuous glucose monitoring apps, such as "Dexcom," "Freestyle Libre," and "Xdrip+" were some of the most popular diabetes apps. In both respondent groups, the cumulative self-care behaviour score was significantly higher among diabetes app users (compared to non-users) and scores for three individual self-care components, namely "blood glucose monitoring," "general diet," and "physical activity" were significantly higher among diabetes app users than among non-users. After adjusting for confounding factors, diabetes app use increased the cumulative self-care score by 1.08 (95%CI: 0.46-1.7) units among persons with type 1 DM and by 1.18 (95%CI: 0.26-2.09) units among persons with type 2 DM, respectively. Conclusion: For both, persons with type 1 and type 2 diabetes, using diabetes apps for self-management was positively associated with self-care behaviour. Our findings suggest that apps can support changes in lifestyle and glucose monitoring in these populations.
Collapse
Affiliation(s)
- Mihiretu M. Kebede
- Leibniz Institute for Prevention Research and Epidemiology-BIPSBremen, Germany
- Health Sciences, University of Bremen, Bremen, Germany
- College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Claudia R. Pischke
- Leibniz Institute for Prevention Research and Epidemiology-BIPSBremen, Germany
- Medical Faculty, Centre for Health and Society, Institute of Medical Sociology, University of Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Aguayo-Mazzucato C, Diaque P, Hernandez S, Rosas S, Kostic A, Caballero AE. Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes Metab Res Rev 2019; 35:e3097. [PMID: 30445663 PMCID: PMC6953173 DOI: 10.1002/dmrr.3097] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022]
Abstract
The prevalence and incidence of type 2 diabetes (T2D) among the Hispanic population in the United States are higher than the national average. This is partly due to sociocultural factors, such as lower income and decreased access to education and health care, as well as a genetic susceptibility to obesity and higher insulin resistance. This review focuses on understanding the Hispanic population living in the United States from a multidisciplinary approach and underlines the importance of cultural, social, and biological factors in determining the increased risk of T2D in this population. An overview of the acute and chronic complications of T2D upon this population is included, which is of paramount importance to understand the toll that diabetes has upon this population, the health system, and society as a whole. Specific interventions directed to the Hispanic populations are needed to prevent and alleviate some of the burdens of T2D. Different prevention strategies based on medications, lifestyle modifications, and educational programmes are discussed herein. Diabetes self-management education (DSME) is a critical element of care of all people with diabetes and is considered necessary to improve patient outcomes. To be more effective, programmes should take into consideration cultural factors that influence the development and progression of diabetes. These interventions aim to enhance long-term effects by reducing the incidence, morbidity, and mortality of T2D in the Hispanic population of the United States.
Collapse
Affiliation(s)
| | - Paula Diaque
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonia Hernandez
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
- Surgery Department, University of Chicago, Chicago, Illinois, USA
| | - Silvia Rosas
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Aleksandar Kostic
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | | |
Collapse
|
22
|
Kebede MM, Schuett C, Pischke CR. The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey. J Clin Med 2019; 8:jcm8010109. [PMID: 30658463 PMCID: PMC6352012 DOI: 10.3390/jcm8010109] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 01/01/2023] Open
Abstract
Background: This study investigated the determinants (with a special emphasis on the role of diabetes app use, use of continuous glucose monitoring (CGM) device, and self-care behavior) of glycemic control of type 1 and type 2 diabetes mellitus (DM). Methods: A web-based survey was conducted using diabetes Facebook groups, online patient-forums, and targeted Facebook advertisements (ads). Demographic, CGM, diabetes app use, and self-care behavior data were collected. Glycemic level data were categorized into hyperglycemia, hypoglycemia, and good control. Multinomial logistic regression stratified by diabetes type was performed. Results: The survey URL was posted in 78 Facebook groups and eight online forums, and ten targeted Facebook ads were conducted yielding 1854 responses. Of those owning smartphones (n = 1753, 95%), 1052 (62.6%) had type 1 and 630 (37.4%) had type 2 DM. More than half of the type 1 respondents (n = 549, 52.2%) and one third the respondents with type 2 DM (n = 210, 33.3%) reported using diabetes apps. Increased odds of experiencing hyperglycemia were noted in persons with type 1 DM with lower educational status (Adjusted Odds Ratio (AOR) = 1.7; 95% Confidence Interval (CI): 1.21–2.39); smokers (1.63, 95% CI: 1.15–2.32), and high diabetes self-management concern (AOR = 2.09, 95% CI: 1.15–2.32). CGM use (AOR = 0.66, 95% CI: 0.44–1.00); “general diet” (AOR = 0.86, 95% CI: 0.79–0.94); and “blood glucose monitoring” (AOR = 0.88, 95%CI: 0.80–0.97) self-care behavior reduced the odds of experiencing hyperglycemia. Hypoglycemia in type 1 DM was reduced by using CGM (AOR = 0.24, 95% CI: 0.09–0.60), while it was increased by experiencing a high diabetes self-management concern (AOR = 1.94, 95% CI: 1.04–3.61). Hyperglycemia in type 2 DM was increased by age (OR = 1.02, 95% CI: 1.00–1.04); high self-management concern (AOR = 2.59, 95% CI: 1.74–3.84); and poor confidence in self-management capacity (AOR = 3.22, 2.07–5.00). Conversely, diabetes app use (AOR = 0.63, 95% CI: 0.41–0.96) and “general diet” self-care (AOR = 0.84, 95% CI: 0.75–0.94), were significantly associated with the reduced odds of hyperglycemia. Conclusion: Diabetes apps, CGM, and educational interventions aimed at reducing self-management concerns and enhancing dietary self-care behavior and self-management confidence may help patients with diabetes to improve glycemic control.
Collapse
Affiliation(s)
- Mihiretu M Kebede
- Health Sciences, University of Bremen, Grazerstrasse 2, D-28359 Bremen, Germany.
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, D-28359 Bremen, Germany.
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Po.box-196 Gondar, Ethiopia.
| | - Cora Schuett
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, D-28359 Bremen, Germany.
| | - Claudia R Pischke
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, D-28359 Bremen, Germany.
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Universitätsstrasse 1, D-40225 Duesseldorf, Germany.
| |
Collapse
|
23
|
Kebede MM, Peters M, Heise TL, Pischke CR. Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes. Diabetes Metab Syndr Obes 2018; 12:59-73. [PMID: 30588055 PMCID: PMC6305167 DOI: 10.2147/dmso.s180106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS Pooling the effect sizes of randomized controlled trials (RCTs) from continuous outcomes, such as glycated hemoglobin level (HbA1c), is an important method in evidence syntheses. However, due to challenges related to baseline imbalances and pre/post correlations, simple analysis of change scores (SACS) and simple analysis of final values (SAFV) meta-analyses result in under- or overestimation of effect estimates. This study was aimed to compare pooled effect sizes estimated by Analysis of Covariance (ANCOVA), SACS, and SAFV meta-analyses, using the example of RCTs of digital interventions with HbA1c as the main outcome. MATERIALS AND METHODS Three databases were systematically searched for RCTs published from 1993 through June 2017. Two reviewers independently assessed titles and abstracts using predefined eligibility criteria, assessed study quality, and extracted data, with disagreements resolved by arbitration from a third reviewer. RESULTS ANCOVA, SACS, and SAFV resulted in pooled HbA1c mean differences of -0.39% (95% CI: [-0.51, -0.26]), -0.39% (95% CI: [-0.51, -0.26]), and -0.34% (95% CI: [-0.48-0.19]), respectively. Removing studies with both high baseline imbalance (≥±0.2%) and pre/post correlation of ≥±0.6 resulted in a mean difference of -0.39% (95% CI: [-0.53, -0.26]), -0.40% (95% CI: [-0.54, -0.26]), and -0.33% (95% CI: [-0.48, -0.18]) with ANCOVA, SACS, and SAFV meta-analyses, respectively. Substantial heterogeneity was noted. Egger's test for funnel plot symmetry did not indicate evidence of publication bias for all methods. CONCLUSION By all meta-analytic methods, digital interventions appear effective in reducing HbA1c in type 2 diabetes. The effort to adjust for baseline imbalance and pre/post correlation using ANCOVA relies on the level of detail reported from individual studies. Reporting detailed summary data and, ideally, access to individual patient data of intervention trials are essential.
Collapse
Affiliation(s)
- Mihiretu M Kebede
- Department of Public Health, University of Bremen, Health Sciences, Bremen, Germany,
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany,
- Department of Health Informatics, University of Gondar, College of Medicine and Health Science, Institute of Public Health, Gondar, Ethiopia,
| | - Manuela Peters
- Department of Public Health, University of Bremen, Health Sciences, Bremen, Germany,
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany,
| | - Thomas L Heise
- Department of Public Health, University of Bremen, Health Sciences, Bremen, Germany,
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany,
| | - Claudia R Pischke
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany,
| |
Collapse
|
24
|
Burner ERE, Menchine MD, Kubicek K, Robles M, Kagawa Singer M, Arora S. Perceptions of Family Among Low-Income Patients With Diabetes in a Text-Based Mobile Health Intervention. J Diabetes Sci Technol 2018; 12:1203-1210. [PMID: 29681170 PMCID: PMC6232730 DOI: 10.1177/1932296818770702] [Citation(s) in RCA: 6] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Diabetes disproportionately affects the US Latino population, due to socioeconomic pressures, genetics, reduced access to care and cultural practices. While efforts to improve self-care through interventions incorporating family are highly rated by Latinos, family can be both supportive and obstructive. To develop effective interventions, this role needs clarification. METHODS We conducted group interviews in Spanish and English with 24 participants with diabetes from a mobile health diabetes self-care intervention. We imported transcripts into Dedoose, a qualitative computer analysis program and analyzed them with a modified grounded theory technique. Utilizing an iterative process, we reexamined transcripts with new codes derived in each round of analysis until saturation was reached. We employed techniques to improve trustworthiness (co-coding, member checking). Broad categorical themes arose from the initial codes and were developed into a conceptual model of barriers to and strategies for diabetes management. RESULTS Family and family responsibilities emerged as both a supportive and obstructive force for diabetes self-care. While the desire to care for family motivated patients, food at family gatherings and pressure from managing multiple family responsibilities contributed to poor diet choices. Yet, some patients believed their diabetes caused their immediate family to make healthier choices. CONCLUSIONS Among these predominantly Latino patients, family and family responsibilities were key motivators as well as obstacles to self-care, particularly regarding nutrition. Finding the ideal design for social support mHealth-based interventions will require careful study and creation of culturally based programs to match the needs of specific populations, and may require educating family members to provide effective social support.
Collapse
Affiliation(s)
- Elizabeth R. E. Burner
- Department of Emergency Medicine, Keck
School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Michael D. Menchine
- Department of Emergency Medicine, Keck
School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Katrina Kubicek
- Community Engagement, SC Clinical &
Translational Science Institute
| | - Marisela Robles
- Community Engagement, SC Clinical &
Translational Science Institute
| | | | - Sanjay Arora
- Department of Emergency Medicine, Keck
School of Medicine of University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
25
|
Abstract
BACKGROUND There is growing evidence supporting the use of mobile health apps for the management of diabetes. Given the disproportionate impact of diabetes on Latinos, especially those with limited English proficiency (LEP) and low literacy, diabetes apps have the potential to address existing health disparities. Our study aimed to understand the current accessibility of diabetes apps for these populations. METHODS We searched the Android and iOS stores for the term "diabetes" to identify patient-facing diabetes apps. We reviewed the app store descriptions and user interfaces for Spanish availability. We assessed the readability of the descriptions in English and Spanish using the Lexile Analyzer and the Flesch-Kincaid Reading Grade Level. RESULTS Overall, in reviewing both app stores, 30% (28/92) of apps had descriptions available in Spanish, of which 41% (18/44) of Android apps were available in Spanish and 21% (10/48) iOS apps were available in Spanish. In addition, the readability of 94% (90/96) for the app store descriptions was above the recommended reading level for patient education material in English and Spanish. The overall kappa coefficient for app translation quality assessment was .72, reflecting moderate interrater agreement. CONCLUSIONS Despite the evidence supporting the use of diabetes apps, they do not cater to the language needs of LEP Latino patients.
Collapse
Affiliation(s)
- Jorge A. Rodriguez
- Division of Clinical Informatics, Beth
Israel Medical Center, Boston, MA, USA
- Jorge A. Rodriguez, MD, Division of Clinical
Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St, Ste 400,
Brookline, MA 02446, USA.
| | - Karandeep Singh
- Departments of Learning Health Sciences
and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI,
USA
| |
Collapse
|
26
|
Chen J, Gemming L, Hanning R, Allman-Farinelli M. Smartphone apps and the nutrition care process: Current perspectives and future considerations. PATIENT EDUCATION AND COUNSELING 2018; 101:750-757. [PMID: 29169863 DOI: 10.1016/j.pec.2017.11.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/02/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To provide dietitians with practical guidance on incorporating smartphone applications (apps) in the nutrition care process (NCP) to optimize patient education and counseling. METHODS The current evidence-base for mobile health (mHealth) apps was searched using PubMed and Google Scholar. Where and how apps could be implemented by dietitians across the four steps of the NCP is discussed. RESULTS With functionality to automatically convert patient dietary records into nutrient components, nutrition assessment can be streamlined using nutrition apps, allowing more time for dietitians to deliver education and nutrition counseling. Dietitians could prescribe apps to provide patients with education on nutrition skills and in counseling for better adherence to behavior change. Improved patient-provider communication is also made possible through the opportunity for real-time monitoring and evaluation of patient progress via apps. A practical framework termed the 'Mobile Nutrition Care Process Grid' provides dietitians with best-practice guidance on how to use apps. CONCLUSIONS Including apps into dietetic practice could enhance the efficiency and quality of nutrition care and counseling delivered by dietitians. PRACTICE IMPLICATIONS Apps should be considered an adjunct to enable dietetic counseling and care, rather than to replace the expertise, social support and accountability provided by dietitians.
Collapse
Affiliation(s)
- Juliana Chen
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.
| | - Luke Gemming
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Rhona Hanning
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Margaret Allman-Farinelli
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
27
|
Schmocker KS, Zwahlen FS, Denecke K. Mobile App for Simplifying Life With Diabetes: Technical Description and Usability Study of GlucoMan. JMIR Diabetes 2018; 3:e6. [PMID: 30291070 PMCID: PMC6238891 DOI: 10.2196/diabetes.8160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/12/2017] [Accepted: 01/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background Patients with diabetes can be affected by several comorbidities that require immediate action when occurring as they may otherwise cause fatal or consequential damage. For this reason, patients must closely monitor their metabolism and inject insulin when necessary. The documentation of glucose values and other relevant measurements is often still on paper in a diabetes diary. Objective The goal of this work is to develop and implement a novel mobile health system for the secure collection of relevant data referring to a person’s metabolis and to digitize the diabetes diary to enable continuous monitoring for both patients and treating physicians. One specific subgoal is to enable data transmission of health parameters to secure data storage. Methods The process of implementing the system consists of (1) requirements analysis with patients and physicians to identify patient needs and specify relevant functionalities, (2) design and development of the app and the data transmission, and (3) usability study. Results We developed and implemented the mobile app GlucoMan to support data collection pertaining to a person’s metabolism. An automated transfer of measured values from a glucometer was implemented. Medication and nutrition data could be entered using product barcodes. Relevant background knowledge such as information on carbohydrates was collected from existing databases. The recorded data was transmitted using international interoperability standards to the MIDATA.coop storage platform. The usability study revealed some design issues that needs to be solved, but in principle, the study results show that the app is easy to use and provides useful features. Conclusions Data collection on a patient’s metabolism can be supported with a multifunctional app such as GlucoMan. Besides monitoring, continuous data can be documented and made available to the treating physician. GlucoMan allows patients to monitor disease-relevant parameters and decide who accesses their health data. In this way, patients are empowered not only to manage diabetes but also manage their health data.
Collapse
Affiliation(s)
- Kaspar S Schmocker
- Institute for Medical Informatics, Bern University of Applied Sciences, Biel, Switzerland
| | - Fabian S Zwahlen
- Institute for Medical Informatics, Bern University of Applied Sciences, Biel, Switzerland
| | - Kerstin Denecke
- Institute for Medical Informatics, Bern University of Applied Sciences, Biel, Switzerland
| |
Collapse
|
28
|
Iftikhar R, Abaalkhail B. Health-Seeking Influence Reflected by Online Health-Related Messages Received on Social Media: Cross-Sectional Survey. J Med Internet Res 2017; 19:e382. [PMID: 29146568 PMCID: PMC5709655 DOI: 10.2196/jmir.5989] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/21/2016] [Accepted: 08/15/2017] [Indexed: 01/07/2023] Open
Abstract
Background Major social networking platforms, such as Facebook, WhatsApp, and Twitter, have become popular means through which people share health-related information, irrespective of whether messages disseminated through these channels are authentic. Objective This study aims to describe the demographic characteristics of patients that may demonstrate their attitudes toward medical information shared on social media networks. Second, we address how information found through social media affects the way people deal with their health. Third, we examine whether patients initiate or alter/discontinue their medications based on information derived from social media. Methods We conducted a cross-sectional survey between April and June 2015 on patients attending outpatient clinics at King Abdulaziz University, Jeddah, Saudi Arabia. Patients who used social media (Facebook, WhatsApp, and Twitter) were included. We designed a questionnaire with closed-ended and multiple-choice questions to assess the type of social media platforms patients used and whether information received on these platforms influenced their health care decisions. We used chi-square test to establish the relationship between categorical variables. Results Of the 442 patients who filled in the questionnaires, 401 used Facebook, WhatsApp, or Twitter. The majority of respondents (89.8%, 397/442) used WhatsApp, followed by Facebook (58.6%, 259/442) and Twitter (42.3%, 187/442). In most cases, respondents received health-related messages from WhatsApp and approximately 42.6% (171/401) reported ever stopping treatment as advised on a social media platform. A significantly higher proportion of patients without heart disease (P=.001) and obese persons (P=.01) checked the authenticity of information received on social media. Social media messages influenced decision making among patients without heart disease (P=.04). Respondents without heart disease (P=.001) and obese persons (P=.01) were more likely to discuss health-related information received on social media channels with a health care professional. A significant proportion of WhatsApp users reported that health-related information received on this platform influenced decisions regarding their family’s health care (P=.001). Respondents’ decisions regarding family health care were more likely to be influenced when they used two or all three types of platforms (P=.003). Conclusions Health education in the digital era needs to be accurate, evidence-based, and regulated. As technologies continue to evolve, we must be equipped to face the challenges it brings with it.
Collapse
Affiliation(s)
- Rahila Iftikhar
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bahaa Abaalkhail
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
29
|
Ankem K, Cho S, Simpson D. Nurses' perceptions and problems in the usability of a medication safety app. Inform Health Soc Care 2017; 44:48-69. [PMID: 29035624 DOI: 10.1080/17538157.2017.1364249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The majority of medication apps support medication adherence. Equally, if not more important, is medication safety. Few apps report on medication safety, and fewer studies have been conducted with these apps. OBJECTIVES The usability of a medication safety app was tested with nurses to reveal their perceptions of the graphical user interface and to discover problems they encountered in using the app. METHODS Usability testing of the app was conducted with RN-BSN students and informatics students (n = 18). Perceptions of the graphical components were gathered in pretest and posttest questionnaires, and video recordings of the usability testing were transcribed. The significance of the difference in mean performance time for 8 tasks was tested, and qualitative analysis was deployed to identify problems encountered and to rate the severity of each problem. RESULTS While all participants perceived the graphical user interface as easy to understand, nurses took significantly more time to complete certain tasks. More nurses found the medication app to be lacking in intuitiveness of user interface design, in capability to match real-world data, and in providing optimal information architecture. CONCLUSION To successfully integrate mobile devices in healthcare, developers must address the problems that nurses encountered in use of the app.
Collapse
Affiliation(s)
- Kalyani Ankem
- a Assistant Professor, Health Informatics , Northern Kentucky University , Highland Heights , KY , USA
| | - Sookyung Cho
- b Assistant Professor, Media Informatics , Northern Kentucky University , Highland Heights , KY , USA
| | - Diana Simpson
- c Baptist Health Lexington, Lexington, KY, USA; Master of Health Informatics Student , Northern Kentucky University , Highland Heights , KY , USA
| |
Collapse
|
30
|
Boyle L, Grainger R, Hall RM, Krebs JD. Use of and Beliefs About Mobile Phone Apps for Diabetes Self-Management: Surveys of People in a Hospital Diabetes Clinic and Diabetes Health Professionals in New Zealand. JMIR Mhealth Uhealth 2017; 5:e85. [PMID: 28666975 PMCID: PMC5511364 DOI: 10.2196/mhealth.7263] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/08/2017] [Accepted: 03/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background People with diabetes mellitus (DM) are using mobile phone apps to support self-management. The numerous apps available to assist with diabetes management have a variety of functions. Some functions, like insulin dose calculators, have significant potential for harm. Objectives The study aimed to establish (1) whether people with DM in Wellington, New Zealand, use apps for DM self-management and evaluate desirable features of apps and (2) whether health professionals (HPs) in New Zealand treating people with DM recommend apps to patients, the features HPs regard as important, and their confidence with recommending apps. Methods A survey of patients seen at a hospital diabetes clinic over 12 months (N=539) assessed current app use and desirable features. A second survey of HPs attending a diabetes conference (n=286) assessed their confidence with app recommendations and perceived usefulness. Results Of the 189 responders (35.0% response rate) to the patient survey, 19.6% (37/189) had used a diabetes app. App users were younger and in comparison to other forms of diabetes mellitus, users prominently had type 1 DM. The most favored feature of the app users was a glucose diary (87%, 32/37), and an insulin calculator was the most desirable function for a future app (46%, 17/37). In non-app users, the most desirable feature for a future app was a glucose diary (64.4%, 98/152). Of the 115 responders (40.2% response rate) to the HPs survey, 60.1% (68/113) had recommended a diabetes app. Diaries for blood glucose levels and carbohydrate counting were considered the most useful app features and the features HPs felt most confident to recommend. HPs were least confident in recommending insulin calculation apps. Conclusions The use of apps to record blood glucose was the most favored function in apps used by people with diabetes, with interest in insulin dose calculating function. HPs do not feel confident in recommending insulin dose calculators. There is an urgent need for an app assessment process to give confidence in the quality and safety of diabetes management apps to people with diabetes (potential app users) and HPs (potential app prescribers).
Collapse
Affiliation(s)
- Leah Boyle
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Rosemary M Hall
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand.,Centre for Endocrine Diabetes and Obesity Research, Capital and Coast Health, Wellington Regional Hospital, Wellington, New Zealand
| | - Jeremy D Krebs
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand.,Centre for Endocrine Diabetes and Obesity Research, Capital and Coast Health, Wellington Regional Hospital, Wellington, New Zealand
| |
Collapse
|
31
|
Wu Y, Yao X, Vespasiani G, Nicolucci A, Dong Y, Kwong J, Li L, Sun X, Tian H, Li S. Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy. JMIR Mhealth Uhealth 2017; 5:e35. [PMID: 28292740 PMCID: PMC5373677 DOI: 10.2196/mhealth.6522] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/20/2016] [Accepted: 02/25/2017] [Indexed: 02/05/2023] Open
Abstract
Background Mobile health apps for diabetes self-management have different functions. However, the efficacy and safety of each function are not well studied, and no classification is available for these functions. Objective The aims of this study were to (1) develop and validate a taxonomy of apps for diabetes self-management, (2) investigate the glycemic efficacy of mobile app-based interventions among adults with diabetes in a systematic review of randomized controlled trials (RCTs), and (3) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy. Methods We developed a 3-axis taxonomy with columns of clinical modules, rows of functional modules and cells of functions with risk assessments. This taxonomy was validated by reviewing and classifying commercially available diabetes apps. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Chinese Biomedical Literature Database, and ClinicalTrials.gov from January 2007 to May 2016. We included RCTs of adult outpatients with diabetes that compared using mobile app-based interventions with usual care alone. The mean differences (MDs) in hemoglobin A1c (HbA1c) concentrations and risk ratios of adverse events were pooled using a random-effects meta-analysis. After taxonomic classification, we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions. Results Across 12 included trials involving 974 participants, using app-based interventions was associated with a clinically significant reduction of HbA1c (MD 0.48%, 95% CI 0.19%-0.78%) without excess adverse events. Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes (MD 0.67%, 95% CI 0.30%-1.03% vs MD 0.37%, 95% CI –0.12%-0.86%). Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction (with complication prevention: MD 1.31%, 95% CI 0.66%-1.96% vs without: MD 0.38%, 95% CI 0.09%-0.67%; intersubgroup P=.01), as was having a structured display (with structured display: MD 0.69%, 95% CI 0.32%-1.06% vs without: MD 0.69%, 95% CI –0.18%-0.53%; intersubgroup P=.03). However, having a clinical decision-making function was not associated with a larger HbA1c reduction (with clinical decision making: MD 0.19%, 95% CI –0.24%-0.63% vs without: MD 0.61%, 95% CI 0.27%-0.95%; intersubgroup P=.14). Conclusions The use of mobile app-based interventions yields a clinically significant HbA1c reduction among adult outpatients with diabetes, especially among those with type 2 diabetes. Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps.
Collapse
Affiliation(s)
- Yuan Wu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xun Yao
- Department of Academic Affairs, West China School of Medicine, Sichuan University, Chengdu, China
| | - Giacomo Vespasiani
- Diabetes Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto (AP), Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Yajie Dong
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Joey Kwong
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Li
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
32
|
Grundy QH, Wang Z, Bero LA. Challenges in Assessing Mobile Health App Quality: A Systematic Review of Prevalent and Innovative Methods. Am J Prev Med 2016; 51:1051-1059. [PMID: 27659122 DOI: 10.1016/j.amepre.2016.07.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/14/2016] [Accepted: 07/07/2016] [Indexed: 01/19/2023]
Abstract
CONTEXT Mobile apps are poised to become a major source of health guidance; however, concerns about their quality and safety remain. Governments, clinicians, and health researchers are struggling to determine how to adequately evaluate the content and function of mobile health apps to guide consumers toward apps that will effectively and safely support their health. Researchers are both adapting existing research methods, such as those for systematic reviews, and exploring novel methods toward this aim. The purpose of this systematic review was to describe prevalent and emerging methods for searching, data extraction, and analysis in the context of mobile health apps and commercial app stores. EVIDENCE ACQUISITION A systematic search was conducted on April 6, 2016, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, for published studies that evaluated health-related apps targeted at consumers in a commercial app store, and a descriptive content analysis of their methods was performed. EVIDENCE SYNTHESIS Although the majority of studies self-identified as "reviews" or "systematic reviews," their claims to have performed an exhaustive, replicable, and systematic search and data extraction are unsupported, given the nature of commercial app stores' search engines and personalized app content. Currently, studies of health-related app content are largely descriptive, and most use surrogate and one-dimensional outcome measures for app content quality. CONCLUSIONS This field is rapidly developing, and innovative methods for systematic searches, multidimensional quality assessment, and contextualizing content assessment are emerging. Areas for future methodologic development are highlighted, including expanding definitions of app "content" and assessing risk of bias.
Collapse
Affiliation(s)
- Quinn H Grundy
- Charles Perkins Centre, Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
| | - Zhicheng Wang
- Charles Perkins Centre, Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Lisa A Bero
- Charles Perkins Centre, Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| |
Collapse
|
33
|
Hood M, Wilson R, Corsica J, Bradley L, Chirinos D, Vivo A. What do we know about mobile applications for diabetes self-management? A review of reviews. J Behav Med 2016; 39:981-994. [PMID: 27412774 DOI: 10.1007/s10865-016-9765-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 07/04/2016] [Indexed: 01/17/2023]
Abstract
Diabetes is a chronic illness with significant health consequences, especially for those who are unable to adhere to the complex treatment regimen. Self-management tasks such as regular medication and insulin use, frequent blood sugar checks, strict diet management, and consistent exercise can be quite challenging. Mobile technologies, specifically mobile applications (apps), present a unique opportunity to help patients improve adherence to these behaviors. The availability of commercial diabetes self-management apps is increasing rapidly, making it difficult for patients and providers to stay informed about app options. A number of reviews have described commercial app technology and use for patients with diabetes. The aims of this article are to summarize the results and themes of those reviews, to review outcomes of apps described in the research literature, and to identify areas for further consideration in the use of mobile apps for diabetes self-management.
Collapse
Affiliation(s)
- Megan Hood
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA.
| | - Rebecca Wilson
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Joyce Corsica
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Lauren Bradley
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Diana Chirinos
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Amanda Vivo
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| |
Collapse
|