Evaluation of a Web Platform to Record Lifestyle Habits in Subjects at Risk of Developing Type 2 Diabetes in a Middle-Income Population: Prospective Interventional Study

BACKGROUND

Lifestyle is the focus of type 2 diabetes (T2D) prevention strategies. Prevention strategies using mobile health (mHealth)-based therapy have shown positive results for T2D prevention in high-income settings, but little is known about their effectiveness in low- and middle-income populations where the burden of T2D is substantial. "Vida Sana" is a web platform designed to record lifestyle habits and medication use within a lifestyle change program.

OBJECTIVE

We sought to identify the barriers, feasibility, usability, and effectiveness of Vida Sana to record lifestyle habits in subjects at risk of developing T2D in a middle-income setting.

METHODS

This was a 3-month prospective interventional study in Mexican individuals. A total of 77 subjects at risk of T2D (with prediabetes and BMI between 24 and 40 kg/m²) were selected. Feasibility was assessed by study retention. Usability was evaluated with the System Usability Scale (SUS). Effectiveness measures included changes in weight, body composition, BMI, glycated hemoglobin A_1c (HbA_1c), and fasting blood glucose from baseline to 3 months. Linear regression models were used to account for covariates.

RESULTS

The feasibility of Vida Sana was 42%, with 33 subjects using the platform, and the usability was 48.7 (SD 14.24). Reported barriers to platform usage were; difficulty in accessing the platform from difficulty of use (12 subjects, 36%), lack of time to record their habits (11 subjects, 34%), lack of interest to record their habits (6 subjects, 18%), and lack of resources (4 subjects, 11%). The platform was effective for lowering glucose in fasting (-3.1 mg/dL vs -0.11 [SD 8.08] mg/dL; P=.038) and at 2 hours (-16.9 mg/dL vs 2.5 [SD 26.1] mg/dL; P=.045), body fat percentage (-1.3 [-2.2 to -0.7] vs -1.02 [-1.9 to -0.3]; P=.02), and waist circumference (-3.2 [SD 5.1] cm vs -1.7 [SD 5.0] cm; P=.02) independent of their age, sex, treatment, and education level.

CONCLUSIONS

The use of the web platform was effective for improving glycemic and anthropometric parameters in a population at risk of developing diabetes. Improving accessibility and ease of navigation could improve the acceptance of digital health solutions in a middle-income population.

Spanish Version of the System Usability Scale for the Assessment of Electronic Tools: Development and Validation

Background

The System Usability Scale (SUS) is a common metric used to assess the usability of a system, and it was initially developed in English. The implementation of electronic systems for clinical counseling (eHealth and mobile health) is increasing worldwide. Therefore, tools are needed to evaluate these applications in the languages and regional contexts in which the electronic tools are developed.

Objective

This study aims to translate, culturally adapt, and validate the original English version of the SUS into a Spanish version.

Methods

The translation process included forward and backward translation. Forward translations were made by 2 native Spanish speakers who spoke English as their second language, and a backward translation was made by a native English speaker. The Spanish SUS questionnaire was validated by 10 experts in mobile app development. The face validity of the questionnaire was tested with 10 mobile phone users, and the reliability testing was conducted among 88 electronic application users.

Results

The content validity index of the new Spanish SUS was good, as indicated by a rating of 0.92 for the relevance of the items. The questionnaire was easy to understand, based on a face validity index of 0.94. The Cronbach α was .812 (95% CI 0.748-0.866; P<.001).

Conclusions

The new Spanish SUS questionnaire is a valid and reliable tool to assess the usability of electronic tools among Spanish-speaking users.