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Experience of diabetes self-management with mobile applications: a focus group study among older people with diabetes

Qing Ye, Suzanne A Boren, Uzma Khan, Eduardo J Simoes, Min Soon Kim

Abstract


Background: The number of mobile diabetes self-management applications (apps) has risen. However, it is not certain whether these apps provide effective diabetes self-management for older people with diabetes. In this study, we aim to identify barriers in features and usability related to the needs of older people with diabetes for diabetes self-management applications.

Methods: We conducted focus groups with 10 older people with diabetes (mean age = 69 years old). Based on the data saturation theory, there were 2 focus groups. Participants completed a set of diabetes self-management tasks using 9 representative diabetes self-management applications on iPads. We collected information regarding demographics, diabetes history, health literacy and prior experience using mobile devices and diabetes self-management applications. We asked participants’ preferences, concerns and needs for diabetes self-management application features. The System Usability Scale (0-100) measured overall usability. Thematic analysis identified the barriers that older participants encountered as they interacted with the diabetes self-management applications.

Results: Participants found mobile applications inadequate for features on Healthy Coping and Problem Solving. The features that participants liked most for the diabetes self-management applications were documentation, information and goal setting. Thematic analysis revealed that usability was their primary concern about diabetes self-management applications in managing diabetes conditions. The average System Usability Scale score was 48 out of 100, which is considered not acceptable.

Conclusions: This study suggests current diabetes self-management applications do not provide evidence-based, usable features for diabetes self-management and may not fulfill the needs of older people with diabetes.

Keywords


Diabetes, focus groups, health education, health literacy, mobile applications, mobile health technologies, patient-centered care, person-centered healthcare, self-management, technology acceptance

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References


National Diabetes Statistics Report, 2017: Estimates of Diabetes and Its Burden in the United States. 2017, Centers for Disease Control and Prevention.

Electronic Healthcare - 4th International Conference, eHealth 2011, Revised Selected Papers, in Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering. (2012).

Brown, A.F., Mangione, C.M., Saliba, D. & Sarkisian, C.A. (2003). Guidelines for improving the care of the older person with diabetes mellitus. Journal of the American Geriatrics Society 51 (5 Supplement Guidelines) S265-280.

Norris, S.L., Lau, J., Smith, S.J., Schmid, C.H. & Engelgau, M.M. (2002). Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care 25 (7) 1159-1171.

Whitlock, L., McLaughlin, A., Harris, M. & Bradshaw, J. (2015). The design of mobile technology to support diabetes self-management in older adults, in Human Aspects of IT for the Aged Population. Design for Everyday Life. Zhou, J. & Salvendy, G. (Eds.) pp. 211-221. Basel: Springer International Publishing.

Beverly, E.A., Fitzgerald, S., Sitnikov, L., Ganda, O.P., Caballero, A.E. & Weinger, K. (2013). Do older adults aged 60-75 years benefit from diabetes behavioral interventions? Diabetes Care 36 (6) 1501-1506.

Lindstrom, J., Louheranta, A., Mannelin, M., Rastas, M., Salminen, V., Eriksson, J., Uusitupa, M. & Tuomilehto, J. (2003). The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 26 (12) 3230-3236.

Free, C., Phillips, G., Watson, L., Galli, L. Felix, L. Edwards, P., Patel, V. & Haines, A. (2013). The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Medicine 10 (1) e1001363.

mHealth App Developer Economics 2016. 2016, Research 2 Guidance.

Arnhold, M., Quade, M. & Kirch, W. (2014). Mobile applications for diabetics: a systematic review and expert-based usability evaluation considering the special requirements of diabetes patients age 50 Years or older. Journal of Medical Internet Research 16 (4) e104.

Boren, S.A. (2007). AADE7TM Self-care Behaviors: systematic reviews. Diabetes Educator 33 (6) 866, 871.

Povey, R.C. & Clark-Carter, D. (2007). Diabetes and healthy eating: a systematic review of the literature. The Diabetes Educator 33 (6) 931-959; discussion 960-961.

Mulcahy, K., Maryniuk, M., Peeples, M., Peyrot, M., Tomky, D., Weaver, T. & Yarborough, P. (2003). Diabetes self-management education core outcomes measures. The Diabetes Educator 29 (5) 768-770, 773-784, 787-788 passim.

Kavookjian, J., Elswick, B.M. & Whetsel, T. (2007). Interventions for being active among individuals with diabetes: a systematic review of the literature. The Diabetes Educator 33 (6) 962-988; discussion 989-990.

McAndrew, L., Schneider, S.H., Burns, E. & Leventhal, H. (2007). Does patient blood glucose monitoring improve diabetes control? A systematic review of the literature. Diabetes Educator 33 (6) 991-1011; discussion 1012-1013.

Odegard, P.S. & Capoccia, K. (2007). Medication Taking and Diabetes: A Systematic Review of the Literature. The Diabetes Educator 33 (6) 1014-1029.

Hill-Briggs, F. & Gemmell, L. (2007). Problem Solving in Diabetes Self-management and Control: A Systematic Review of the Literature. The Diabetes Educator 33 (6) 1032-1050.

Boren, S.A., Gunlock, T.L., Schaefer, J. & Albright, A. (2007). Reducing Risks in Diabetes Self-management: A Systematic Review of the Literature. The Diabetes Educator 33 (6) 1053-1077.

Fisher, E.B., Thorpe, C.T., DeVellis, B.M. & DeVellis, R.F. (2007). Healthy Coping, Negative Emotions, and Diabetes Management: A Systematic Review and Appraisal. The Diabetes Educator 33 (6) 1080-1103.

AADE 7 Self Care Behaviors. (2014). Available from: https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/publications/aade7_position_statement_final.pdf?sfvrsn=4.

Powers, M.A., Bardsley, J., Cypress, M., Duker, P., Funnell, M.M., Fischl, A.H., Maryniuk, M.D., Siminerio, L. & Vivian, E. (2016). Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of The Diabetes Educators, and the Academy of Nutrition and Dietetics. Clinical Diabetes 34 (2) 70-80.

American Geriatrics Society Expert Panel on the Care of Older Adults with Diabetes. (2013). Guidelines Abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 Update. Journal of the American Geriatrics Society 61 (11) 2020-2026.

Breland, J.Y., Yeh, V.M. & Yu, J. (2013). Adherence to evidence-based guidelines among diabetes self-management apps. Translational Behavioral Medicine 3 (3) 277-286.

Chomutare, T., Fernandez-Luque, L., Arsand, E. & Hartvigsen, G. (2011). Features of mobile diabetes applications: Review of the literature and analysis of current applications compared against evidence-based guidelines. Journal of Medical Internet Research 13 (3) e65.

ISO 9241-11: Ergonomic Requirements for Office Work with Visual Display Terminals (VDTs): Part 11: Guidance on Usability. 1st edn. (1998). Geneva: International Organization for Standardization.

Finkelstein, J., Knight, A., Marinopoulos, S., Gibbons, M.C., Berger, Z., Aboumatar, H., Wilson, R.F., Lau, B.D., Sharma, R. & Bass, E.B. (2012). Enabling patient-centered care through health information technology. Evidence Report/Technology Assessment (206) 1-1531.

Kitzinger, J. (2005). Focus group research: using group dynamics. Qualitative Research 10 (5) 605-624..

Liamputtong, P. (2010). The science of Words and the Science of Numbers: Research Methods as Foundations for Evidence-based Practice in Health. Available at: www.lib.oup.com.au/he/health/samples/ liamputtong_researchmethods_sample.pdf.

Creswell, J.W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Thousand Oaks, CA: Sage Publications.

Brooke, J. (1996). SUS - A quick and dirty usability scale. In: Usability Evaluation in Industry, Jordan, P.W., Thomas, B., Lyall McClelland, I. & Weerdmeester, B, (eds). London: Taylor & Francis.

Morris, N.S., MacLean, C.D., Chew, L.D. & Littenberg, B. (2006). The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability. BMC Family Practice 7, 21.

Dumas, J.S. & Redish, J. (1999). A practical guide to usability testing. Bristol, UK: Intellect Books.

Bangor, A., Kortum, P.T. & Miller, J.T. (2008). An Empirical Evaluation of the System Usability Scale. International Journal of Human-Computer Interaction 24 (6) 574-594.

Boyatzis, R.E. (1998). Transforming qualitative information: Thematic analysis and code development. London: Sage.

Ravert, R.D., Boren, S.A. & Wiebke, E. (2015). Transitioning through college with diabetes: themes found in online forums. Journal of American College Health 63 (4) 258-267.

American Community Survey Profile Report.( 2015). Missouri Census Data Center.

Sauro, J. 7 Ways To Handle Missing Data. (2015). [cited 2016 May 10]; Available from: http://www.measuringu.com/blog/handle-missing-data.php.

Kent, D., Haas, L., Randal, D., Lin, E., Thorpe, C.T., Boren, S.A., Fisher, J., Heins, J., Lustman, P., Nelson, J., Ruggiero, L., Wysocki, T., Fitzner, K., Sherr, D. & Martin, A.L. (2010). Healthy coping: issues and implications in diabetes education and care. Population Health Management 13 (5) 227-233.

AADE. Healthy Coping. [cited 2016 November 7]; Available from: https://www.diabeteseducator.org/patient-resources/aade7-self-care-behaviors/healthy-coping.

Dillon, A. & Morris, M.G. (1996). User acceptance of new information technology: theories and models. Annual Review of Information Science and Technology 31, 2-32.

Demidowich, A.P., Lu, K., Tamler, R. & Bloomgarden, Z. (2012). An evaluation of diabetes self-management applications for Android smartphones. Journal of Telemedicine and Telecare 18 (4) 235-238.

Isakovic, M., Sedlar, U., Volk, M. & Bester, J. (2016). Usability Pitfalls of Diabetes mHealth Apps for the Elderly. Journal of Diabetes Research doi: 10.1155/2016/1604609.

de Barros, A.C., Leitão, R. & Ribeiro, J. (2014). Design and evaluation of a mobile user interface for older adults: navigation, interaction and visual design recommendations. Procedia Computer Science 27, 369-378.

Al-Razgan, M.S., Al-Khalifa, H.S., Al-Shahrani, M.D. & AlAjmi. H.H. (2012). Touch-based mobile phone interface guidelines and design recommendations for elderly people: A survey of the literature. In: International Conference on Neural Information Processing.

Schütt, M., Fach, E.M., Seufert, J., Kerner, W., Lang, W., Zeyfang, A., Welp, R., Holl, R.W., DPV Iinitiative & the German BMBF Competence Network Diabetes Mellitus. (2012). Multiple complications and frequent severe hypoglycaemia in ‘elderly’ and ‘old’ patients with Type 1 diabetes. Diabetic Medicine 29 (8) e176-e179.

Kirkman, M.S., Briscoe, V.J., Clark, N., Florez, H., Haas, L.B., Halter, J.B., Huang, E.S., Korytkowski, M.T., Munshi, M.N., Odegard, P.S., Pratley, R.E. & Swift, C.S. (2012). Diabetes in Older Adults. Diabetes Care 35 (12) 2650-2664.




DOI: http://dx.doi.org/10.5750/ejpch.v6i2.1451

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