scholarly journals Eliciting Requirements for a Diabetes Self-Management Application for Underserved Populations: A Multi-Stakeholder Analysis

Author(s):  
Samuel Bonet Olivencia ◽  
Arjun Rao ◽  
Alec Smith ◽  
Farzan Sasangohar

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 with 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 form. Healthcare providers indicated that glucose monitoring, educational content, and graphical visualization of diabetes data were among the top-rated app features. These findings suggest that specific design requirements for the underserved may 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.

Author(s):  
Samuel Bonet Olivencia ◽  
Arjun H. Rao ◽  
Alec Smith ◽  
Farzan Sasangohar

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.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 374.1-374
Author(s):  
S. Mills ◽  
K. Khehra ◽  
P. Ghuman ◽  
D. Au ◽  
C. L. Koehn ◽  
...  

Background:Underserved populations, such as ethnic minorities, low-income adults, and Indigenous people living with arthritis are more likely to have lower health literacy, higher rates of multi-morbidity, and face challenges in accessing care1-3. Self-management support (SMS) can help to mitigate the impacts of living with arthritis4. However, we require a more in-depth understanding of the daily barriers underserved communities face in living with arthritis in order to develop effective SMS that can meaningfully improve well-being and quality of life.Objectives:The study objective was to bring together underserved people living with arthritis to identify common barriers they face in taking care of their conditions in daily life, and to identify their solutions to the identified challenges.Methods:A team of researchers from several universities, nurse practitioners, physicians, policy makers, an arthritis consumer-patient leader and our community partners (Multi-lingual Orientation Service Association for Immigrant Communities and the Portland Hotel Society Community Services Society) engaged in a Community-based Participatory and Concept Mapping (CM) study5-7 where participants from underserved communities identified major barriers they face in managing arthritis, agreed on key themes that emerged, and determined priorities for actions. This involved three key CM activities: 1) brainstorming ideas; 2) sorting and rating ideas; and 3) analyzing and interpreting concept maps8. Data was collected through face-to-face interviews and prioritized and interpreted in workshop settings.Results:Sixty-three individuals who were ethnic minorities, immigrants, refugees, low-income, over 65, and/or housing insecure and living with arthritis identified 35 common barriers and made recommendations in the areas of financial difficulties, social services, access to health services, quality of health services, lack of knowledge, and mental health. Additional funding has been sought through Community-University Engagement Support Funding to enable our community partners to prioritize the recommendations in their communities, and to develop mechanisms for implementation using already existing community structures, processes, and services.Conclusion:Persons living with arthritis in diverse underserved communities face significant health and social inequities, including lack of access to basic life necessities such as food, housing, employment, and safety, which creates barriers to self-managing arthritis and other chronic conditions in daily life. SMS for these communities needs to address these social and environmental barriers shaping capacity for self-management, and ultimately, quality of life and well-being.References:[1]Ackerman I, Busija L. Access to self-management education, conservative treatment and surgery for arthritis according to socioeconomic status. Best Pr Res Clin Rheumatol. 2012;26(5):561–83.[2]Shadmi E. Multimorbidity and equity in health. Int J Equity Heal. 2013;12(59):59.[3]Foster M, Kendall E, Dickson P, Chaboyer W, Hunter B, Gee T. Participation and chronic disease self-management: are we risking inequitable resource allocation? Aust J Prim Health. 2003;9(3):132–40.[4]Brady T, Anderson L, Kobau R. Chronic disease self-management support: public health perspectives. Front Public Heal. 2015;2(234).[5]Trochim W. An introduction to concept mapping for planning and evaluation. Eval Progr Plann. 1989;12(1):1–16.[6]Anderson L, Day K, Vandenberg A. Using a concept map as a tool for strategic planning: the healthy brain initiative. Prev Chronic Dis. 2011;8(5):A117.[7]Petrucci C, Quinlan K. Bridging the research practice gap: concept mapping as a mixed methods strategy in practice-based research and evaluation. J Soc Serv Res. 2007;34(2):25–42.[8]Kane M, Trochim W. Concept mapping for planning and evaluation. Thousand Oaks (CA): SAGE Publications; 2007.Disclosure of Interests:None declared


BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044777
Author(s):  
Susanne Lundin ◽  
Marina Jonsson ◽  
Carl-Fredrik Wahlgren ◽  
Emma Johansson ◽  
Anna Bergstrom ◽  
...  

ObjectivesLearning to take control of one’s health is an important part of the transition from adolescence to adulthood. This study aimed to explore young adults’ perceptions of living with atopic dermatitis (AD) in relation to the concept of self-management.DesignA qualitative study with an inductive approach was performed through semistructured interviews (n=15). The interviews were recorded, transcribed verbatim and analysed with systematic text condensation.ParticipantsYoung adults (mean age 23,4 years) with persistent AD in a longitudinal population-based birth cohort. To capture experience of living with persistent AD (preschool/school-age onset) of different severity (mild to severe/very severe), a purposive selection was performed. In total, 15 young adults were included. Persistent AD (preschool/school-age onset) was defined as dry skin in combination with itchy rash of typical localisation in the 12 months preceding the 16-year and the 24-year follow-ups. Severity was self-assessed using the Patient Oriented Eczema Measure.ResultsDespite having experience of AD since childhood, the respondents expressed uncertainty about treatment and how it affected their bodies. Their uncertainties and feelings affected how they used topical corticosteroids. The respondents emphasised that they perceived availability of healthcare and knowledge about treatment of AD among healthcare providers to be limited. The participants did not state any experiences of support to self-management from healthcare, which affect young adults’ possibilities to take full control of their AD care.ConclusionsYoung adults with preschool/school-age onset of AD are unsure how to treat and manage the disease. One explanation may be insufficient transition process.


2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Maria J. Santana ◽  
Darrell J. Tomkins

Abstract Introduction The patient is the person who experiences both the processes and the outcomes of care. Information held by the patient is vital for clinical and self-management, improving health outcomes, delivery of care, organization of health systems, and formulation of health policies. Patient-reported outcome measures (PROMs) play an important role in supporting patient’s self-management. This narrative describes a patient-led use of a PROM to self-manage after a rotator cuff injury. Methods This is a narrative of a patient who tore the supraspinatus tendon in her right shoulder in an accident. The Disabilities of the Arm, Shoulder and Hand, the DASH questionnaire, was used to monitor and self-manage recovery after the accident. The DASH questionnaire is a self-reported questionnaire that measures the difficulty in performing upper extremity activities and pain in the arm, shoulder or hand. It has been widely used in research studies, but here the patient initiated its use for self-management while waiting for and after rotator cuff surgery. The patient created separate sub-scale scores for function and for pain to answer questions from healthcare providers about her recovery. Results There was noticeable improvement over 3 months of conservative treatment, from a high level of disability of 56 to 39 (score changed 17); however, the scores were nowhere near the general population normative score of 10.1. Surgery improved the score from 39 pre-surgery to 28. Post-surgical interventions included physiotherapy, pain management and platelet-riched plasma treatment (PRP). The score was 14 4 weeks post-PRP. Conclusions The patient found the DASH useful in monitoring recovery from a rotator cuff injury (before and after surgery). The DASH contributed to communication with healthcare professionals and supported the clinical management. The DASH questionnaire was able to capture the patient’s experience with the injury and surgical recovery, corroborating an improvement in function while there was persistent post-surgical pain.


2021 ◽  
pp. 136749352110136
Author(s):  
Logan J Camp-Spivey ◽  
Ayaba Logan ◽  
Michelle Nichols

The primary aim of this integrative review was to critically evaluate and synthesize published, peer-reviewed research to better understand self-management strategies of children and adolescents with chronic diseases. This review was guided by Whittemore and Knafl’s methodological framework. The Pediatric Self-management Model provided the theoretical framework for understanding how self-management behaviors operate within the domains of individual, family, community, and healthcare systems. In June 2019, the electronic databases of EBSCOhost, PubMed, and Scopus, along with reference lists of applicable studies, were searched for appropriate publications. The initial searches yielded 920 citations. Of these, 11 studies met inclusion criteria. A key finding was that involving children and adolescents in the design and delivery phases of interventions was most effective in improving self-management when the interventions did not outweigh cognitive ability or maturity level. In addition, incorporating self-efficacy promotion into self-management interventions may lead to greater sense of responsibility and improved health outcomes. In terms of intervention delivery of self-management strategies, the use of technological platforms and devices was revealed as a promising avenue for youth. A final implication was the importance of family members, peers, and healthcare providers in supporting children and adolescents in adopting self-management behaviors.


Author(s):  
Sahar Khenarinezhad ◽  
Ehsan Ghazanfari Savadkoohi ◽  
Leila Shahmoradi

Aim: During the epidemic and with an increase in coronavirus (COVID-19) disease prevalence, emergency care is essential to help people stay informed and undertake self-management measures to protect their health. One of these self-management procedures is the use of mobile apps in health. Mobile health (mHealth) applications include mobile devices in collecting clinical health data, sharing healthcare information for practitioners and patients, real-time monitoring of patient vital signs, and the direct provision of care (via mobile telemedicine). Mobile apps are increasing to improve health, but before healthcare providers can recommend these applications to patients, they need to be sure the apps will help change patients' lifestyles. Method: A search was conducted systematically using the keywords "Covid-19," "Coronavirus," "Covid-19, and Self-management" at the "Apple App Store". Then we evaluated the apps according to MARS criteria in May 2020. Results: A total of 145 apps for COVID-19 self-management were identified, but only 32 apps met our inclusion criteria after being assessed. The overall mean MARS score was 2.9 out of 5, and more than half of the apps had a minimum acceptability score (range 2.5-3.9). The "who academy" app received the highest functionality score. Who Academy, Corona-Care and First Responder COVID-19 Guide had the highest scores for behavior change. Conclusion: Our findings showed that few apps meet the quality, content, and functionality criteria for Covid-19 self-management. Therefore, developers should use evidence-based medical guidelines in creating mobile health applications so that, they can provide comprehensive and complete information to both patients and healthcare provider.


2021 ◽  
pp. 21
Author(s):  
Dalia Alemam

Introduction: One of the contributing factors to the burden of low back pain (LBP) is the failure to provide patients with appropriate education and advice about diagnosis and management. To date, no information exists about whether the content of patients’ information and educational material provided in physiotherapy clinics in Saudi Arabia is in line with the Clinical Practice Guidelines and contemporary practice. Therefore, the aim of this study was to investigate the content of educational material provided by physiotherapy clinics, hospitals, or distributed by healthcare associations to people with LBP in Saudi Arabia, to determine whether this information is adequate to reassure patients and inform self-management. This study also seeks to explore whether these materials are consistent with CPGs for people with LBP. Methodology: A sample of educational items (English or Arabic) in Saudi Arabia was collected. Content analysis was conducted to analyze data based on manifest content. Result: Seventeen educational materials were included, originating from diverse sources; the Ministry of Health hospitals (n = 10), military hospitals (n = 4), private hospitals (n = 2), and multidisciplinary healthcare association (n = 1). Six main sub-themes were identified: epidemiological/anatomical data about LBP (n = 6); causes/risk factors (n = 10); exercise (n = 14) and physical activity-related recommendations (n = 3); treatment-related recommendations (n = 2); general health and lifestyle-related recommendations (n = 8); and postural and ergonomics-related recommendations (n = 13). Ultimately, one theme was formulated, namely, the content of educational materials was hindering reassurance and self-management for people with LBP. The items reviewed were heavily influenced by the biomedical model of pain. Conclusion: The educational materials reviewed failed to properly report information about LBP from a biopsychosocial perspective and were inadequate to assure patients or inform self-management.


2021 ◽  
Vol 11 (1) ◽  
pp. 124-132
Author(s):  
Sh Sugiharto ◽  
Wiwiek Natalya ◽  
Bambang Widjanarko Otok

Background: Evidence shows that most general practitioners have low knowledge related to diabetes self-management during Ramadan fasting. However, studies on healthcare providers’ competencies related to diabetes self-management during Ramadan fasting are still rare.Purpose: This study aimed to investigate healthcare providers’ knowledge, attitude, and perspective concerning diabetes self-management during Ramadan fasting.Methods: The study applied a cross-sectional design and was conducted in forty-one (41) community health centers in Pekalongan, Central Java, Indonesia. The study participants were medical doctors, nurses, nutritionists, pharmacists, and public health officers. The total sampling technique was used. There were 205 healthcare providers who met the inclusion criteria. Their knowledge, attitude, and perspective were assessed using a questionnaire developed by Zainudin and Hussain. The Wilcoxon test was used to analyze the data. Results: The healthcare providers’ knowledge of Ramadan fasting was very low (36.79±26.11). More than half of the respondents (53.17%) advised diabetic patients to manage diabetes in general, although specific counseling for diabetic patients related to fasting in Ramadan month was not provided (55.12%). The perspective of Ramadan fasting among healthcare providers was moderate (62.68%±30.40). The results also showed that general and safe practice knowledge significantly affected the healthcare providers’ perspective toward Ramadan fasting (Z=-12.49, p=0.000), (Z=-12.02, p=0.000), respectively. Conclusion: Healthcare providers’ knowledge and attitude concerning diabetes self-management during Ramadan fasting were low. Accordingly, this affected their perspective. It is strongly recommended that a formal Ramadan fasting management training program should be given regularly to provide appropriate consultations and services. 


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