scholarly journals Acceptability of an Embodied Conversational Agent for Type 2 Diabetes Self-Management Education and Support via a Smartphone App: Mixed Methods Study

10.2196/17038 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e17038 ◽  
Author(s):  
Shaira Baptista ◽  
Greg Wadley ◽  
Dominique Bird ◽  
Brian Oldenburg ◽  
Jane Speight ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Mixed Methods ◽  
Qualitative Data ◽  
Management Education ◽  
Qualitative Interviews ◽  
User Preferences ◽  
Self Management ◽  
Conversational Agents ◽  
Motivational Support

Background Embodied conversational agents (ECAs) are increasingly used in health care apps; however, their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated. Objective This study aimed to evaluate the acceptability of the ECA (Laura) used to deliver diabetes self-management education and support in the My Diabetes Coach (MDC) app. Methods A sequential mixed methods design was applied. Adults with T2D allocated to the intervention arm of the MDC trial used the MDC app over a period of 12 months. At 6 months, they completed questions assessing their interaction with, and attitudes toward, the ECA. In-depth qualitative interviews were conducted with a subsample of the participants from the intervention arm to explore their experiences of using the ECA. The interview questions included the participants’ perceptions of Laura, including their initial impression of her (and how this changed over time), her personality, and human character. The quantitative and qualitative data were interpreted using integrated synthesis. Results Of the 93 intervention participants, 44 (47%) were women; the mean (SD) age of the participants was 55 (SD 10) years and the baseline glycated hemoglobin A1c level was 7.3% (SD 1.5%). Overall, 66 of the 93 participants (71%) provided survey responses. Of these, most described Laura as being helpful (57/66, 86%), friendly (57/66, 86%), competent (56/66, 85%), trustworthy (48/66, 73%), and likable (40/66, 61%). Some described Laura as not real (18/66, 27%), boring (26/66, 39%), and annoying (20/66, 30%). Participants reported that interacting with Laura made them feel more motivated (29/66, 44%), comfortable (24/66, 36%), confident (14/66, 21%), happy (11/66, 17%), and hopeful (8/66, 12%). Furthermore, 20% (13/66) of the participants were frustrated by their interaction with Laura, and 17% (11/66) of the participants reported that interacting with Laura made them feel guilty. A total of 4 themes emerged from the qualitative data (N=19): (1) perceived role: a friendly coach rather than a health professional; (2) perceived support: emotional and motivational support; (3) embodiment preference acceptability of a human-like character; and (4) room for improvement: need for greater congruence between Laura’s words and actions. Conclusions These findings suggest that an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing ongoing, friendly, nonjudgmental, emotional, and motivational support is well received. Nevertheless, the ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences. Trial Registration Australian New Zealand Clinical Trials Registry CTRN12614001229662; https://tinyurl.com/yxshn6pd

scholarly journals Acceptability of an Embodied Conversational Agent for Type 2 Diabetes Self-Management Education and Support via a Smartphone App: Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Shaira Baptista ◽  
Greg Wadley ◽  
Dominique Bird ◽  
Brian Oldenburg ◽  
Jane Speight ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Mixed Methods ◽  
Qualitative Data ◽  
Management Education ◽  
Qualitative Interviews ◽  
User Preferences ◽  
Self Management ◽  
Conversational Agents ◽  
Motivational Support

BACKGROUND Embodied conversational agents (ECAs) are increasingly used in health care apps; however, their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated. OBJECTIVE This study aimed to evaluate the acceptability of the ECA (Laura) used to deliver diabetes self-management education and support in the My Diabetes Coach (MDC) app. METHODS A sequential mixed methods design was applied. Adults with T2D allocated to the intervention arm of the MDC trial used the MDC app over a period of 12 months. At 6 months, they completed questions assessing their interaction with, and attitudes toward, the ECA. In-depth qualitative interviews were conducted with a subsample of the participants from the intervention arm to explore their experiences of using the ECA. The interview questions included the participants’ perceptions of Laura, including their initial impression of her (and how this changed over time), her personality, and human character. The quantitative and qualitative data were interpreted using integrated synthesis. RESULTS Of the 93 intervention participants, 44 (47%) were women; the mean (SD) age of the participants was 55 (SD 10) years and the baseline glycated hemoglobin A1c level was 7.3% (SD 1.5%). Overall, 66 of the 93 participants (71%) provided survey responses. Of these, most described Laura as being helpful (57/66, 86%), friendly (57/66, 86%), competent (56/66, 85%), trustworthy (48/66, 73%), and likable (40/66, 61%). Some described Laura as not real (18/66, 27%), boring (26/66, 39%), and annoying (20/66, 30%). Participants reported that interacting with Laura made them feel more motivated (29/66, 44%), comfortable (24/66, 36%), confident (14/66, 21%), happy (11/66, 17%), and hopeful (8/66, 12%). Furthermore, 20% (13/66) of the participants were frustrated by their interaction with Laura, and 17% (11/66) of the participants reported that interacting with Laura made them feel guilty. A total of 4 themes emerged from the qualitative data (N=19): (1) perceived role: a friendly coach rather than a health professional; (2) perceived support: emotional and motivational support; (3) embodiment preference acceptability of a human-like character; and (4) room for improvement: need for greater congruence between Laura’s words and actions. CONCLUSIONS These findings suggest that an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing ongoing, friendly, nonjudgmental, emotional, and motivational support is well received. Nevertheless, the ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences. CLINICALTRIAL Australian New Zealand Clinical Trials Registry CTRN12614001229662; https://tinyurl.com/yxshn6pd

2180-PUB: Integration of Continuous Glucose Monitoring in Diabetes Self-Management Education for Type 2 Diabetes Improves Glycemic Control

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 2180-PUB
Author(s):  
ADDIE L. FORTMANN ◽  
ALESSANDRA BASTIAN ◽  
CODY J. LENSING ◽  
SHANE HOVERSTEN ◽  
KIMBERLY LUU ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Management Education ◽  
Glucose Monitoring ◽  
Self Management

scholarly journals Type 2 diabetes patients’ views on prevention of hypoglycaemia – a mixed methods study investigating self-management issues and self-identified causes of hypoglycaemia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Stijn Crutzen ◽  
Tessa van den Born-Bondt ◽  
Petra Denig ◽  
Katja Taxis
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Mixed Methods ◽  
Food Intake ◽  
Mixed Methods Study ◽  
Self Management ◽  
Hypoglycaemic Event ◽  
Glucose Levels ◽  
Management Issues

Abstract Background Hypoglycaemia is a common and potentially avoidable adverse event in people with type 2 diabetes (T2D). It can reduce quality of life, increase healthcare costs, and reduce treatment success. We investigated self-management issues associated with hypoglycaemia and self-identified causes of hypoglycaemia in these patients. Methods In this mixed methods study qualitative semi-structured interviews were performed, which informed a subsequent quantitative survey in T2D patients. All interviews were audio recorded, transcribed verbatim and coded independently by two coders using directed content analysis, guided by the Theoretical Domains Framework. Descriptive statistics were used to quantify the self-management issues and causes of hypoglycaemia collected in the survey for the respondents that had experienced at least one hypoglycaemic event in the past. Results Sixteen participants were interviewed, aged 59–84 years. Participants perceived difficulties in managing deviations from routine, and they sometimes lacked procedural knowledge to adjust medication, nutrition or physical activity to manage their glucose levels. Grief and loss of support due to the loss of a partner interfered with self-management and lead to hypoglycaemic events. Work ethic lead some participant to overexerting themselves, which in turn lead to hypoglycaemic events. The participants had difficulties preventing hypoglycaemic events, because they did not know the cause, suffered from impaired hypoglycaemia awareness and/or did not want to regularly measure their blood glucose. When they did recognise a cause, they identified issues with nutrition, physical activity, stress or medication. In total, 40% of respondents reported regular stress as an issue, 24% reported that they regularly overestimated their physical abilities, and 22% indicated they did not always know how to adjust their medication. Around 16% of patients could not always remember whether they took their medication, and 42% always took their medication at regular times. Among the 83 respondents with at least one hypoglycaemic event, common causes for hypoglycaemia mentioned were related to physical activity (67%), low food intake (52%), deviations from routine (35%) and emotional burden (28%). Accidental overuse of medication was reported by 10%. Conclusion People with T2D experience various issues with self-managing their glucose levels. This study underlines the importance of daily routine and being able to adjust medication in relation to more physical activity or less food intake as well as the ability to reduce and manage stress to prevent hypoglycaemic events.

scholarly journals Self-Management Education for Adults With Type 2 Diabetes: A meta-analysis of the effect on glycemic control

Diabetes Care ◽  
2002 ◽  
Vol 25 (7) ◽  
pp. 1159-1171 ◽  
Author(s):  
S. L. Norris ◽  
J. Lau ◽  
S. J. Smith ◽  
C. H. Schmid ◽  
M. M. Engelgau
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Management Education ◽  
Meta Analysis ◽  
Self Management

Efficacy of a self-management education programme on patients with type 2 diabetes in primary care: A randomised controlled trial

2019 ◽  
Vol 13 (2) ◽  
pp. 122-133 ◽  
Author(s):  
Estibaliz Gamboa Moreno ◽  
Maider Mateo-Abad ◽  
Lourdes Ochoa de Retana García ◽  
Kalliopi Vrotsou ◽  
Emma del Campo Pena ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Randomised Controlled Trial ◽  
Management Education ◽  
Controlled Trial ◽  
Education Programme ◽  
Self Management ◽  
Randomised Controlled

scholarly journals Social Network Analysis of Support Exchanges on a Virtual Environment for Diabetes Self-Management Education and Support (Preprint)

2020 ◽  
Author(s):  
Carlos A Pérez-Aldana ◽  
Allison A Lewinski ◽  
Constance M Johnson ◽  
Allison Vorderstrasse ◽  
Sahiti Myneni
Keyword(s):  
Social Support ◽  
Type 2 Diabetes ◽  
Social Interactions ◽  
Virtual Environments ◽  
Virtual Communities ◽  
Management Education ◽  
Support Networks ◽  
Self Management ◽  
Instrumental Support

BACKGROUND Diabetes remains a major health problem in the US affecting an estimated 10.5% of the population. Diabetes self-management interventions improve diabetes knowledge, self-management behaviors, and metabolic control. Widespread Internet connectivity facilitates the use of eHealth interventions, which positively impacts knowledge, social support, clinical, and behavioral outcomes. Particularly, diabetes interventions based in virtual environments have the potential to improve diabetes self-efficacy and support while being highly feasible and usable. However, little is known about the pattern of social interactions and support taking place within type 2 diabetes-specific virtual communities. OBJECTIVE The objective of this study was to examine social support exchanges from a type 2 diabetes self-management education and support intervention that was delivered via a virtual environment (VE). METHODS Data comprised VE-meditated synchronous interactions among participants and between participants and providers from an intervention for type 2 diabetes self-management education and support. Network data derived from such social interactions were used to create networks to analyze patterns of social support exchange with the lens of social network analysis. Additionally, network correlations were used to explore associations between social support networks. RESULTS Findings reveal structural differences between support networks as well as key network characteristics of supportive interactions facilitated by the intervention. Emotional and appraisal support networks are the larger, most centralized, and most active networks, suggesting that virtual communities can be good sources for these types of support. In addition, appraisal and instrumental support networks are more connected, suggesting that members of virtual communities are more likely to engage in larger group interactions where these types of support can be exchanged. Lastly, network correlations suggest participants that exchanged emotional support are likely to exchange appraisal or instrumental support, and participants that exchanged appraisal support are likely to exchange instrumental support. CONCLUSIONS Social interaction patterns from disease-specific virtual environments can be studied using a social network analysis approach to better understand the exchange of social support. Network data can provide valuable insights into the design of novel and effective eHealth interventions given the unique opportunity virtual environments have facilitating realistic environments that are effective and sustainable where social interactions can be leveraged to achieve diverse health goals.

scholarly journals Stigma as a Barrier to Participant Recruitment of Minority Populations in Diabetes Research: Viewpoint and Lessons Learned From a Randomized Control Trial of Virtual Diabetes Self-Management Education (Preprint)

2021 ◽  
Author(s):  
Suzanne Mitchell ◽  
Alexa Bragg ◽  
Ioana Moldovan ◽  
Shakiyla Woods ◽  
Katherine Melo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Socioeconomic Factors ◽  
Management Education ◽  
Lessons Learned ◽  
Self Management ◽  
Advisory Group ◽  
Diabetes Research ◽  
Phone Calls ◽  
Related Stigma

BACKGROUND Background: The development of evidence-based care geared towards Black/African American and Latina women living with uncontrolled type 2 diabetes is contingent upon their active recruitment into clinical interventions. Well-documented impediments to recruitment include a historical mistrust of the research community and socioeconomic factors that limit awareness and access to research studies. While sociocultural and socioeconomic factors deter minorities from participating in clinical research, it is equally important to consider the role of stigma in chronic disease intervention studies. OBJECTIVE Objective: We aim to share our discovery of diabetes-related stigma as an under-recognized impediment to recruitment for the Women in Control 2.0 virtual diabetes self-management education study. METHODS Methods: Our initial recruitment plan utilized traditional strategies to recruit minority women with uncontrolled type 2 diabetes, including letters and phone calls to targeted patients, referrals from clinicians, and posted flyers. After engaging a patient advisory group and consulting with experts in community advocacy, diabetes-related stigma emerged as a prominent barrier to recruitment. The study team reviewed and revised recruitment scripts and outreach material in order to better align with the lived experience and needs of potential enrollees. RESULTS Results: Utilizing a more nuanced, community-centered recruitment approach, we achieved our target recruitment goal, enrolling 309 participants into the study, exceeding our target of 212. CONCLUSIONS Conclusions: There is a need for updated recruitment methods that can increase research participation of patients who experience internalized diabetes stigma. In order to address disparities in minority health, further research is needed to better understand diabetes-related stigma and devise strategies to avert or address it. CLINICALTRIAL NCT02726425

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