Barriers and drivers regarding the use of mobile health applications among type 2 diabetes patients in the Netherlands: an explanatory sequential design (Preprint)

BACKGROUND In the Netherlands, type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases and the number of patients is expected to increase in the coming years. Self-monitoring of blood glucose levels, food intake and physical activity supports the self-management of patients with T2DM. In the past few years, there has been a rise in the development and availability of mobile health applications (apps) for T2DM. OBJECTIVE The aim of this study was to explore the actual use of diabetes mobile health applications among T2DM-patients and main barriers and drivers among app-users and non-users. METHODS An explanatory sequential design was applied, starting with a web-based questionnaire followed by semi-structured in-depth interviews. Data were collected between July and December 2020. Questionnaire data from 103 respondents were analyzed using IBM SPSS Statistics 25.0. Descriptive statistics were performed for actual use of apps among T2DM-patients and the individual items of the Unified Theory of Acceptance and Use of Technology (UTAUT). Differences between users and non-users were tested through chi-square tests for the individual items. Independent t-tests were performed to test for differences in mean scores per UTAUT-construct. A total of 16 respondents contributed to the in-depth interviews, of which ten were users and six non-users of apps for T2DM. Content analysis with a deductive approach was performed on all transcripts guided by the UTAUT. RESULTS Regarding actual use, 55% (n=57) were non-users and 45% (n=46) were users of apps for T2DM. Mean scores were significantly higher among users of apps for T2DM for the constructs performance expectancy, effort expectancy, facilitating conditions and knowledge compared to the non-users (P<.001). One of the main drivers for use was the belief that using diabetes-apps would result in better personal health and well-being. Time and energy needed to keep track of data and understand the app were mentioned as barriers. Users scored significantly higher regarding social influence compared to the non-users (P.007). Healthcare professionals play an important role in the support of T2DM-patients in using apps. Respondents wanted to use the apps and acquired data together with their healthcare professionals. However, respondents noticed that their professionals often were not supportive regarding the use of diabetes-apps, didn’t had interest or did not talk about apps or acquired data. Reimbursement by insurance companies was mentioned as missing facilitator. CONCLUSIONS Empowering healthcare professionals’ engagement is of utmost important to support T2DM-patients in using apps. Insurance companies can have a role in facilitating the use of diabetes-apps, for example to assure reimbursement. Further research should focus on evaluation of patients experiences with different diabetes-apps and how to integrate mobile health applications with diabetes self-management care.