Unpacking Peer Conversations in a Virtual Communitiy for Diabetes Self-Management Education and Support: Behavior Science and Linguistics Perspective

2021 ◽  
Author(s):  
Carlos A Pérez-Aldana ◽  
Allison A Lewinski ◽  
Constance M Johnson ◽  
Allison A Vorderstrasse ◽  
Sahiti Myneni
Keyword(s):  
Behavior Change ◽  
Virtual Environments ◽  
Management Education ◽  
Digital Health ◽  
Virtual Community ◽  
Self Management ◽  
Management Support ◽  
Linguistic Features ◽  
Behavior Change Techniques ◽  
Behavior Science

Diabetes is a chronic disease that can be effectively managed and controlled using strategies such as self-management education and ongoing support. Virtual environments offer innovative and realistic settings where patients can achieve self-management education and obtain ongoing self-management support from peers and healthcare professionals. Transcribed real-time conversations in an innovative virtual community were analyzed using qualitative and linguistic analysis. These virtual interactions were manually coded to identify embedded behavior change techniques and linguistic features. Results showed 13 behavior change techniques were manifested. Further, language differences were observed between behavior change techniques and social support types. Our research can provide valuable insights into the design of effective digital health interventions that maximize sustained use of virtual environments, subsequently impacting self-management of chronic conditions such as diabetes.

The influencing contexts and potential mechanisms behind the use of online self-management support interventions: a realist evaluation (Preprint)

2021 ◽  
Author(s):  
Marscha Engelen ◽  
Betsie van Gaal ◽  
Hester Vermeulen ◽  
Rixt Zuidema ◽  
Sebastian Bredie ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Behavior Change ◽  
Realist Evaluation ◽  
Support Programs ◽  
Self Management ◽  
Management Support ◽  
Behavior Change Techniques ◽  
Qualitative Interview Study ◽  
Program Characteristics

BACKGROUND Self-management can increase self-efficacy and quality of life and improve disease outcomes in patients with chronic conditions. Effective self-management may also help to reduce the pressure on healthcare systems. However, patients need support in dealing with their disease and in developing skills to manage the symptoms, treatment, physical consequences, psychological consequences, and lifestyle changes associated with their condition. Online self-management support programs have helped patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA) but program use was low. OBJECTIVE This study aims to identify the patient-, disease- and program characteristics that determine whether patients use online self-management support programs or not. METHODS A realist evaluation methodology was used to give a comprehensive oversight of context (patient- and disease characteristics), mechanism (program characteristics), and outcome (program use). The relation between context (sex, age, education, employment status, living situation, self-management [measured using PAM-13], quality of life [measured using RAND-36], interaction efficacy [measured using PEPPI-5], diagnosis, physical comorbidity, and time since diagnosis) and outcome (program use) was analyzed through logistic regression analyses. The relation between mechanism (program design, implementation strategies, behavior change techniques) and outcome was analyzed through a qualitative interview study. RESULTS For this study, 68 non-users and 111 users of the online self-management support programs were included, of which 57% were diagnosed with CVD and 43% with RA. Younger age and a lower level of education were associated with program use. An interaction effect was found between program use and diagnosis (CVD or RA) and four quality of life subscales (social functioning, physical role limitations, vitality, and bodily pain). CVD patients with higher self-management and quality of life scores were less likely to use the program, while RA patients with higher self-management and quality of life scores were more likely to use the program. Interviews with ten non-users, ten low-users, and 18 high-users were analyzed to give insight into the relation between mechanisms and outcome. Program use was encouraged by an easy to use, clear, and transparent design and by recommendations from a professional and email reminders. Five behavior change techniques were identified as potential mechanisms to promote program use: tailored information, self-reporting behavior with delayed feedback, giving information on peer behavior, and modeling. CONCLUSIONS This realist evaluation showed that certain patient-, disease-, and program characteristics are associated with the use of online self-management support programs. These results can help developers of future online self-management support programs to tailor the interventions to increase use and effectiveness.

scholarly journals Digital Person-Centered Self-Management Support for People With Type 2 Diabetes: Qualitative Study Exploring Design Challenges

JMIR Diabetes ◽  
10.2196/10702 ◽  
2019 ◽  
Vol 4 (3) ◽  
pp. e10702
Author(s):  
Robyn Schimmer ◽  
Carljohan Orre ◽  
Ulrika Öberg ◽  
Karin Danielsson ◽  
Åsa Hörnsten
Keyword(s):  
Type 2 Diabetes ◽  
Digital Health ◽  
Work Practice ◽  
Current Work ◽  
Self Management ◽  
Substantial Part ◽  
Management Support ◽  
Design Decisions ◽  
Ehealth Service

Background Self-management is a substantial part of treatment for patients with type 2 diabetes (T2D). Modern digital technology, being small, available, and ubiquitous, might work well in supporting self-management. This study follows the process of developing a pilot implementation of an electronic health (eHealth) service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations that can serve as guides in the development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce. Objective The objective of this study was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources, that is, interviews, observations, focus groups, and a Mentimeter (interactive presentation with polling) survey among stakeholders, representing various perspectives of T2D. Methods A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews, and observations. The different data sources enabled a triangulation of data. Results Results show that user needs related to an eHealth service for person-centered T2D self-management support are multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge, which indicates that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention toward changing the organization of work to fully support a new eHealth service. Conclusions A total of three overarching challenges—flexible access, reducing administrative tasks, and patient empowerment—each having a significant impact on design, are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies investigating patient needs in everyday life is identified to better support the implementation of technology that does not give specific attention to organizational perspectives but instead approach design with the patient perspective in focus.

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 Prostate Cancer Survivors’ and Caregivers’ Experiences Using Behavior Change Techniques during a Web-Based Self-Management and Physical Activity Program: A Qualitative Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3244
Author(s):  
Laura Hallward ◽  
Keryn Chemtob ◽  
Sylvie D. Lambert ◽  
Lindsay R. Duncan
Keyword(s):  
Physical Activity ◽  
Prostate Cancer ◽  
Qualitative Study ◽  
Behavior Change ◽  
Management Program ◽  
Self Management ◽  
Positive Outcomes ◽  
Structured Interviews ◽  
Behavior Change Techniques ◽  
Web Based

Both men with prostate cancer and their caregivers report experiencing a number of challenges and health consequences, and require programs to help support the cancer patient–caregiver dyad. A tailored, web-based, psychosocial and physical activity self-management program (TEMPO), which implements behavior change techniques to help facilitate behavior change for the dyads was created and its acceptability was tested in a qualitative study. The purpose of this secondary analysis was to explore the dyads’ experiences using behavior change techniques to change behavior and address current needs and challenges while enrolled in TEMPO. Multiple semi-structured interviews were conducted with 19 prostate cancer-caregiver dyads over the course of the program, resulting in 46 transcripts that were analyzed using an inductive thematic analysis. Results revealed four main themes: (1) learning new behavior change techniques, (2) engaging with behavior change techniques learned in the past, (3) resisting full engagement with behavior change techniques, and (4) experiencing positive outcomes from using behavior change techniques. The dyads’ discussions of encountering behavior change techniques provided unique insight into the process of learning and implementing behavior change techniques through a web-based self-management program, and the positive outcomes that resulted from behavior changes.

scholarly journals Gamification and Behavior Change Techniques in Diabetes Self-Management Apps

2019 ◽  
Vol 13 (5) ◽  
pp. 954-958 ◽  
Author(s):  
Lilli Priesterroth ◽  
Jennifer Grammes ◽  
Kimberly Holtz ◽  
Anna Reinwarth ◽  
Thomas Kubiak
Keyword(s):  
Behavior Change ◽  
Diabetes Management ◽  
Self Management ◽  
Systematic Research ◽  
User Engagement ◽  
Inclusion Criteria ◽  
Behavior Change Techniques ◽  
Positive Effects ◽  
And Behavior ◽  
App Design

Background: Diabetes management apps may have positive effects on diabetes self-management. It remains unclear, however, which app features are particularly effective and encourage sustained app usage. Behavior change techniques (BCTs) and gamification are promising approaches to improve user engagement. However, little is known about the frequency BCTs and gamification techniques (GTs) are actually used. This app review aims to provide an overview of BCTs and GTs in current diabetes management apps. Methods: Google’s Play Store was searched for applications using a broad search strategy (keyword: “diabetes”). We limited our research to freely available apps. A total of 56 apps matched the inclusion criteria and were reviewed in terms of the features they offer to support self-management. We used a taxonomy comprising 29 BCTs and 17 GTs to evaluate the applications. Two independent raters tested and evaluated each app. Results: Interrater agreement was high (ICC = .75 for BCTs; ICC = .90 for GTs). An average of 7.4 BCTs (SD = 3.1) and an average of 1.4 out of 17 GTs (SD = 1.6) were implemented in each app. Five out of 29 BCTs accounted for 55.8% of the BCTs identified in total. The GT most often identified was “feedback” and accounted for 50% of the GTs. Conclusions: The potential of BCTs and GTs in diabetes management apps has not been fully exploited yet. Only very restricted sets of BCTs and gamification features were implemented. Systematic research on the efficacy of specific BCTs and GTs is needed to provide further guidance for app design.

scholarly journals Complementarity of Digital Health and Peer Support: “This Is What’s Coming”

2021 ◽  
Vol 2 ◽  
Author(s):  
Patrick Y. Tang ◽  
Janet Duni ◽  
Malinda M. Peeples ◽  
Sarah D. Kowitt ◽  
Nivedita L. Bhushan ◽  
...  
Keyword(s):  
Peer Support ◽  
Diabetes Management ◽  
Digital Health ◽  
Scale Up ◽  
Value Added ◽  
Self Management ◽  
Free Form ◽  
Primary Group ◽  
Management Support ◽  
Health Coaches

PurposeThis study examined integration of peer support and a Food and Drug Administration-cleared, diabetes management app (DMA) in diabetes self-management support as a scalable model for those with type 2 diabetes mellitus (T2DM).MethodsTwo lay health Coaches delivered telephone-based self-management support to adults (N = 43) with T2DM recruited through a primary group practice. Those eligible were offered no-cost access to DMA for the entire 6-month study. Coaches introduced DMA and contacted individuals by phone and text with frequency dependent on participant needs/preferences. DMA supported monitoring of blood glucose, carbohydrate intake, and medication use, as well as messaging personalized to participants’ medication regimens. Clinical data were extracted from DMA, electronic medical records, and Coaches’ records. Structured interviews of 12 participants, 2 Coaches, and 5 project staff were analyzed using deductive pre-identified codes (regarding adoptability, patterns of use, value added, complementarity, and sustainability) utilizing standard procedures for qualitative analysis.ResultsOf the 43 participants, 38 (88.4%) enrolled in DMA. In general, participants used both DMA and lay health coaches, averaging 144.14 DMA entries (structured, e.g., medications, and free form, e.g., “ate at a restaurant” and “stressed”) and 5.86 coach contacts over the 6-month intervention. Correlation between DMA entries and coach contacts (r = .613, p < 0.001) was consistent with complementarity as were participants’ and coaches’ observations that (a) DMA facilitated recognition of patterns and provided reminders and suggestions to achieve self-management plans, whereas (b) coaching provided motivation and addressed challenges that emerged. Mean hemoglobin A1c (A1c) declined from 9.93% to 8.86% (p < 0.001), with no pattern of coaching or DMA use significantly related to reductions. Staff identified resources to coordinate coach/DMA interventions as a major sustainability challenge.ConclusionsDMA and peer support for diabetes management are compatible and complementary. Additional practice integration research is needed for adoption and scale-up.

scholarly journals Spoken Animated Self-Management Video Messages Aimed at Improving Physical Activity in People With Type 2 Diabetes: Development and Interview Study

10.2196/15397 ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. e15397
Author(s):  
Colette van het Schip ◽  
Kei Long Cheung ◽  
Stan Vluggen ◽  
Ciska Hoving ◽  
Nicolaas C Schaper ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Behavior Change ◽  
Positive Reinforcement ◽  
Qualitative Content Analysis ◽  
Activity Level ◽  
Self Management ◽  
Behavior Change Techniques ◽  
Physically Active

Background Web-based tailored interventions are a promising approach to help people with type 2 diabetes successfully adopt regular physical activity. Spoken animation seems to be effective regardless of the characteristics of the user and may be a relevant strategy to communicate complex health information Objective The objectives of our study were to evaluate (1) pretesting communication elements and user appreciation, and (2) the applied behavior change techniques of the previously designed spoken animated video messages in a tailored self-management program for people with type 2 diabetes. Methods We conducted semistructured interviews with patients with type 2 diabetes recruited from general practices located in different socioeconomic status urban neighborhoods. Based on the pretesting key communication elements of Salazar’s model, we asked participants about the spoken animated video messages’ attractiveness, comprehensibility, acceptance, believability, involvement, and relevance and to what extent the video messages motivated them to become more physically active. We also assessed participants’ intention to use the spoken animated video messages and to recommend them to others. To evaluate participants’ appreciation of the different applied behavior change techniques, we conducted a post hoc analysis of the qualitative data using the MAXQDA program. Transcripts were coded by 2 coders using iterative qualitative content analysis methods to uncover key health communication issues. Results Of 23 patients who expressed an interest in participating, 17 met the inclusion criteria and 15 took part in the interviews. The positive appreciation of the comprehensibility, believability, and personalization was supported by participants’ statements on behavior change techniques and other communication elements. Reinforcement of and feedback on participants’ answers were positively evaluated as was the simplicity and concreteness of the spoken animated video messages. Most participants indicated reasons for not feeling motivated to increase their physical activity level, including being already sufficiently physically active and the presence of other impeding health factors. Conclusions Spoken animated video messages should be simple, short, concrete, and without the use of medical terminology. Providing positive reinforcement, feedback on participants’ answers, examples that match user characteristics, and the possibility to identify with the animation figures will enhance involvement in the health message. To connect more with patients’ needs and thereby increase the perceived relevance of and motivation to use an animated video program, we suggest offering the program soon after diabetes mellitus is diagnosed. We recommend piloting behavior change techniques to identify potential resistance.

scholarly journals Behavior Change Techniques and the Effects Associated With Digital Behavior Change Interventions in Sedentary Behavior in the Clinical Population: A Systematic Review

2021 ◽  
Vol 3 ◽  
Author(s):  
Jaime Martín-Martín ◽  
Cristina Roldán-Jiménez ◽  
Irene De-Torres ◽  
Antonio Muro-Culebras ◽  
Adrian Escriche-Escuder ◽  
...  
Keyword(s):  
Social Support ◽  
Systematic Review ◽  
Behavior Change ◽  
Sedentary Behavior ◽  
Randomized Clinical Trials ◽  
Digital Health ◽  
Clinical Population ◽  
Outcome Variable ◽  
Behavior Change Techniques ◽  
Behavior Change Interventions

Background: Sedentary behavior (SB) negatively impact health and is highly prevalent in the population. Digital behavior change interventions (DBCIs) have been developed to modify behaviors such as SB by technologies. However, it is unknown which behavior change techniques (BCTs) are most frequently employed in SB as well as the effect associated with DBCIs in this field. The aim of this systematic review was: (a) to evaluate the BCT most frequently employed in digital health including all technologies available and interventions aimed at increasing physical activity (PA), reducing sedentary time, and improving adherence to exercise in the clinical population, and (b) to review the effect associated with DBCIs in this field.Methods: The database used was Medline, as well as Scopus, Scielo, and Google Scholar. For the search strategy, we considered versions of behavior/behavioral, mHealth/eHealth/telemedicine/serious game/gamification. The terms related to PA and SB were included, the criteria for inclusion were randomized clinical trials (RCTs), adults, intervention based on digital media, and outcome variable lifestyle modification; a last 5 years filter was included. Michie's Taxonomy was used to identify BCTs. The study was registered under the number PROSPERO CRD42019138681.Results: Eighteen RCTs were included in the present systematic review, 5 of them healthy adults, and 13 of them with some illness. Studies included 2298 sedentary individuals who were followed up for 5 weeks−3 years. The most used BCTs were goal setting, problem solving, review outcomes/goals, feedback on behavior and outcomes of behavior, self-monitoring of behavior, social support, information about health consequences, and behavior practice/rehearsal. The effect associated with DBCIs showed improvements, among several related to PA and physiologic self-reported and anthropometric outcomes.Conclusion: The BCTs most used in digital health to change outcomes related to SB were goals and planning, feedback and monitoring, social support, natural consequences, repetition, and substitution. Besides these findings, DBCIs are influenced by several factors like the type of intervention, patients' preferences and values, or the number of BCTs employed. More research is needed to determine with precision which DBCIs or BCTs are the most effective to reduce SB in the clinical population.

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