Tele-Self-Management Support for Type 2 Diabetes Care : Working through public primary care centers in Santiago, Chile

We studied the use, uptake, and effects of e-Vita, a personal health record, with self-management support and personalized asynchronized coaching, for type 2 diabetes patients treated in primary care. Patients were invited by their practice nurse to join the study aimed at testing use and effects of a personal health record. Patients were followed up for 6 months. Uptake and usage were monitored using log data. Outcomes were self-reported diabetes self-care, diabetes-related distress, and emotional wellbeing. Patients’ health status was collected from their medical chart. 132 patients agreed to participate in the study of which less than half (46.1%) did not return to the personal health record after 1st login. Only 5 patients used the self-management support program within the personal health record, 3 of whom asked a coach for feedback. Low use of the personal health record was registered. No statistical significant differences on any of the outcome measures were found between baseline and 6 month follow-up. This study showed minimal impact of implementing a personal health record including self-management support in primary diabetes care. Successful adoption of web-based platforms, as ongoing patient centered care, is hard to achieve without additional strategies aimed at enhancing patient motivation and engaging professionals.

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Get moving! Self-management support using mobile technology : a counselling protocol extended with a web-based coaching system to promote physical activity in patients with COPD or type 2 diabetes in primary care: the It’s LiFe! study

10.26481/dis.20150916rv ◽

2015 ◽

Author(s):

R. Verwey

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Primary Care ◽

Mobile Technology ◽

Self Management ◽

Management Support ◽

Web Based ◽

Life Study

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Get moving! Self-management support using mobile technology : a monitoring and feedback tool embedded in a counselling protocol to increase physical activity of patients with COPD or type 2 diabetes in primary care: the It’s LiFe! study

10.26481/dis.20150916sw ◽

2015 ◽

Author(s):

S. van der Weegen

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Primary Care ◽

Mobile Technology ◽

Self Management ◽

Management Support ◽

Life Study

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

Primary Care Diabetes ◽

10.1016/j.pcd.2018.10.001 ◽

2019 ◽

Vol 13 (2) ◽

pp. 122-133 ◽

Cited By ~ 6

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

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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.

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Preferences for mHealth Technology and Text Messaging Communication in Patients With Type 2 Diabetes: Qualitative Interview Study (Preprint)

10.2196/preprints.25958 ◽

2020 ◽

Author(s):

Julie C Lauffenburger ◽

Renee A Barlev ◽

Ellen S Sears ◽

Punam A Keller ◽

Marie E McDonnell ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Care ◽

Mobile Technology ◽

Diabetes Care ◽

Technology Use ◽

Text Messages ◽

Self Management ◽

Care Providers ◽

Mhealth Technology

BACKGROUND Individuals with diabetes need regular support to help them manage their diabetes on their own, ideally delivered via mechanisms that they already use, such as their mobile phones. One reason for the modest effectiveness of prior technology-based interventions may be that the patient perspective has been insufficiently incorporated. OBJECTIVE This study aims to understand patients’ preferences for mobile health (mHealth) technology and how that technology can be integrated into patients’ routines, especially with regard to medication use. METHODS We conducted semistructured qualitative individual interviews with patients with type 2 diabetes from an urban health care system to elicit and explore their perspectives on diabetes medication–taking behaviors, daily patterns of using mobile technology, use of mHealth technology for diabetes care, acceptability of text messages to support medication adherence, and preferred framing of information within text messages to support diabetes care. The interviews were digitally recorded and transcribed. The data were analyzed using codes developed by the study team to generate themes, with representative quotations selected as illustrations. RESULTS We conducted interviews with 20 participants, of whom 12 (60%) were female and 9 (45%) were White; in addition, the participants’ mean glycated hemoglobin A<sub>1c</sub> control was 7.8 (SD 1.1). Overall, 5 key themes were identified: patients try to incorporate <i>cues</i> into their routines to help them with consistent medication taking; many patients leverage some form of technology as a cue to support adherence to medication taking and diabetes self-management behaviors; patients value simplicity and integration of technology solutions used for diabetes care, managing medications, and communicating with health care providers; some patients express reluctance to rely on mobile technology for these diabetes care behaviors; and patients believe they prefer positively framed communication, but communication preferences are highly individualized. CONCLUSIONS The participants expressed some hesitation about using mobile technology in supporting diabetes self-management but have largely incorporated it or are open to incorporating it as a cue to make medication taking more automatic and less burdensome. When using technology to support diabetes self-management, participants exhibited individualized preferences, but overall, they preferred simple and positively framed communication. mHealth interventions may be improved by focusing on integrating them easily into daily routines and increasing the customization of content.

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Effects of the Proactive Interdisciplinary Self-Management (PRISMA) Program on Online Care Platform Usage in Patients with Type 2 Diabetes in Primary Care: A Randomized Controlled Trial

Journal of Diabetes Research ◽

10.1155/2020/5013142 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Esther du Pon ◽

Nanne Kleefstra ◽

Frits Cleveringa ◽

Ad van Dooren ◽

Eibert R. Heerdink ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Randomized Controlled Trial ◽

Usual Care ◽

Controlled Trial ◽

Self Management ◽

Online Platform ◽

Randomized Controlled ◽

Number Of Patients

Online care platforms can support patients with type 2 diabetes (T2DM) in managing their health. However, in the use of eHealth, a low participation rate is common. The Proactive Interdisciplinary Self-Management (PRISMA) program, aimed at improving patients’ self-management skills, was expected to encourage patients to manage their disease through the use of an online platform. Therefore, the objective of the current study was to investigate whether a group education program can improve the use of an online care platform in patients with T2DM treated by primary care providers in the Netherlands. In a randomized controlled trial, patients with T2DM received either PRISMA with usual care or usual care only. During a six-month follow-up period in 2014-2015, usage (number of log-ons and time spent per session) of an online care platform (e-Vita) aimed at improving T2DM self-management was assessed. A training about the functionalities of e-Vita was offered. The sample consisted of 203 patients. No differences were found between the intervention and control groups in the number of patients who attended the platform training (interested patients) (X21=0.58; p=0.45), and the number of patients who logged on at least once (platform users) (X21=0.46; p=0.50). In addition, no differences were found between the groups in the type of users—patients who logged on twice or more (active users) or patients who logged on once (nonactive users) (X21=0.56; p=0.45). The PRISMA program did not change platform usage in patients with T2DM. In addition, only a small proportion of the patients logged on twice or more. Patients probably need other encouragements to manage their condition using an online platform.

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