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Desveaux L, Shaw J, Saragosa M, et al. A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation. J Med Internet Res. 2018;20(3):e81doi: 10.2196/jmir.8712.
Desveaux, L., Shaw, J., Saragosa, M., Soobiah, C., Marani, H., Hensel, J., Agarwal, P., Onabajo, N., Bhatia, R. S., & Jeffs, L. (2018). A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation. Journal of medical Internet research, 20(3), e81. https://doi.org/10.2196/jmir.8712
Desveaux, Laura, et al. "A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation." Journal of medical Internet research vol. 20,3 (2018): e81. doi: https://doi.org/10.2196/jmir.8712
Desveaux L, Shaw J, Saragosa M, Soobiah C, Marani H, Hensel J, Agarwal P, Onabajo N, Bhatia RS, Jeffs L. A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation. J Med Internet Res. 2018 Mar 16;20(3):e81. doi: 10.2196/jmir.8712. PMID: 29549070; PMCID: PMC5878364.
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J Med Internet Res. 2018 Mar 16;20(3):e81. doi: 10.2196/jmir.8712.

A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation.

Journal of medical Internet research

Laura Desveaux, James Shaw, Marianne Saragosa, Charlene Soobiah, Husayn Marani, Jennifer Hensel, Payal Agarwal, Nike Onabajo, R Sacha Bhatia, Lianne Jeffs

Affiliations

  1. Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.
  2. Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
  3. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
  4. American Academy of Nursing, Washington, DC, United States.

PMID: 29549070 PMCID: PMC5878364 DOI: 10.2196/jmir.8712

Abstract

BACKGROUND: The increasing use of Web-based solutions for health prevention and promotion presents opportunities to improve self-management and adherence to guideline-based therapy for individuals with type 2 diabetes (T2DM). Despite promising preliminary evidence, many users stop using Web-based solutions due to the burden of data entry, hidden costs, loss of interest, and a lack of comprehensive features. Evaluations tend to focus on effectiveness or impact and fail to evaluate the nuanced variables that may interact to contribute to outcome success (or failure).

OBJECTIVE: This study aimed to evaluate a Web-based solution for improving self-management in T2DM to identify key combinations of contextual variables and mechanisms of action that explain for whom the solution worked best and in what circumstances.

METHODS: A qualitative realist evaluation was conducted with one-on-one, semistructured telephonic interviews completed at baseline, and again toward the end of the intervention period (3 months). Topics included participants' experiences of using the Web-based solution, barriers and facilitators of self-management, and barriers and facilitators to effective use. Transcripts were analyzed using thematic analysis strategies, after which the key themes were used to develop statements of the relationships between the key contextual factors, mechanisms of action, and impact on the primary outcome (glycated hemoglobin, HbA

RESULTS: Twenty-six interviews (14 baseline, 12 follow-up) were completed with 16 participants with T2DM, and the following 3 key groups emerged: the easiest fit, the best fit, and those who failed to activate. Self-efficacy and willingness to engage with the solution facilitated improvement in HbA

CONCLUSIONS: Self-efficacy, competing priorities, previous behavior change, and beliefs about Web-based solutions interact to determine engagement and impact on the clinical outcomes. Considering the balance of these patient characteristics is likely to help health care providers identify individuals who are apt to benefit from a Web-based solution to support self-management of T2DM. Web-based solutions could be modified to incorporate the existing screening measures to identify individuals who are at risk of suboptimal adherence to inform the provision of additional support(s) as needed.

©Laura Desveaux, James Shaw, Marianne Saragosa, Charlene Soobiah, Husayn Marani, Jennifer Hensel, Payal Agarwal, Nike Onabajo, R Sacha Bhatia, Lianne Jeffs. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 16.03.2018.

Keywords: diabetes mellitus; qualitative research; self-management; telemedicine

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