A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation.
A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation.
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DOI：
10.2196/jmir.8712
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发表时间：
2018-03-16
影响因子：
7.4
通讯作者：
Jeffs L
中科院分区：
文献类型：
--
作者：
Desveaux L;Shaw J;Saragosa M;Soobiah C;Marani H;Hensel J;Agarwal P;Onabajo N;Bhatia RS;Jeffs L
基于网络的解决方案越来越多地用于健康预防和促进，这为 2 型糖尿病 (T2DM) 患者改善自我管理和遵守基于指南的治疗提供了机会。尽管初步证据很有希望，但由于数据输入负担、隐藏成本、兴趣丧失以及缺乏综合功能，许多用户停止使用基于 Web 的解决方案。评估往往侧重于有效性或影响力，而未能评估可能相互作用以促成结果成功（或失败）的细微差别变量。本研究旨在评估用于改善 T2DM 自我管理的基于网络的解决方案，以确定情境变量和行动机制的关键组合，以解释该解决方案对谁最有效以及在什么情况下最有效。通过在基线时完成的一对一、半结构化电话访谈以及在干预期（3 个月）结束时再次进行定性现实主义评估。主题包括参与者使用基于网络的解决方案的经验、自我管理的障碍和促进因素，以及有效使用的障碍和促进因素。使用主题分析策略对转录本进行分析，然后使用关键主题来阐述关键背景因素、作用机制以及对主要结果（糖化血红蛋白、HbA1c）的影响之间的关系。对 16 名 T2DM 参与者完成了 26 次访谈（14 次基线访谈，12 次随访访谈），并得出以下 3 个关键组：最容易适应、最适合和未能激活的群体。自我效能和参与解决方案的意愿促进了 HbA1c 的改善，而相互竞争的优先事项和社会心理问题则造成了参与的障碍。具有高基线自我效能感、积极主动、对自己的行动拥有主人翁精神并优先考虑糖尿病管理的个人是该应用程序的早期和热切采用者，并在干预期间记录了 HbA1c 的改善。基线自我效能感中等且没有竞争优先事项的个人，在了解自己的行为如何影响健康方面存在差距，他们采用该方法的速度较慢，但糖化血红蛋白 (HbA1c) 的改善最大。最后一组的自我效能感基线较低，并确定了一系列心理社会问题和相互竞争的优先事项。这些参与者不确定使用基于网络的解决方案支持自我管理的好处，最终导致参与度最低且 HbA1c 没有改善。自我效能、竞争优先事项、先前的行为改变以及对基于网络的解决方案的信念相互作用，以确定参与度和对临床结果的影响。考虑这些患者特征的平衡可能会帮助医疗保健提供者识别哪些人容易从基于网络的解决方案中受益，以支持 T2DM 的自我管理。基于网络的解决方案可以进行修改，以纳入现有的筛查措施，以识别存在依从性不佳风险的个人，以便根据需要通知提供额外的支持。
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). 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. 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, HbA1c). 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 HbA1c, whereas competing priorities and psychosocial issues created barriers to engagement. Individuals with high baseline self-efficacy who were motivated, took ownership for their actions, and prioritized diabetes management were early and eager adopters of the app and recorded improvements in HbA1c over the intervention period. Individuals with moderate baseline self-efficacy and no competing priorities, who identified gaps in understanding of how their actions influence their health, were slow to adopt use but recorded the greatest improvements in HbA1c. The final group had low baseline self-efficacy and identified a range of psychosocial issues and competing priorities. These participants were uncertain of the benefits of using a Web-based solution to support self-management, ultimately resulting in minimal engagement and no improvement in HbA1c. 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.
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