Opening the Black Box of an mHealth Patient-Reported Outcome Tool for Diabetes Self-Management: Interview Study Among Patients With Type 2 Diabetes.
Opening the Black Box of an mHealth Patient-Reported Outcome Tool for Diabetes Self-Management: Interview Study Among Patients With Type 2 Diabetes.
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DOI：
10.2196/47811
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发表时间：
2023-09-19
影响因子：
2.2
通讯作者：
Schoenthaler, Antoinette
中科院分区：
文献类型：
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作者：
Marini, Christina;Cruz, Jocelyn;Payano, Leydi;Flores, Ronaldo Patino;Arena, Gina-Maria;Mandal, Soumik;Leven, Eric;Mann, Devin;Schoenthaler, Antoinette
移动的健康（mHealth）工具用于收集患者报告结果（PRO）的数据，并促进对患者在诊所环境之外的自我管理行为的评估。尽管mHealth糖尿病工具的可用性很高，但人们对这些mHealth PRO工具在改变患者自我管理行为方面成功或失败的根本原因缺乏了解。本研究的目的是确定的因素，推动参与的mHealth PRO工具，促进患者的自我管理行为的采用，以及引出改进的建议。这项定性研究是在一项随机对照试验的背景下进行的，旨在评估mHealth PRO工具（称为i-Matter）与常规护理在降低糖化血红蛋白（HbA 1c）水平和坚持自我管理行为方面的有效性12个月时患有不受控制的2型糖尿病的患者。随机分配至i-Matter的患者参加了关于他们在3个月、6个月、9个月和12个月研究访视时的经历的半结构化访谈。访谈的质性分析由2位经验丰富的质性研究者使用传统的质性内容分析法进行。样本包括71例患者，其中67例（94%）完成了至少一次访谈（n=48，72%为女性患者; n=25，37%为非裔美国人或黑人;平均年龄56.65 [SD 9.79]岁）。我们确定了4个总体主题和6个次主题。主题1表明，患者参与i-Matter的原因是多因素的。患者受到内部激励因素的驱动，这些因素增强了他们的参与度，并帮助他们对自己的糖尿病负责（子主题1），外部激励因素有助于提醒他们与自我管理行为保持一致（子主题2）。主题2揭示了i-Matter的使用从两个方面改变了患者对疾病和健康行为的态度：患者对自己的病情和有效自我管理的能力产生了更积极的态度（子主题3），他们也对自己当前的行为有了更好的认识，这促使他们采取更健康的生活方式行为（子主题4）。主题3表明，由于使用i-Matter，患者对自己的健康感到更加投入。主题4强调了i-Matter的局限性，包括其技术设计（次主题5）和需要更多资源来支持通过该工具收集和共享的PRO数据（次主题6）。这项研究隔离了促使患者改变对糖尿病的看法的内部和外部因素，使他们更加参与干预和健康，并采取健康的行为。这些行为机制提供了重要的见解，以推动未来发展的mHealth干预措施，可能导致持续的行为改变。
Mobile health (mHealth) tools are used to collect data on patient-reported outcomes (PROs) and facilitate the assessment of patients’ self-management behaviors outside the clinic environment. Despite the high availability of mHealth diabetes tools, there is a lack of understanding regarding the underlying reasons why these mHealth PRO tools succeed or fail in terms of changing patients’ self-management behaviors. This study aims to identify the factors that drive engagement with an mHealth PRO tool and facilitate patients’ adoption of self-management behaviors, as well as elicit suggestions for improvement. This qualitative study was conducted within the context of a randomized controlled trial designed to evaluate the efficacy of an mHealth PRO tool (known as i-Matter) versus usual care regarding reduction in glycated hemoglobin (HbA1c) levels and adherence to self-management behaviors at 12 months among patients with uncontrolled type 2 diabetes. Patients randomized to i-Matter participated in semistructured interviews about their experiences at the 3-, 6-, 9-, and 12-month study visits. A qualitative analysis of the interviews was conducted by 2 experienced qualitative researchers using conventional qualitative content analysis. The sample comprised 71 patients, of whom 67 (94%) completed at least one interview (n=48, 72% female patients; n=25, 37% identified as African American or Black; mean age 56.65 [SD 9.79] years). We identified 4 overarching themes and 6 subthemes. Theme 1 showed that the patients’ reasons for engagement with i-Matter were multifactorial. Patients were driven by internal motivating factors that bolstered their engagement and helped them feel accountable for their diabetes (subtheme 1) and external motivating factors that helped to serve as reminders to be consistent with their self-management behaviors (subtheme 2). Theme 2 revealed that the use of i-Matter changed patients’ attitudes toward their disease and their health behaviors in 2 ways: patients developed more positive attitudes about their condition and their ability to effectively self-manage it (subtheme 3), and they also developed a better awareness of their current behaviors, which motivated them to adopt healthier lifestyle behaviors (subtheme 4). Theme 3 showed that patients felt more committed to their health as a result of using i-Matter. Theme 4 highlighted the limitations of i-Matter, which included its technical design (subtheme 5) and the need for more resources to support the PRO data collected and shared through the tool (subtheme 6). This study isolated internal and external factors that prompted patients to change their views about their diabetes, become more engaged with the intervention and their health, and adopt healthy behaviors. These behavioral mechanisms provide important insights to drive future development of mHealth interventions that could lead to sustained behavior change.