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A Review of Mobile Terminal-Based Applications for Self-Management of Patients with Diabetes

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This is presented at eTELEMED 2009

This is presented at eTELEMED 2009

Published in: Health & Medicine

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  • 1. A Review of Mobile Terminal-Based Applications for Self- Management of Patients with Diabetes Naoe Tataraa,b, Eirik Årsanda,b, Heidi Nilsena, and Gunnar Hartvigsenb,a a Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Norway b Department of Computer Science, University of Tromsø, Norway eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 2. Outline • Introduction • Methods – Literature search – Inclusion and exclusion criteria • Results – Data extracted and summarized in 9 categories • Discussion • Conclusion eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 3. Introduction High preverance of diabetes and the importance of self- management Regular Blood Glucose (BG) measuremenet Maintain BG level within a safe range Proper nutrition Physical activity All images are from Google Image
  • 4. Introduction High preverance of diabetes and the importance of self- management Regular Blood Glucose (BG) measuremenet Leading to BG level Maintain additional and complex diseases within a safe range Proper nutrition Physical activity All images are from Google Image
  • 5. Introduction High preverance of diabetes and the importance of self- management Regular Blood Glucose (BG) measuremenet MobileMaintain BG level phones Leading to additional and complex diseases within a safe range • Pervasiveness • Portability • Inherent technologies Proper nutrition Promising support device? Physical activity All images are from Google Image
  • 6. Introduction High preverance of diabetes and the importance of self- management Purpose of this study –Identify studies that examined feasibility, acceptability or effectiveness of mobile terminal-based applications –Review research methods and technologies used –Summarize useful findings by empirical methods involving prospective users
  • 7. Literature search • Data sources – Pubmed, ISI Web of Science, INSPEC, EMBASE, CINAHL, PsycINFO, Cochrane Library, ACM digital library, IEEExplore, and JMIR • Search terms – Diabetes AND (mobile OR handheld OR cellular phone OR cell phone OR PDA) • June to July 2008 • No restriction by year of publication eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 8. Inclusion and exclusion criteria • A mobile terminal-based application is used, examined or developed for  supporting diabetes self-management the health care professionals’ side only collection of medical data only • Qualitative or quantitative results obtained by empirical methods involving subjects or clinical outcome evaluation are concretely described Reviews without primary data Concept work or only technological work • Publications should appear in peer-reviewed journals or reviewed international conference proceedings Publications written not in English eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 9. Data extraction categories • Study design • Targeted population • Terminals used • People involved in the application • Data input by patients and data entry methods • Functions of the applications • Methods used to evaluate feasibility, acceptability or effectiveness • Methods and results of clinical outcome evaluations • Research findings (positive/negative aspects)
  • 10. Results of literature search Search results after removal of duplicates: 817 publications review of titles and abstracts 94 publications examination of full texts following inclusion and exclusion criteria 36 publications describing 27 studies Removal of 3 publications reporting midterm results of clinical evaluation, whose final results were included in newer ones Addition of 3 publications describing 1 study Addition of 3 publications relevant to 2 of the studies included 39 publications describing 28 studies eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 11. Study design Commercial Self-developed applications: 20 applications Other: 1 :7 In 25 studies: applications were tested in field settings (inc. 15 studies clinical evaluation were conducted) In 3 studies: results from usability engineering process were described eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 12. Targeted population Type2 Type not specified Type1 diabetes: 13 diabetes :9 :6 Other specification of target • Child, adolescent, or young adult patients (8 studies) • Parents of child patients (1 study) • Insulin-treated patients (5 studies) • Newly diagnosed patients (1 study) eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 13. Terminals used Mobile phone: 20 PDA: 8 Other: 1 Both mobile phone and PDA: 1 Among the 20 studies where mobile phones are used: • In 5 studies, the participants used their own mobile phones. • In 5/8 studies targeting child or young patients with Type1 diabetes, a mobile phone is used. • In 8 studies, SMS is used for data entry, feedback, or reminder • In 3 studies, WAP is used as an alternative data entry means besides SMS and a web browser on a PC. In 10 studies, a PC is used as an additional terminal. eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 14. People involved in the applications Family of Health Care Professionals (HCPs): 20 Patients None: 5 :3 Among the studies where HCPs are involved in applications • In 13 studies: HCPs give manual feedback to the patients • In 3 studies: HCPs can only view the uploaded data by patients • In 2 studies: HCPs are involved at the patients’ regular clinic visits • In 1 study: HCPs participate in usability engineering process All studies where family of patients are involved are targeting young patients with Type1 diabetes
  • 15. Data input methods and data type • Blood glucose data Both automatic Automatic: 13 and mannual Mannual: 14 Not used: 4 :3 • Activity data Automatic Mannual: 12 Not used: 14 :2 • Other mannually input data food intake (15 studies), medication (10 studies), general comments (7 studies), general health (4 studies), other daily measurements (3 studies) eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 16. Functions of the applications • Data view: in 16 studies – By only using a mobile terminal (6 studies) – By only accessing through a website using a PC (5 studies) – By using more than one terminals (5 studies) • Automatic feedback: in 8 studies – Alarms are generated according to blood glucose values (4 studies) • Reminder: in 9 studies • Educational tool: in 6 studies • Communication platform: in 5 studies eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 17. Evaluation methods • Questionnaires (in 24 studies) – The Summary of Diabetes Self-Care Activities (SDSCA) is used in 4 studies – In most of the studies, self-developed questionnaires are used • Log files (in 18 studies) • Qualitative methods – Interviews (in 7 studies) – Focus group meetings (in 3 studies) – Feedback through free comments (in 3 studies) – User meeting (in 2 studies) • Clinical evaluation (in 15 studies) eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 18. Clinical evaluations • The 15 studies vary in design of: – Clinical evaluation (Randomized controlled trial, one group pre- post intervention study, randomized crossover trial, or a non- randomized parallel group trial) – Duration of intervention (4 weeks to 12 months) – The number of patients (10 to 203) – Statistical analysis methods – Features of applications • In 10/15 studies, a significant decrease in HbA1c is shown (inc. 3 studies with certain conditions) eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 19. Findings [positive aspects] • Automatic and wireless data transmission • Ease of use, menu structure, data presentation (fast analysis, data visualization, no difficulty in reading) • Use of mobile phone > PC – Participants’ own mobile phone – SMS > WAP – Reminding effect • Message delivery at a frequency of 1-2 times a day • Better communication and feeling of security • Statistically significant improvement in various aspects of diabetes self-management
  • 20. Findings [negative aspects] • Technical problems – Data transmission failures, difficulties – Hardware (small size of buttons or displays, short battery-life, slow processors, small memories) – Software (menu structures, data entry methods and little flexibility in data entry rules) • Time requried (too time-consuming) • Difficulties in long-term use • Dropping-out users and enthusiastic users eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 21. Discussion • Key Assessment points – Motivation in self-management – Long-term adherence (Dropping-out ratio) – Relationship between patients, HCPs and families – Glycemic control as a result • Features that applications should consider – Automation, manual operation by patients, and support by HCPs or patient peers – Time required to use and reflection-in-action – Intuitive and informative user interface eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 22. Conclusion • Studies that examined feasibility, acceptability or effectiveness of mobile terminal-based applications were identified and reviewed. • Mobile terminal-based applications for self-management of diabetes are generally well accepted by patient users. • Useful findings in development of such applications were summarized. • Long-term adherence and enhancing motivation on unmotivated patients are left as future works. eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico
  • 23. Thank you for your attention! Questions? Acknowledgement This work was supported by the Centre for Research-based Innovation, Tromsø Telemedicine Laboratory (TTL), Norwegian Research Council Grant No.174934 eTELEMED 2009, 1-7 Feb 2009, Cancun, Mexico