Instrument for assessing mobile technology acceptability in diabetes self-management: a validation and reliability study

A novel questionnaire for evaluating digital tool use (DTUQ-D) among individuals with type 2 diabetes: exploring the digital landscape

Introduction

Effective healthcare currently incorporates a patient-centric system and accessible technology for patient self-management. This study aimed to develop and validate a novel questionnaire titled the Digital Tool Use Questionnaire for Diabetes (DTUQ-D) - a screening tool identifying the type, number, and frequency of digital tools used by Type 2 Diabetes Mellitus (T2DM) patients with within HMOs, online, and via applications.

Methods

The questionnaire was administered to two ethnic groups and both genders. A mixed-methods approach was used. In the qualitative phase, the questionnaire was developed through phone surveys of 29 T2DM patients, two endocrinologists and two technology experts. In the quantitative phase, involving 367 participants, convergent validity, construct validity, and reliability were examined.

Results

Findings indicated that the DTUQ-D is valid and reliable, successfully identifying digital tools utilized by T2DM patients, notwithstanding variations in factor structures between ethnic groups. This questionnaire provides a foundation for future research, offering a standardized approach to evaluating digital tool usage.

Discussion

The study enhances understanding of the role of digital tools in healthcare, especially for T2DM self-management. It also can be easily adapted to assess digital tool use for other illnesses by adjusting instructions and the wording of certain items.

High engagement in mobile peer support is associated with better glycemic control in type 1 diabetes: a real-world study

AIMS

Peer support for diabetes has become convenient and interactive following the emergence of mobile health (mHealth). We aimed to evaluate the association between engagement in peer support via mHealth app and glycemic control in type 1 diabetes (T1D).

METHODS

This retrospective study included adults with T1D who had joined the mobile community "TangTangQuan (TTQ)" since May 2018 for at least one year. "Like", "comment" and "share" were the major interaction indicators of mobile community and were used to assess engagement in peer support. The patients were divided into four engagement groups by quartile. The primary outcome was the change in HbA_1c , mean fasting blood glucose (FBG) and postprandial blood glucose (PBG) from baseline to the 12th month. Other outcomes included the change of self-monitoring of blood glucose frequency, hypoglycemia frequency, and the proportion of reaching optimal glycemic control.

RESULTS

Among the 693 individuals, the HbA_1c , mean FBG and PBG improved in the 12th month. Multiple regression analysis showed that higher engagement in peer support was associated with a greater reduction of HbA_1c (β=-0.45, P<0.001) and mean FBG (β=-0.82, P<0.001). In the subgroup of poor glycemic control, the association between engagement in peer support and glycemic improvement still remained (HbA_1c : β=-0.86, P=0.002; FBG: β=-1.36, P=0.001). The engagement in mobile peer support was positively correlated with educational level (OR=1.42, P=0.042), household income (OR=1.43, P=0.013), and the use of continuous subcutaneous insulin infusion (OR=1.73, P=0.009).

CONCLUSION

High engagement in mobile peer support was associated with better glycemic control in adults with T1D.

Measuring the Knowledge, Attitude and Practice of Patients With Diabetes Mellitus-The Design and Development Process

INTRODUCTION

Health behavior is important to control Diabetes Mellitus (DM) complications. Knowledge, attitude and practice (KAP) questionnaires are needed to assess healthy behavior. This research aimed to design and develop instruments to measure KAP of diabetic patients in the control of fasting blood glucose (FBG).

METHODS

Evaluation of the validity and reliability was assessed by calculating the score of internal consistency, testing the validity of the items by Pearson product moment correlation test, and confirmatory factor analysis. The validity and reliability tests were done at primary care centers in Yogyakarta. This study was conducted from August to October 2019. There were three stages of validity testing and one stage of reliability testing.

RESULTS

The results of the knowledge variable validity test showed 16 question items were valid, while the attitude variable had 23 valid question items and the practice variable had 26 valid question items. The Cronbach Alpha scores of the KAP questionnaire were 0.597; 0.777; 0.824, with all values > r for each table (0.344; 0.361; 0.355), respectively. The questionnaire is concluded as valid and reliable if it is able to measure variables well and can be used repeatedly in the same conditions and give the same results. Questionnaires concerning KAP in controlling FBG are needed to support changes in healthy behaviors of patients with DM.

CONCLUSION

The questionnaire to assess KAP proved to be valid and reliable. It is hoped that psychometric research concerning this questionnaire continues in various countries as a basis for improving these instruments.

Factors Affecting Adoption of a Technology-Based Tool for Diabetes Self-Management Education and Support Among Adult Patients with Type 2 Diabetes in South Texas

PURPOSE

The purpose of this study is to describe a novel computerized diabetes education tool and explore factors influencing self-selection and use among primarily Hispanic patients diagnosed with type 2 diabetes in south Texas.

METHODS

Study participants included 953 adult patients with type 2 diabetes enrolled in a diabetes education program between July 1, 2016, and June 30, 2017. Participants were asked to choose either a new technology-based diabetes education tool with a touch-screen device or a traditional face-to-face education method. Multivariate logistic regression analysis was applied to identify factors associated with adopting the computerized diabetes education tool among the patients.

RESULTS

When comparing technology-based tool adopters and nonadopters, several demographic and health-related factors differentiated technology use in bivariate analyses. The multivariate logistic regression model showed that Hispanic patients were less likely to choose a technology-based tool. Patients who perceived their health status as excellent/good were more likely to adopt the technologic education method than those with fair/poor perceived health status. A1C level was negatively associated with self-selection of technology.

CONCLUSIONS

Specific demographic and health-related characteristics are significant contributing factors to patients' adoption of a technology-based diabetes education tool. Health care providers can utilize these findings to target and refer specific patients to a computerized diabetes education tool for more effective diabetes care and to optimize technology adoption success.

Promoting built-for-disaster-purpose mobile applications: An interdisciplinary literature review to increase their penetration rate among tourists

This study focuses on the promotion and use of tourist-oriented built-for-disasterpurpose mobile applications. The investigation relies on two trends that are characterizing modern societies. The first trend refers to the fact that recently, rapidly, and worldwide, the number of mobile applications users increased. The second trend refers to the fact that, worldwide, international tourism demand highly increased from the beginning of the 1960s to the mid-years of 2010s. These travelers are also users of mobile applications, and they use apps for several reasons, including those related to security/emergency issues. International travelers may need information such as risks at the destination, warnings, shelter locator services, emergency routes information, and traveler telephone hotline to be used in the case of earthquakes, tsunamis, infectious diseases, or other disasters. We considered the role of built-for-disasterpurpose mobile applications as a tool to provide information to tourists, increase their risk-awareness, and improve their disaster-preparedness. Previous studies suggest that these tools may have a high impact in that sense. However, the number of users informed about these applications tends to be very low. We systematically reviewed interdisciplinary academic contributions to analyze research on apps-users’ intention to adopt mobile applications. Findings suggest opportunities for future tourism-oriented studies aiming at increasing the number of users of built-for-disasters mobile applications. In particular, we provide a research agenda taking into consideration the geographical spread of the studies, the used research techniques, and the adopted theories.

Implementation outcome instruments for use in physical healthcare settings: a systematic review

BACKGROUND

Implementation research aims to facilitate the timely and routine implementation and sustainment of evidence-based interventions and services. A glaring gap in this endeavour is the capability of researchers, healthcare practitioners and managers to quantitatively evaluate implementation efforts using psychometrically sound instruments. To encourage and support the use of precise and accurate implementation outcome measures, this systematic review aimed to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings.

METHOD

The following data sources were searched from inception to March 2019, with no language restrictions: MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL and the Cochrane library. Studies that evaluated the measurement properties of implementation outcome instruments in physical healthcare settings were eligible for inclusion. Proctor et al.'s taxonomy of implementation outcomes was used to guide the inclusion of implementation outcomes: acceptability, appropriateness, feasibility, adoption, penetration, implementation cost and sustainability. Methodological quality of the included studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Psychometric quality of the included instruments was assessed using the Contemporary Psychometrics checklist (ConPsy). Usability was determined by number of items per instrument.

RESULTS

Fifty-eight publications reporting on the measurement properties of 55 implementation outcome instruments (65 scales) were identified. The majority of instruments assessed acceptability (n = 33), followed by appropriateness (n = 7), adoption (n = 4), feasibility (n = 4), penetration (n = 4) and sustainability (n = 3) of evidence-based practice. The methodological quality of individual scales was low, with few studies rated as 'excellent' for reliability (6/62) and validity (7/63), and both studies that assessed responsiveness rated as 'poor' (2/2). The psychometric quality of the scales was also low, with 12/65 scales scoring 7 or more out of 22, indicating greater psychometric strength. Six scales (6/65) rated as 'excellent' for usability.

CONCLUSION

Investigators assessing implementation outcomes quantitatively should select instruments based on their methodological and psychometric quality to promote consistent and comparable implementation evaluations. Rather than developing ad hoc instruments, we encourage further psychometric testing of instruments with promising methodological and psychometric evidence.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2017 CRD42017065348.