Best Practices for Developing a Diabetes mHealth App

The widespread use of smartphones in the United States has led to a surge in mHealth apps designed to support people with various health issues. Yet the effectiveness and long-term impacts of these apps still need to be determined. This article presents a case study of the development of MyT1DHero, an mHealth app for people with type 1 diabetes, to identify best practices for app development. We propose four essential best practices based on the insights gained from this case study: incorporating theoretical frameworks, prioritizing user feedback, engaging key stakeholders, and establishing a robust data-collection foundation. These findings have practical implications for researchers and developers seeking to create effective mHealth interventions. Furthermore, we suggest future research directions to advance the development and implementation of innovative health technologies.

Young adults' adoption and use of mental health apps: efficient, effective, but no replacement for in-person care

Objective: Millions of people use mobile phone or computer-based applications-apps-to maintain their mental health and connect with treatment providers through text- and video-based chat functions. The present study sought to understand young adults' motivations for adopting this technology using the unified theory of acceptance and use of technology (UTAUT), how they use mental health apps, and the gratifications they receive from using mental health apps. Participants: One hundred-eighteen mental health app users responded to an online survey. Methods: A survey was conducted with students at a Midwestern university. The survey included questions regarding current mental health services, mental health apps used, UTAUT and gratifications survey items. Results: A regression analysis suggested users' performance expectancies, effort expectancies, and facilitating conditions predicted the adoption of mental health apps. Young adults most often use mental health apps for stress relief. While they preferred in-person treatment, users described mental health apps as efficient and helpful. Conclusion: Overall, the results reinforce the sense of optimism for the future of mental health apps, suggesting the potential for apps to supplement-but not necessarily replace-in-person care.

The effect of an mHealth intervention for adolescents with Type 1 diabetes and their parents

BACKGROUND

Past research has demonstrated that adolescents with Type 1 diabetes (T1D) typically have a decline in health outcomes as they begin to assume more self-management activities. Mobile app interventions have been suggested as one possible way to improve this behavior.

PURPOSE

The primary aim of this study was to address declines in health outcomes by pilot testing the satisfaction, use and feasibility of an app-based family communication intervention aimed to assist in adolescent self-management of T1D.

METHODS

Thirty-three adolescent-parent pairs were enrolled in and completed the 12-week pilot study. Participants were randomized 2:1 to intervention (app use) or control group. Pre/post quantitative and qualitative data were collected, including HbA1c and surveys. Paired-sample t-tests and ANOVA statistics were conducted.

RESULTS

The parents and adolescents reported high satisfaction with the app, and that it was easy to use. Results showed HbA1c stability in the intervention group and significant worsening in the control group. There were also significant improvements in adherence to diabetes management and quality of life for the parents in the intervention group. The adolescents did not show any improvement in quality-of-life measures.

CONCLUSION

This study suggests that the app intervention is acceptable, shows promise for improving health outcomes for adolescents with T1D, and may improve family communication. The public health implications of this work are that app interventions have a potential role in positively influencing chronic disease outcomes. Additional research with a more extensive and diverse sample is needed to determine generalizability.

Assessing College Students' Perceptions of and Intentions to Use a Mobile App for Mental Health

Background: College students face high rates of depression, anxiety, and suicide. Therefore, the focus of this study was to examine college students' intention to use a mental health app provided by the university, called MySSP, through use of the unified theory of acceptance and use of technology (UTAUT). Materials and Methods: An online survey was developed based on responses to focus groups previously conducted by the authors regarding MySSP. A multiple linear regression was conducted to test the associations between the UTAUT variables and behavioral intention. In addition, moderation analyses were conducted to explore the effects of depression, anxiety, stigma, and quality of life as moderators. Results: Results suggest that performance expectancy (PE) (t = 3.088, p = 0.003) and social influence (SI) (t = -2.163, p = 0.03) were the only significant predictors of behavioral intention. The only significant moderator was stigma in the relationship between effort expectancy and behavioral intention (b = -1.6081, standard error (SE) = 0.7454, confidence interval (CI): -3.0691 to -0.1472) as well as facilitating conditions (FCs) and behavioral intention (b = -2.2292, SE = 0.8580, CI: -3.9110 to -0.5475). Conclusions: This study provides an initial exploration of college students' intentions to use MySSP. The results suggest that successful interventions include features related to PE (usefulness) and SI (norms), which should be focused on when developing and testing apps for mental health. Additionally, the stigma of mental health has significant negative impacts on the adoption of mental health apps and should be considered in implementation of mental health interventions geared toward college students.

Informed Consent for Online Research-Is Anybody Reading?: Assessing Comprehension and Individual Differences in Readings of Digital Consent Forms

Informed consent is an important part of the research process; however, some participants either do not read or skim the consent form. When participants do not read or comprehend informed consent, then they may not understand the potential benefits, risks, or details of the study before participating. This study used previous research to develop experimentally manipulated online consent forms utilizing various presentations of the consent form and interactive elements. Participants (n = 576) were randomly exposed to one of six form variations. Results found that the highly interactive condition was significantly better for comprehension than any of the other conditions. The highly interactive condition also performed better for readability, though not significantly. Further research should explore the effects of interactive elements to combat habituation and to engage participants with the parts of the consent form unique to the study.

Barriers for Telemedicine Use Among Nonusers at the Beginning of the Pandemic

Telemedicine has garnered considerably more attention during the COVID-19 pandemic than in any time previously. However, before the beginning of the pandemic, many individuals had not accessed care in this manner. The purpose of this study was to understand the central reasons that individuals had not used telemedicine before the pandemic. Therefore, we conducted a convenience sample survey in March-April 2020, and 539 participants living in the United States answered questions about exploring their reasons for not having used telemedicine. Descriptive statistics and correlations were conducted to analyze the data. Two themes emerged from these data, including the importance of the patient-provider relationship and that access to technology was not the issue for this particular population. Although technology was not a barrier, many, specifically older participants, had concerns over privacy and security. As the world gains some control over the COVID-19 pandemic and medical appointments begin to return to a new normal, the implication for the continued use of telemedicine is still important to address as this will become a standard of care.

Evaluating the most popular diabetes websites in the USA: a content analysis

Over 1.5 million Americans are diagnosed with diabetes every year, and the majority of them go online to learn about their condition. Unfortunately, the online diabetes landscape is crowded, and the quality of website content is unknown-guidance for patients and healthcare providers regarding online diabetes information is needed. To address this, nine of the top diabetes websites in the USA were identified through a comprehensive, multiple-query search and a content analysis was conducted. Two coders, with high inter-coder reliability, evaluated these websites on six factors: (i) Design; (ii) Credibility; (iii) Accessibility; (iv) Literacy; (v) Engagement; and (vi) Diabetes Content. The analysis revealed that the websites presented most of the assessed design features. Few of the sites scored well on the credibility assessment, while the majority of sites did not note an author, editor or reviewer. With regard to accessibility, less than half of the items we assessed were met. Furthermore, the websites possessed wide variability in literacy, with an average readability grade level of 8.8. Most of the websites fared well in engagement, demonstrating multiple avenues to interact with the organization. All of the websites provided basic information regarding diabetes, but many did not include information for caregivers, providers or insurance information. In conclusion, patients and their family members will continue to seek online information about diabetes, its effects and treatment options. Therefore, this multiple-metric evaluation provides essential information for these individuals, and healthcare providers, who can now give better informed website recommendations to their patients and families.

Perceptions and Attitudes Toward a Mobile Phone App for Mental Health for College Students: Qualitative Focus Group Study

BACKGROUND

Many college students who have mental health issues do not receive professional care for various reasons. Students who do not receive help often have both short- and long-term adverse health outcomes. Mobile apps for mental health services such as MySSP, a service provided to college students through their university, may help eliminate barriers to seeking mental health care and result in more positive outcomes for college students.

OBJECTIVE

This qualitative study aims to better understand college students' perceptions and attitudes toward the adoption and use of a mobile phone app for mental health, MySSP, using the technology acceptance model (TAM).

METHODS

A series of nine focus groups were conducted with college students (N=30) between February and May 2019 at a large, public Midwestern university. The moderator's guide was based on the TAM, and focus group sessions primarily focused on the use and knowledge of apps for mental health, specifically, MySSP. The focus group transcriptions were hand-coded to develop a set of themes that encompassed students' perceptions and attitudes toward MySSP.

RESULTS

The analysis of the focus groups suggested the following themes: (1) existing awareness of the app, (2) perceived usefulness, (3) perceived ease of use, (4) attitudes toward apps for mental health and MySSP, and (5) social influence.

CONCLUSIONS

The results of this study provide deeper insights into the perceptions of a mobile app for mental health among college students. Future research should explore the specific contexts in which an app for mental health will be most effective for college students.

Patients Perceptions of Telemedicine Visits Before and After the Coronavirus Disease 2019 Pandemic

Purpose: This study sought to determine whether the necessitated use of telemedicine due to coronavirus disease 2019, and limited choice of both the provider and patient, impacts the perceptions of telemedicine by patients who experienced telemedicine prepandemic and those who first experienced telemedicine during the pandemic. Methodology: Participants for this survey were a convenience sample. An invitation to participate was shared through social media and e-mail listservs. To participate, individuals had to be at least 18 years of age and gave consent to their data being used. The online survey took ∼10-15 min to complete, the survey was available from March 31 to April 20, 2020. Results: Two hundred sixty-four (n = 264, 60.8%) individuals had used telemedicine on or before December 2019 and 170 (39.2%) individuals used telemedicine for the first time January 2020 or later. There were no significant differences in demographics between groups, except that new users were more likely to have a primary care physician [F(407) = 13.51, p < 0.001]. Satisfaction of telemedicine was measured using a 10-item scale, demonstrating that all participants were overall satisfied with their telemedicine experience(s), (mean = 1.67, standard deviation = 0.61). Broadly, the differences in perceptions between the groups included the reasons for using telemedicine, perceptions of quality of in-person care, continuity of care, and a technical issue. Conclusions: Overall, patients are satisfied using telemedicine, however, for new users, both providers and patients, some acclimation needs to occur.

Using User-Feedback to Develop a Website: MyT1DHope, for Parents of Children with T1D

Effectively caring for a child with type-1 diabetes (T1D) can be extremely demanding and stressful for the entire family. The difficulties of caring for a child with T1D impact the psychological and physical well-being of the parents. Interventions aimed at reducing stress and increasing coping may improve parental outcomes. This project sought to develop a resource to be used as a preliminary intervention step for these parents. This research was conducted in two parts. Part 1 includes three stages of formative evaluation, including a focus group, interviews, and a survey with parents to examine the current landscape of diabetes websites as a resource. Using data from Part 1, Part 2 of the study included the identification of a theory to guide the design of a website, the development of the website, and an 8-week pilot study of the website with parents with a child with T1D. Significant improvements were found in diabetes knowledge and caregivers' satisfaction of life. No changes were found in social support, self-efficacy, or quality of life. Overall, the data show that the parents were generally satisfied with the website. Through this work, researchers were able to develop a deeper understanding of the needs of parents caring for a child with T1D to develop the initial component of a larger intervention.

Patient-Centered Methods for Designing and Developing Health Information Communication Technologies: A Systematic Review

Background: Chronic disease management and maintaining healthy behaviors to prevent disease are important lifelong considerations. Adherence to prescribed management and behaviors often falls short of physician recommendations, which can result in negative health outcomes. Information communication technologies (ICTs) offer an approach to combat this issue. However, uptake and sustainability of ICTs have mixed results. One reason could be that technologies are often created without an understanding of the complexities of patient needs. Therefore, the intent of this study is to explore the current landscape of patient-centered design and development of health ICTs through a systematic review. Materials and Methods: Systematic literature searches were conducted in the databases EBSCO, PubMed, and Web of Science between October 2016 and February 2017. Each paper was critically evaluated for each data extraction classification, and was categorized based on the chronic disease or health focus, method of patient-centered design, resulting themes, and use of theory. Results: The study search resulted in 3,748 articles total. After duplicates and articles not meeting criteria were removed, 57 articles were selected for assessment. Four main themes emerged: participant experience, technological requirements, behavioral and knowledge components, and social components. Conclusions: Adhering to chronic disease management and healthy behaviors are both crucial to attain positive health outcomes. ICTs can play an interesting role in aiding disease management and healthy behavior promotion, but involving end-users and applying a theoretical foundation in the design and development of these technologies should be considered.

Using an mHealth App to Transition Care of Type 1 Diabetes from Parents to Teens: Protocol for a Pilot Study

BACKGROUND

Type 1 diabetes mellitus (T1DM) afflicts approximately 154,000 people under the age of 20 in the United States. Most people with T1DM are diagnosed at a young age, and parents have to take on the responsibility of T1DM management. Eventually, the child must begin to transition to self-management. Adolescents often struggle to take on responsibility for all the necessary tasks to successfully self-manage their T1DM. In fact, approximately three-quarters of adolescents are not achieving American Diabetes Association-recommended glycated hemoglobin (HbA_1c) targets. This lack of adherence can lead to negative health outcomes.

OBJECTIVE

The goals of this interdisciplinary proposal are as follows: (1) to develop a unique and theory-driven technology using a mobile phone app to promote self-management behaviors for adolescents aged 10-15 years with T1DM and their parents and (2) to explore the feasibility and impact of the self-management mobile app.

METHODS

This study has two phases: app development and pilot testing. In the app development phase, the app will be conceptualized and a prototype will be tested. In Phase 2, the mobile app will undergo pilot testing to determine its feasibility and impact on diabetes self-management.

RESULTS

The pilot test was launched in September 2017. Data collection for the final pilot test is underway, and results are forthcoming.

CONCLUSIONS

Adolescents with T1DM and their parents can have a difficult time managing the transition of diabetes care. It is hoped that this app can help. The focus groups and prototype testing have indicated promising outcomes of app use.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 (Archived by WebCite at http://www.webcitation.org/72tHXTE2Z).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/10803.

Serious Games for Children with Chronic Diseases: A Systematic Review

OBJECTIVE

The purpose of this study was to systematically review the literature to assess if serious games impact health outcomes for children less than 18 years of age with chronic diseases. Additionally, the impact of self-efficacy, adherence, knowledge, use of theory, parent involvement, and study quality was also examined.

MATERIALS AND METHODS

Searches were conducted in databases EBSCO, PubMed, and Web of Science between June and August 2016. Randomized controlled trials using a serious game as an intervention, for participants under 18 years of age, to improve their chronic disease were included.

RESULTS

Data were extracted by two independent researchers, including: Title, author, and publication year; chronic disease; game description; number and age of participants; intervention duration; significant findings; parent involvement; theory; and study quality. Any disagreements were tackled and consensus was achieved. Eighteen studies were included in the review. The areas of health addressed included cerebral palsy, asthma, diabetes, developmental coordination disorders, and vision disorders. In these articles, eight health outcome variables were measured, including: lung function, glycemic control, hospital visits, motor proficiency, and visual acuity. Psychosocial variables that were assessed included self-efficacy and knowledge. Two articles included parents in the intervention, and three articles used theory. Six studies had significant health outcome finding, and four studies found a significant change in one psychosocial variable.

CONCLUSION

This review demonstrates the potential for games to improve health outcomes of young individuals. However, the mixed results suggest that more serious game interventions need to be better designed and rigorously tested to support their impact on improving health outcomes.

The design and development of MyT1DHero: A mobile app for adolescents with type 1 diabetes and their parents

INTRODUCTION

Type 1 diabetes impacts approximately 1.25 m Americans, many of them young children. As a child grows, there is a transition towards independence and they must learn to manage their diabetes independently. The objective of this study was to design, develop and conduct a prototype test to assess the satisfaction and feasibility of a mobile app for adolescents with type 1 diabetes and their parents to aid in this transition.

METHODS

Ten parent/adolescent groups used MyT1DHero for four weeks. They were given a pre-test/post-test survey regarding family conflict with three tasks of diabetes management and the general tone of family communication. At post-test they were asked questions regarding their satisfaction and perception of ease of use of the app. They also participated in short interviews regarding the app. Additionally, we used server data to examine actual app usage.

RESULTS

The parents' perceptions of conflict around the results of the blood sugar tests increased ( t(9) = 2.71, p = .02) as did perceptions of conflict around logging the blood sugar results ( t(9) = 3.67, p = .005). The adolescents perceived increased conflict surrounding the results around logging the blood sugars results ( t(9) = 3.09, p = .01).There was no change in the tone of general family communication. During the prototype testing, we discovered that the app crashed repeatedly and several of the functions were not working properly. In the interview data, three main themes emerged, app-crashing issues, problems with notifications and positive feedback.

DISCUSSION

Through this process, all of the reported issues were corrected and new features were planned for subsequent versions. A smartphone application has the potential to be a novel intervention for engaging adolescents and their parents in positive communication to support type 1 diabetes management.

Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents

Background

Type 1 diabetes (T1D) afflicts approximately 154,000 people under 20 years of age. Three-quarters of adolescents are not achieving glycosylated hemoglobin (HbA1c) targets, which leads to negative health outcomes. Mobile health (mHealth), the use of technology in health, has been used successfully to improve health in many chronic conditions, including diabetes.

Objective

The purpose of this study was to use patient-centered research methods to inform and improve the design and functionality of our T1D app, MyT1DHero, and to provide insight for others who are designing a health app for adolescents and parents.

Methods

This study included data from focus groups with participants recruited from the Juvenile Diabetes Research Foundation (JDRF) southeast Michigan’s family network. All data collected during the sessions were audio-recorded, transcribed, and coded.

Results

Four key themes were identified: (1) diabetes is unpredictable, (2) negative and frustrated communication, (3) motivations to use an app, and (4) feedback specific to our app.

Conclusions

A patient-centered approach was used to assist in the development of an app for adolescents with T1D. Participants were satisfied with overall app design; customization, interactivity, and tangible rewards were identified as being necessary for continued use. Participants believed the app would help improve the communication between parents and adolescents. Many apps developed in the health context have not used a patient-centered design method or have seen vast improvements in health. This paper offers suggestions to others seeking to develop apps for adolescents and their parents.

Visioning technology for the future of telehealth

By its very nature, telehealth relies on technology. Throughout history, as new technologies emerged and afforded people the ability to send information across distances, it was not long before this capability was applied to the most basic need of all: maintaining health. While much of the early work in telehealth was driven by technology (e.g., making opportunistic use of the systems and devices that were available at the time), recent trends are beginning to push the demand for and the development of new technologies specific to the individual needs of telehealth applications. The future of telehealth will benefit greatly from this technology innovation, in particular, in areas such as home telehealth and remote monitoring, e-health and patient portal applications, personal health records, interactive Internet technologies, and robotics. Telehealth, while not a panacea for all of the challenges facing modern healthcare systems, has a substantial and ever-expanding potential to revolutionize the ways in which people receive medical care while offering the possibility to contain costs, manage chronic diseases, and prevent secondary complications. By demanding innovative solutions and speaking out in support of the field, the telehealth community can and should be leading the charge for greater attention to human factors in technology development, interoperable medical records, staff training and competencies, standards and guidelines, and support for expanded telehealth coverage at the national, state, and local levels.