Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation

Background

As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis.

Objective

This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers.

Methods

The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire.

Results

The developed mobile app includes modules that support several features. A person’s data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician’s portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app.

Conclusions

Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up.

The design and evaluation of an antimicrobial resistance surveillance system for neonatal intensive care units in Iran

INTRODUCTION

Neonatal intensive care units (NICUs) have complex patients in terms of their diagnoses and required treatments. Antimicrobial treatment is a common therapy for patients in NICUs. To solve problems pertaining to empirical therapy, antimicrobial stewardship programs have recently been introduced. Despite the success of these programs in terms of data collection, there is still inefficiency in terms of analyzing and reporting the data. Thus, to successfully implement these stewardship programs, the design of antimicrobial resistance (AMR) surveillance systems is recommended as a first step. As a result, this study aimed to design an AMR surveillance system for use in the NICUs in northwestern Iranian hospitals to cover these information gaps.

METHODS

The recommended system is compatible with the World Health Organization (WHO) guidelines. The business intelligence (BI) requirements were extracted in an interview with a product owner (PO) using a valid and reliable checklist. Following this, an AMR surveillance system was designed and evaluated in relation to user experiences via a user experience questionnaire (UEQ). Finally, an association analysis was performed on the database, and the results were reported by identifying the important multidrug resistances in the database.

RESULTS

A customized software development methodology was proposed. The three major modules of the AMR surveillance are the data registry, dashboard, and decision support modules. The data registry module was implemented based on a three-tier architecture, and the Clinical Decision Support System (CDSS) and dashboard modules were designed based on the BI requirements of the Scrum product owner (PO). The mean values of UEQ measures were in a good range. This measures showed the suitable usability of the AMR surveillance system.

CONCLUSION

Applying efficient software development methodologies allows for the systems' compatibility with users' opinions and requirements. In addition, the construction of interdisciplinary communication models for research and software engineering allows for research and development concepts to be used in operational environments.

A national framework for an antimicrobial resistance surveillance system within Iranian healthcare facilities: Towards a global surveillance system

OBJECTIVES

The threat of antimicrobial resistance (AMR) is growing rapidly, perhaps more dramatically in developing countries. A demand to monitor, surveil and predict AMR has prompted the design and implementation of AMR surveillance systems (AMRSSs) at all geographic levels, especially in the national context. This study reviewed AMRSSs in leading countries and organisations in order to customise a comprehensive framework for a national system in Iran.

METHODS

The research was conducted in two phases: a review of the literature and comparative analysis; and a knowledge, attitude and practice study. In the first phase, the AMRSSs of pioneering organisations and countries were reviewed by examining related documents. In the second phase, important components for the Iranian national system were determined on the basis of the World Health Organization's Global Antimicrobial Resistance Surveillance System (WHO GLASS).

RESULTS

This study determined the surveillance methods, priority specimens and pathogens, testing methods, reporting protocols and scheduling, recommended data sets, and tools and information flow necessary for the Iranian system. On this basis, a national framework was developed using the class and activity diagrams in Unified Modelling Language. A context diagram was also designed on the basis of a generic biosurveillance architecture.

CONCLUSIONS

The design and implementation of a national AMRSS for Iranian healthcare facilities is critically required because of irrational antimicrobial use in Iran and insufficient data regarding its consequences.