These results are similar to in-person DSME in medically underserved patients, showing that well-designed HIT DSME has the potential to increase access and improve outcomes for this vulnerable group.
Objective
To outline new design directions for informatics solutions that facilitate personal discovery with self-monitoring data. We investigate this question in the context of chronic disease self-management with the focus on type 2 diabetes.
Materials and methods
We conducted an observational qualitative study of discovery with personal data among adults attending a diabetes self-management education (DSME) program that utilized a discovery-based curriculum. The study included observations of class sessions, and interviews and focus groups with the educator and attendees of the program (n = 14).
Results
The main discovery in diabetes self-management evolved around discovering patterns of association between characteristics of individuals’ activities and changes in their blood glucose levels that the participants referred to as “cause and effect”. This discovery empowered individuals to actively engage in self-management and provided a desired flexibility in selection of personalized self-management strategies. We show that discovery of cause and effect involves four essential phases: (1) feature selection, (2) hypothesis generation, (3) feature evaluation, and (4) goal specification. Further, we identify opportunities to support discovery at each stage with informatics and data visualization solutions by providing assistance with: (1) active manipulation of collected data (e.g., grouping, filtering and side-by-side inspection), (2) hypotheses formulation (e.g., using natural language statements or constructing visual queries), (3) inference evaluation (e.g., through aggregation and visual comparison, and statistical analysis of associations), and (4) translation of discoveries into actionable goals (e.g., tailored selection from computable knowledge sources of effective diabetes self-management behaviors).
Discussion
The study suggests that discovery of cause and effect in diabetes can be a powerful approach to helping individuals to improve their self-management strategies, and that self-monitoring data can serve as a driving engine for personal discovery that may lead to sustainable behavior changes.
Conclusions
Enabling personal discovery is a promising new approach to enhancing chronic disease self-management with informatics interventions.
Purpose-The purpose of this study is to describe the characteristics and technology training needs of underserved adults with type 2 diabetes mellitus (T2DM) who participated in a health information technology (HIT) diabetes self-management education (DSME) intervention.Methods-The baseline physiological, psychosocial and technology use characteristics for 220 adults with poorly controlled T2DM were evaluated. Intervention participants received a one-time intervention training, which included basic technology help, introduction to the Mobile Diabetes Detective (MoDD) website and text message features, and account activation that included subject specific tailoring. Four additional on-site sessions for participants' needing computer or Internet access or technology support were made available based on need. Data regarding on-site visits for usual care were collected. Data were analyzed using descriptive statistics and bivariate analysis.Results-The participants were predominately Hispanic and female with a baseline mean A1C of 10% (86 mmol/mol). Only half of participants regularly used computers or text messages in daily life. The average introductory MoDD training session lasted 73.6 minutes. Following training, approximately one third (35%) of intervention participants returned for basic and MoDDspecific technology assistance at their FQHC. The most frequently reported duration for the extra training sessions was 30-45 minutes.Corresponding author: Elizabeth M Heitkemper, MSN, RN, Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032, Fax: 212-305-6937, Phone: 206-696-1205.columbia.edu. Compliance with ethical standards: All procedures performed with human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study prior to participation.
Clinical trial information:Clinical trial identification number: NCT02021591; Website URL: https://clinicaltrials.gov/ct2/show/ NCT02021591
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Author ManuscriptConclusions-Training and support needs were greater than anticipated. Diabetes educators should assess technology abilities prior to implementing HIT DSME in underserved adults. Future research must invest resources in technology access, anticipate subject training and develop new training approaches to ensure HIT DSME use and engagement.Optimizing health-related behaviors is a fundamental aspect of effective management for people living with type 2 diabetes mellitus (T2DM). 1 To acquire the knowledge and skills needed to facilitate lifestyle changes and confidently make daily self-management decisions, formal diabetes self-management education (DSME) is recommended at diagnosis and as needed thereafter. 2,3 Unfortunately, participation in DSME remains low, 4,5 particularly for the me...
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