Effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life and clinical outcomes in patients with type 2 diabetes: A systematic review and meta-analysis

Aminuddin, Haziqah Binte; Jiao, Nana; Jiang, Ying; Hong, Jingfang; Wang, Wenru

doi:10.1016/j.ijnurstu.2019.02.003

Cited by 97 publications

(99 citation statements)

References 65 publications

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“…Making time for and having access to adequate face-to-face education and support are often challenging for people with newly diagnosed T2D [ 4 , 6 , 7 ]. Our data support previous research demonstrating that providing diabetes education and self-management support via an app could be a feasible and acceptable complement to clinical care [ 8 - 10 , 14 ]. Equally important is the suggestion that this support may be more successful in engaging people when accessed immediately following diagnosis [ 37 , 49 , 50 ].…”

Section: Discussionsupporting

confidence: 89%

User Experiences With a Type 2 Diabetes Coaching App: Qualitative Study

et al. 2020

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Background Diabetes self-management apps have the potential to improve self-management in people with type 2 diabetes (T2D). Although efficacy trials provide evidence of health benefits, premature disengagement from apps is common. Therefore, it is important to understand the factors that influence engagement in real-world settings. Objective This study aims to explore users’ real-world experiences with the My Diabetes Coach (MDC) self-management app. Methods We conducted telephone-based interviews with participants who had accessed the MDC self-management app via their smartphone for up to 12 months. Interviews focused on user characteristics; the context within which the app was used; barriers and facilitators of app use; and the design, content, and delivery of support within the app. Results A total of 19 adults with T2D (8/19, 42% women; mean age 60, SD 14 years) were interviewed. Of the 19 interviewees, 8 (42%) had T2D for <5 years, 42% (n=8) had T2D for 5-10 years, and 16% (n=3) had T2D for >10 years. In total, 2 themes were constructed from interview data: (1) the moderating effect of diabetes self-management styles on needs, preferences, and expectations and (2) factors influencing users’ engagement with the app: one size does not fit all. Conclusions User characteristics, the context of use, and features of the app interact and influence engagement. Promoting engagement is vital if diabetes self-management apps are to become a useful complement to clinical care in supporting optimal self-management. Trial Registration Australia New Zealand Clinical Trials Registry CTRN126140012296; URL https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366925&isReview=true

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Section: Discussionsupporting

confidence: 89%

User Experiences With a Type 2 Diabetes Coaching App: Qualitative Study

et al. 2020

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“…Despite the growing number of studies using mobile technologies for diabetes management [ 10 , 11 , 15 ], the effectiveness of introducing apps to people with T2DM to support their self-management at large scale remains uncertain given the generally poor quality of apps [ 12 , 13 , 32 ], unmet consumer needs [ 14 ], and studies lacking robust designs with long-term evaluations [ 10 , 15 ]. The MDC program is highly innovative with its conversational element.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the increasing use of mobile apps for health purposes, reviews have found that existing digital health solutions are not generally able to meet the needs of people with diabetes, and more evidence is required before their wider scale-up [ 10 , 11 ]. Most commercially available apps employ limited use of behavior change techniques and inadequate features, other than self-monitoring [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, people with diabetes expect apps to be engaging; incorporating multiple functions; and covering a broad range of content, including psychological and emotional support [ 14 ]. Although some recent systematic reviews and meta-analyses have indicated a modest effect for app-based interventions to support diabetes self-management [ 10 , 11 , 15 ], there still remains a great deal of uncertainty about their feasibility, acceptability, and effectiveness in the real world [ 10 , 15 - 17 ].…”

Section: Introductionmentioning

confidence: 99%

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My Diabetes Coach, a Mobile App–Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness-Implementation Trial

Gong¹,

Baptista²,

Russell³

et al. 2020

J Med Internet Res

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Background Delivering self-management support to people with type 2 diabetes mellitus is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health. Objective This study aims to evaluate the adoption, use, and effectiveness of the My Diabetes Coach (MDC) program, an app-based interactive embodied conversational agent, Laura, designed to support diabetes self-management in the home setting over 12 months. Methods This randomized controlled trial evaluated both the implementation and effectiveness of the MDC program. Adults with type 2 diabetes in Australia were recruited and randomized to the intervention arm (MDC) or the control arm (usual care). Program use was tracked over 12 months. Coprimary outcomes included changes in glycated hemoglobin (HbA1c) and health-related quality of life (HRQoL). Data were assessed at baseline and at 6 and 12 months, and analyzed using linear mixed-effects regression models. Results A total of 187 adults with type 2 diabetes (mean 57 years, SD 10 years; 41.7% women) were recruited and randomly allocated to the intervention (n=93) and control (n=94) arms. MDC program users (92/93 participants) completed 1942 chats with Laura, averaging 243 min (SD 212) per person over 12 months. Compared with baseline, the mean estimated HbA1c decreased in both arms at 12 months (intervention: 0.33% and control: 0.20%), but the net differences between the two arms in change of HbA1c (−0.04%, 95% CI −0.45 to 0.36; P=.83) was not statistically significant. At 12 months, HRQoL utility scores improved in the intervention arm, compared with the control arm (between-arm difference: 0.04, 95% CI 0.00 to 0.07; P=.04). Conclusions The MDC program was successfully adopted and used by individuals with type 2 diabetes and significantly improved the users’ HRQoL. These findings suggest the potential for wider implementation of technology-enabled conversation-based programs for supporting diabetes self-management. Future studies should focus on strategies to maintain program usage and HbA1c improvement. Trial Registration Australia New Zealand Clinical Trials Registry (ACTRN) 12614001229662; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001229662

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“…We conducted a systematic review to acquire evidence to develop the NSSMP programme (Aminuddin, Jiao, Jiang, Hong, & Wang, 2019). The systematic review aimed to establish the effectiveness of smartphone‐based self‐management interventions on clinical outcomes, health‐related quality of life, self‐care activities, and the self‐efficacy of type 2 DM patients.…”

Section: The Studymentioning

confidence: 99%

The development and testing of a nurse‐led smartphone‐based self‐management programme for diabetes patients with poor glycaemic control

Wang

Cheng

Leong

et al. 2020

Journal of Advanced Nursing

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Aims: To describe a systematic process for the development of a nurse-led smartphone-based self-management programme for type 2 diabetes patients with poor glycaemic control in Singapore. Methods: A three-step process involving the application of a theoretical framework, evidence from literature, content validity, and pilot tests were conducted for the content and technical development of the programme. Content experts and lay patients evaluated the appropriateness, relevance, and comprehensibility of the newly developed Care4Diabetes application. A pilot randomized controlled trial was conducted with 40 patients recruited in Singapore. Twenty patients each were randomly allocated to the control and intervention groups. The study outcomes were collected at baseline and at 3 months thereafter. Results: The nurse-led smartphone-based self-management programme was developed with integration of the Care4Diabetes application and the web-portal system. The pilot results indicated that the effects of this smartphone-based programme on patient's health-related outcomes were comparable with those of the currently available nurse-led diabetes service. Conclusion: The smartphone-based self-management intervention was deemed effective, yet full-scale randomized controlled trials are still ongoing and the results of these may provide strong evidence of the effectiveness of such an approach in improving patient care. Impact: The uniqueness of this study lies in the integrated system used, which offers a clinical platform for diabetes nurses to provide personalized coaching and care to patients remotely, while monitoring patients' progress closely. By adopting such an approach, it would free up more time for nurses to cater to patients who are more critically in need of their direct attention.

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Effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life and clinical outcomes in patients with type 2 diabetes: A systematic review and meta-analysis

Cited by 97 publications

References 65 publications

User Experiences With a Type 2 Diabetes Coaching App: Qualitative Study

User Experiences With a Type 2 Diabetes Coaching App: Qualitative Study

My Diabetes Coach, a Mobile App–Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness-Implementation Trial

The development and testing of a nurse‐led smartphone‐based self‐management programme for diabetes patients with poor glycaemic control

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