App Design Features Important for Diabetes Self-management as Determined by the Self-Determination Theory on Motivation: Content Analysis of Survey Responses From Adults Requiring Insulin Therapy

Abstract

Background Using a diabetes app can improve glycemic control; however, the use of diabetes apps is low, possibly due to design issues that affect patient motivation. Objective This study aimed to describes how adults with diabetes requiring insulin perceive diabetes apps based on 3 key psychological needs (competence, autonomy, and connectivity) described by the Self-Determination Theory (SDT) on motivation. Methods This was a qualitative analysis of data collected during a crossover randomized laboratory trial (N=92) testing 2 diabetes apps. Data sources included (1) observations during app testing and (2) survey responses on desired app features. Guided by the SDT, coding categories included app functions that could address psychological needs for motivation in self-management: competence, autonomy, and connectivity. Results Patients described design features that addressed needs for competence, autonomy, and connectivity. To promote competence, electronic data recording and analysis should help patients track and understand blood glucose (BG) results necessary for planning behavior changes. To promote autonomy, BG trend analysis should empower patients to set safe and practical personalized behavioral goals based on time and the day of the week. To promote connectivity, app email or messaging function could share data reports and communicate with others on self-management advice. Additional themes that emerged are the top general app designs to promote positive user experience: patient-friendly; automatic features of data upload; voice recognition to eliminate typing data; alert or reminder on self-management activities; and app interactivity of a sound, message, or emoji change in response to keeping or not keeping BG in the target range. Conclusions The application of the SDT was useful in identifying motivational app designs that address the psychological needs of competence, autonomy, and connectivity. User-centered design concepts, such as being patient-friendly, differ from the SDT because patients need a positive user experience (ie, a technology need). Patients want engaging diabetes apps that go beyond data input and output. Apps should be easy to use, provide personalized analysis reports, be interactive to affirm positive behaviors, facilitate data sharing, and support patient-clinician communication.

Designing a Collaborative Patient-Centered Digital Health Platform for Pediatric Diabetes Care in British Columbia: Formative Needs Assessment by Caregivers of Children and Youths Living With Type 1 Diabetes and Health Care Providers

“…Adult patients also desire mental health apps geared toward social support and well-being to be a part of diabetes digital apps [9,19]. In this study, insufficient access to mental health support was identified as one of the key challenges by caregivers and patients cared for by HCPs.…”

“…Most diabetes health apps only seem to be designed for patients [3] and integrating preferences in the design of the diabetes digital apps from both patients and HCPs is limited [3,[9][10][11]14,19]. To successfully implement digital solutions in health care, it is essential to involve end users in the design and development as early as possible.…”

“…User engagement in evaluating diabetes digital apps is low, and most apps have involved patients only after the apps have been created [6]. Some apps have studied the needs and key features desired by patients with diabetes in the design of digital health platforms [9][10][11]. Adults living with diabetes prioritize access to their diabetes data and communication with the health care team as key functions in diabetes apps [9,11].…”

“…Some apps have studied the needs and key features desired by patients with diabetes in the design of digital health platforms [9][10][11]. Adults living with diabetes prioritize access to their diabetes data and communication with the health care team as key functions in diabetes apps [9,11]. A diabetes app that motivates adolescents with type 1 diabetes (T1D) to self-manage their diabetes by recording their glucometer data identified social interaction in a group, customization, and tangible rewards as motivating factors to use the app [10].…”

“…A diabetes app that motivates adolescents with type 1 diabetes (T1D) to self-manage their diabetes by recording their glucometer data identified social interaction in a group, customization, and tangible rewards as motivating factors to use the app [10]. However, the perceptions of HCPs in the design of these apps were not evaluated [9,10].…”