Design, feasibility, and acceptability of an intervention using personal digital assistant-based self-monitoring in managing type 2 diabetes

Abstract

Background-The information processing demands associated with behavioral self-management of diabetes are extensive. Pairing personal digital assistant (PDA)-based self-monitoring with a behavioral self-management intervention may improve adherence and patient outcomes.Methods-ENHANCE is a randomized controlled trial to test an intervention designed to improve regimen adherence in adults with type 2 diabetes. The intervention, based on Social Cognitive Theory (SCT), is paired with PDA-based self-monitoring. In this paper we describe the: (a) manner in which PDA-based self-monitoring is integrated within the SCT-based intervention, (b) feasibility and acceptability of PDA-based dietary self-monitoring, and (c) issues encountered in teaching participants to self-monitor using a PDA.Results-During the first 30 months of this 5-year study, 232 participants were screened and 151 were randomized. To date, 6 cohorts have completed the study. The retention rate is 85% (n=129). Of those randomized to the intervention (n=74) and completing the study (n=61), 88% reported understanding the usefulness of PDA-monitoring, 85% reported ease in entering foods into the Correspondence concerning this article should be addressed to: Mary Ann Sevick, ScD, VA Pittsburgh Healthcare System and the School of Medicine, University of Pittsburgh, Suite 600, 230 McKee Place, Pittsburgh PA, 15213. Phone: (412)586-9788. FAX: (412)692-4838. E-mail: E-mail: sevick@pitt.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript device, 70% reported ease in interpreting feedback graphs, and 82% indicated that they would continue to use the PDA for self-monitoring after the study concluded. Assuming 3 meals per day, participants entered an average of 58% of their meals in their PDA, and 43% were entered assuming 4 meals per day. If we eliminate from the analysis those individuals who entered less than 10% of their expected meals (n=12), the average rate of self-monitoring was 69% assuming 3 meals per day, and 52% assuming 4 meals per day.Conclusions-PDA-based dietary monitoring is perceived by participants to be useful and acceptable. The approach used to instruct participants in use of the PDA and lessons learned are discussed. PDA technology shows promise as a tool for assisting those with type 2 diabetes in their efforts to manage their disease.

Factors Affecting Acceptability and Usability of Technological Approaches to Diabetes Self-Management: A Case Study

“…The personal digital assistant (PDA) has been considered a promising management tool to improve patient satisfaction and increase compliance with recommended behaviors for diseases, including diabetes. [4][5][6][7][8][9][10][11] In fact, PDAs have been used extensively throughout the world, including the United States, some European countries, such as The Netherlands, France, Germany, and the United Kingdom, China, and India. 12,13 However, advancements in mobile devices and Web 2.0 have been superseded by other technological platforms.…”

Usage of Mobile Applications in Diabetes Management: A Review

“…Six studies tested the effects of the intervention on diabetes outcome measures (Faridi et al 2008;Forjuoh et al 2008;Hee-Sung 2007;Quinn et al 2008;Yoon & Kim 2008). One study tested the feasibility and acceptability of the application program, including the issues encountered by participants when using the system for self-monitoring (Sevick et al 2008). Additionally, one study tested the usability of the prototype system on diabetes type 1 patients (Carroll et al 2007).…”

“…One out of the 8 studies (Sevick et al 2008) did not report the results of the impact of the intervention program on diabetes monitoring parameters. This study examined the feasibility and acceptability of PDA-based dietary self-monitoring and addressed the issues encountered in its implementation.…”

A Behavioral Lifestyle Intervention Enhanced With Multiple-Behavior Self-Monitoring Using Mobile and Connected Tools for Underserved Individuals With Type 2 Diabetes and Comorbid Overweight or Obesity: Pilot Comparative Effectiveness Trial (Preprint)

“…Although traditional paper diaries were used for self-monitoring in the two landmark behavioral intervention studies, researchers have tested the use of electronic diaries for self-monitoring [18][19][20] and found these as effective as paper diaries and less burdensome and time consuming. Initially, Burke and colleagues examined the use of personal digital assistants (PDAs) for selfmonitoring [18,19] to strengthen the effect of a behavioral weight loss intervention and found PDAs to be a viable alternative that is convenient to use.…”

“…Initially, Burke and colleagues examined the use of personal digital assistants (PDAs) for selfmonitoring [18,19] to strengthen the effect of a behavioral weight loss intervention and found PDAs to be a viable alternative that is convenient to use. As technological advances have rendered PDAs obsolete, more recent research tested smartphones to reduce patient burden in self-monitoring and in counting calories using a booklet.…”