Development of the Support self-guided, web application for adults living with type 1 diabetes in Canada by a multi-disciplinary team using a people-oriented approach based on the Behaviour Change Wheel

Abstract

Background Diabetes self-management education and support (DSME/S) are central in type 1 diabetes (T1D) where individuals are responsible for 95% of care. In-person DSME/S programs have been proven clinically effective (e.g. optimizing glycemic management, improving diabetes-related behaviors) but are limited by a lack of accessibility and long-term follow-up. Self-guided digital tools such as web applications (web apps) can be an alternative for delivering DSME/S. Objective This article describes the development of Support, a behavioral theory-based, self-guided, web application for adults living with T1D in the province of Quebec, Canada. Methods A multi-disciplinary team developed Support. Patient partners first proposed its focus, learning topics, and expressed barriers to using digital tools for DSME/S. These barriers were analyzed based on the Behaviour Change Wheel. A group of healthcare professionals (HCPs) drafted the evidence-based learning content which was reviewed by external HCPs and by patient partners. Results Support is a bilingual (English and French) web app accessible at any time via the Internet. It has four learning paths focusing on hypoglycemia and based on the user's method of diabetes treatment. Learning modules are divided into six categories with a maximum of three learning levels. It contains features such as a discussion forum, videos, and quizzes to ensure interactivity, provide social support, and maintain the motivation and long-term engagement of users. Conclusions To the best of the authors’ knowledge, Support is the first self-guided evidence-based web app for adults living with T1D. It is currently under study to evaluate its feasibility and clinical impacts.

Adaptation of an Adult Web Application for Type 1 Diabetes Self-management to Youth Using the Behavior Change Wheel to Tailor the Needs of Health Care Transition: Qualitative Interview Study

“…This technique can be combined with features relating to “social support” (eg, providing feedback for a discussion forum post”) or be used alone (eg, answers given after quiz completion); it can be given in a text format (eg, “Congratulation for your good answers!”), rewards (eg, points provided with the number of quizzes completed), communication with the health care team (eg, providing a medical certificate for program completion), or individualized communication (eg, follow-up phone calls). However, although this method may be effective in achieving self-management outcomes, it may not be feasible owing to financial constraints to produce the feedback algorithm in all circumstances [ 21 ]. In addition, feedback must be provided by a qualified person, which further increases the cost of human resources.…”

“…For instance, the participants expressed that the rewards might be a motivator for children but not for teenagers and suggested a preference for tangible rather than virtual rewards. As incorporating features related to gamification (eg, virtual rewards) and a greater level of interactivity are associated with a higher financial cost at the design phase of the digital tool [ 21 ] and tangible rewards imply long-term financial investment, we suggest investigating the preferences of the users on these features during its planification.…”

“…The interviews were based on an existing self-guided web app designed for adults with T1D (ie, Support [ 21 ]) as an example of a web-based DSME/S resource. The information on Support is divided into 6 learning categories with 3 levels of complexity.…”

“…To convey these behavioral changes from a technological perspective, BCTs can guide the choice of characteristics and features [ 19 , 20 ]. An example of the application of BCTs for T1D is Support [ 21 ], a self-guided web app for people living with T1D that has an evidence-based design [ 22 ]. It offers multidimensional education and support to adults living with T1D to improve their DSM.…”

“…Developed by HCPs in the field, in collaboration with patient partners, it is personalized based on the user’s treatment regimen to offer tailored content. This web app also includes a discussion forum mediated by HCPs and features requiring active participation (eg, quizzes and calculators) [ 21 ]. However, as youth living with T1D encounter specific challenges of health care transition, DSME/S for this population should address this specific issue.…”