Factors Influencing the Use of a Web-Based Application for Supporting the Self-Care of Patients with Type 2 Diabetes: A Longitudinal Study

Abstract

BackgroundThe take-up of eHealth applications in general is still rather low and user attrition is often high. Only limited information is available about the use of eHealth technologies among specific patient groups.ObjectiveThe aim of this study was to explore the factors that influence the initial and long-term use of a Web-based application (DiabetesCoach) for supporting the self-care of patients with type 2 diabetes.MethodsA mixed-methods research design was used for a process analysis of the actual usage of the Web application over a 2-year period and to identify user profiles. Research instruments included log files, interviews, usability tests, and a survey.ResultsThe DiabetesCoach was predominantly used for interactive features like online monitoring, personal data, and patient–nurse email contact. It was the continuous, personal feedback that particularly appealed to the patients; they felt more closely monitored by their nurse and encouraged to play a more active role in self-managing their disease. Despite the positive outcomes, usage of the Web application was hindered by low enrollment and nonusage attrition. The main barrier to enrollment had to do with a lack of access to the Internet (146/226, 65%). Although 68% (34/50) of the enrollees were continuous users, of whom 32% (16/50) could be defined as hardcore users (highly active), the remaining 32% (16/50) did not continue using the Web application for the full duration of the study period. Barriers to long-term use were primarily due to poor user-friendliness of the Web application (the absence of “push” factors or reminders) and selection of the “wrong” users; the well-regulated patients were not the ones who could benefit the most from system use because of a ceiling effect. Patients with a greater need for care seemed to be more engaged in long-term use; highly active users were significantly more often medication users than low/inactive users (P = .005) and had a longer diabetes duration (P = .03).ConclusionInnovations in health care will diffuse more rapidly when technology is employed that is simple to use and has applicable components for interactivity. This would foresee the patients’ need for continuous and personalized feedback, in particular for patients with a greater need for care. From this study several factors appear to influence increased use of eHealth technologies: (1) avoiding selective enrollment, (2) making use of participatory design methods, and (3) developing push factors for persistence. Further research should focus on the causal relationship between using the system’s features and actual usage, as such a view would provide important evidence on how specific technology features can engage and captivate users.

Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support (Preprint)

“…Interactive eHealth tools designed to provide feedback on patients' self-monitoring appear to engage patients the most, since personalised and interactive features stimulate active participation by both the patient and the nurse. Nijland et al [35] reported that the diabetes patients in their study felt better monitored by the feedback they received and were therefore more motivated to take a more active role in the self-management of their illness, something that also led to increased independence.…”

“…Several studies report that eHealth is promising with regard to selfmanagement support, and that people with chronic conditions desire tools that effectively reduce the limitations of life caused by disease [34][35][36].…”

“…Ahern et al [40] concluded that the potential of patient technologies can only be accomplished by activating patients to become more engaged and responsible for their own care. In a study by Nijland et al [35], the authors argued that interactive eHealth applications must be continuously changed and developed to promote individual self-care, through feedback and exchange of information, something that is in line with the value of independence. Interactive eHealth tools designed to provide feedback on patients' self-monitoring appear to engage patients the most, since personalised and interactive features stimulate active participation by both the patient and the nurse.…”

Computer-based interactive health communications for people with chronic disease

“…50 IHCAs have been investigated with relation to medication adherence for many chronic health conditions, including diabetes, hypertension, asthma, and cardiovascular conditions. [51][52][53] A recent review was conducted of IHCAs aimed at increasing adherence among the patients prescribed cardiovascular and diabetes medications. 50 This review …”

5thAnnual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and Beyond, May 3–5, 2012, Dublin, Ireland

“…20 The first interesting outcome was that on average people logged on 49 times over 2 years with a progressively declining rate of engagement. The study observed that common barriers to sustainable engagement were:…”