Abstract:Background
Information technologies (IT) are increasingly implemented in type 2 diabetes (T2D) treatment as a resource for remotely supported health care. However, possible pitfalls of introducing IT in health care are generally overlooked. Specifically, the effectiveness of IT to improve health care may depend on the user’s readiness for health technology.
Objective
We aim to investigate readiness for health technology in relation to mental well-being,… Show more
“…Using apps for managing diabetes requires not only knowledge but also digital competences of end users in order to become familiar with the use of apps and to integrate them into daily life. The need for competence and digital literacy has been acknowledged in many other studies [ 20 , 21 , 24 , 39 , 40 ]. Thorsen et al [ 40 ] concluded that the implementation of health technology among patients with T2DM should be based on a comprehensive consideration of readiness for health technology.…”
Section: Discussionmentioning
confidence: 99%
“…The need for competence and digital literacy has been acknowledged in many other studies [ 20 , 21 , 24 , 39 , 40 ]. Thorsen et al [ 40 ] concluded that the implementation of health technology among patients with T2DM should be based on a comprehensive consideration of readiness for health technology. Reimbursement by insurance companies was mentioned as a missing facilitator, as often the financial resources are lacking among patients with T2DM in the Netherlands.…”
Background
Self-monitoring of blood glucose levels, food intake, and physical activity supports self-management of patients with type 2 diabetes mellitus (T2DM). There has been an increase in the development and availability of mobile health apps for T2DM.
Objective
The aim of this study is to explore the actual use of mobile health apps for diabetes among patients with T2DM and the main barriers and drivers among app users and nonusers.
Methods
An explanatory sequential design was applied, starting with a web-based questionnaire followed by semistructured in-depth interviews. Data were collected between July and December 2020. Questionnaire data from 103 respondents were analyzed using IBM SPSS Statistics (version 25.0). Descriptive statistics were performed for the actual use of apps and items of the Unified Theory of Acceptance and Use of Technology (UTAUT). The UTAUT includes 4 key constructs: performance expectancy (the belief that an app will help improve health performance), effort expectancy (level of ease associated with using an app), social influence (social support), and facilitating conditions (infrastructural support). Differences between users and nonusers were analyzed using chi-square tests for individual items. Independent 2-tailed t tests were performed to test for differences in mean scores per the UTAUT construct. In total, 16 respondents participated in the interviews (10 users and 6 nonusers of apps for T2DM). We performed content analysis using a deductive approach on all transcripts, guided by the UTAUT.
Results
Regarding actual use, 55.3% (57/103) were nonusers and 44.7% (46/103) were users of apps for T2DM. The main driver for the use of apps was the belief that using apps for managing diabetes would result in better personal health and well-being. The time and energy required to keep track of the data and understand the app were mentioned as barriers. Mean scores were significantly higher among users compared with nonusers of apps for T2DM for the constructs performance expectancy (4.06, SD 0.64 vs 3.29, SD 0.89; P<.001), effort expectancy (4.04, SD 0.62 vs 3.50, SD 0.82; P<.001), social influence (3.59, SD 0.55 vs 3.29, SD 0.54; P=.007), and facilitating conditions (4.22, SD 0.48 vs 3.65, SD 0.70; P<.001). On the basis of 16 in-depth interviews, it was recognized that health care professionals play an important role in supporting patients with T2DM in using apps. However, respondents noticed that their health care professionals were often not supportive of the use of apps for managing diabetes, did not show interest, or did not talk about apps. Reimbursement by insurance companies was mentioned as a missing facilitator.
Conclusions
Empowering health care professionals’ engagement is of utmost importance in supporting patients with T2DM in the use of apps. Insurance companies can play a role in facilitating the use of diabetes apps by ensuring reimbursement.
“…Using apps for managing diabetes requires not only knowledge but also digital competences of end users in order to become familiar with the use of apps and to integrate them into daily life. The need for competence and digital literacy has been acknowledged in many other studies [ 20 , 21 , 24 , 39 , 40 ]. Thorsen et al [ 40 ] concluded that the implementation of health technology among patients with T2DM should be based on a comprehensive consideration of readiness for health technology.…”
Section: Discussionmentioning
confidence: 99%
“…The need for competence and digital literacy has been acknowledged in many other studies [ 20 , 21 , 24 , 39 , 40 ]. Thorsen et al [ 40 ] concluded that the implementation of health technology among patients with T2DM should be based on a comprehensive consideration of readiness for health technology. Reimbursement by insurance companies was mentioned as a missing facilitator, as often the financial resources are lacking among patients with T2DM in the Netherlands.…”
Background
Self-monitoring of blood glucose levels, food intake, and physical activity supports self-management of patients with type 2 diabetes mellitus (T2DM). There has been an increase in the development and availability of mobile health apps for T2DM.
Objective
The aim of this study is to explore the actual use of mobile health apps for diabetes among patients with T2DM and the main barriers and drivers among app users and nonusers.
Methods
An explanatory sequential design was applied, starting with a web-based questionnaire followed by semistructured in-depth interviews. Data were collected between July and December 2020. Questionnaire data from 103 respondents were analyzed using IBM SPSS Statistics (version 25.0). Descriptive statistics were performed for the actual use of apps and items of the Unified Theory of Acceptance and Use of Technology (UTAUT). The UTAUT includes 4 key constructs: performance expectancy (the belief that an app will help improve health performance), effort expectancy (level of ease associated with using an app), social influence (social support), and facilitating conditions (infrastructural support). Differences between users and nonusers were analyzed using chi-square tests for individual items. Independent 2-tailed t tests were performed to test for differences in mean scores per the UTAUT construct. In total, 16 respondents participated in the interviews (10 users and 6 nonusers of apps for T2DM). We performed content analysis using a deductive approach on all transcripts, guided by the UTAUT.
Results
Regarding actual use, 55.3% (57/103) were nonusers and 44.7% (46/103) were users of apps for T2DM. The main driver for the use of apps was the belief that using apps for managing diabetes would result in better personal health and well-being. The time and energy required to keep track of the data and understand the app were mentioned as barriers. Mean scores were significantly higher among users compared with nonusers of apps for T2DM for the constructs performance expectancy (4.06, SD 0.64 vs 3.29, SD 0.89; P<.001), effort expectancy (4.04, SD 0.62 vs 3.50, SD 0.82; P<.001), social influence (3.59, SD 0.55 vs 3.29, SD 0.54; P=.007), and facilitating conditions (4.22, SD 0.48 vs 3.65, SD 0.70; P<.001). On the basis of 16 in-depth interviews, it was recognized that health care professionals play an important role in supporting patients with T2DM in using apps. However, respondents noticed that their health care professionals were often not supportive of the use of apps for managing diabetes, did not show interest, or did not talk about apps. Reimbursement by insurance companies was mentioned as a missing facilitator.
Conclusions
Empowering health care professionals’ engagement is of utmost importance in supporting patients with T2DM in the use of apps. Insurance companies can play a role in facilitating the use of diabetes apps by ensuring reimbursement.
“…Participants for the individual interviews were purposefully selected among individuals with T2D referred (by their general practitioner) to diabetes-related rehabilitation (typically 6–8 weeks) including educational group sessions in a classroom setting supplemented by group activities (e.g., cooking and exercising) (The Capital Region of Denmark, 2016). Specifically, we used data from a previous questionnaire survey to sample individuals from various health technology readiness profiles with distinct levels of eHealth literacy, self-management capacity and social support, and with varying receptiveness to IT use in PA (Thorsen et al, 2020). For the focus groups, we used criterion-based purposeful sampling to select participants representing both short (≤3 years) and long (>3 years) education levels (OECD, European Union, UNESCO Institute for Statistics, 2015) and prior community-based diabetes-related rehabilitation program experience (plus/minus).Figure 1.Overview of sampling sites and criteria.…”
Section: Methodsmentioning
confidence: 99%
“…Some trials have further implemented technology for continuous monitoring and feedback of individuals’ PA levels with varying effect on glycemic control (Wu et al, 2019). However, a one-size-fits-all approach to technology implementation is generally problematic as readiness for health technology widely varies among individuals with T2D (Thorsen et al, 2020). In a recent study, we found that three of five health technology readiness profiles were not immediately ready to interact with health technologies (Thorsen et al, 2020), indicating that novel insights are warranted to exploit the potential of technology to provide remote, flexible, and continued support for PA.…”
Lack of physical activity (PA) is common among individuals with type 2 diabetes (T2D). We apply a practice theory approach to investigate PA engagement in the context of T2D. Data were collected through semi-structured individual interviews ( n = 23) and focus groups ( n = 3x6) and analyzed by deductive-inductive reflexive thematic analysis using a practice theory framework. Forty-one purposefully selected individuals with T2D (29 men) between the ages of 54 and 77 years were included. The analysis resulted in three main themes informed by five subthemes, reflecting the key elements of practice theory (i.e., meanings, materialities, and competencies). One overarching theme identified PA engagement as an unsustainable and insurmountable project in constant and unequal competition with the practice of physical inactivity. To increase PA among individuals with T2D, future PA interventions and strategies should aim to establish a stronger link between PA and everyday life practices.
“…Both the eHLF [ 17 , 18 ] and the eHLQ may, alone [ 19 , 20 ] or in combination with other scales such as the Readiness and Enablement Index for Health Technology instrument [ 21 - 23 ], help identify potential barriers or facilitators with respect to the user’s capabilities, their trust and motivation, and their experiences with digital services.…”
Background
The implementation of an integrated electronic health record (EHR) system can potentially provide health care providers with support standardization of patient care, pathways, and workflows, as well as provide medical staff with decision support, easier access, and the same interface across features and subsystems. These potentials require an implementation process in which the expectations of the medical staff and the provider of the new system are aligned with respect to the medical staff’s knowledge and skills, as well as the interface and performance of the system. Awareness of the medical staff’s level of eHealth literacy may be a way of understanding and aligning these expectations and following the progression of the implementation process.
Objective
The objective of this study was to investigate how a newly developed and modified instrument measuring the medical staff’s eHealth literacy (staff eHealth Literacy Questionnaire [eHLQ]) can be used to inform the system provider and the health care organization in the implementation process and evaluate whether the medical staff’s perceptions of the ease of use change and how this may be related to their level of eHealth literacy.
Methods
A modified version of the eHLQ was distributed to the staff of a medical department in Denmark before and 3 months after the implementation of a new EHR system. The survey also included questions related to users’ perceived ease of use and their self-reported information technology skills.
Results
The mean age of the 194 participants before implementation was 43.1 (SD 12.4) years, and for the 198 participants after implementation, it was 42.3 (SD 12.5) years. After the implementation, the only difference compared with the preimplementation data was a small decrease in staff eHLQ5 (motivated to engage with digital services; unpaired 2-tailed t test; P=.009; effect size 0.267), and the values of the scales relating to the medical staff’s knowledge and skills (eHLQ1-3) were approximately ≥3 both before and after implementation. The range of scores was narrower after implementation, indicating that some of those with the lowest ability benefited from the training and new experiences with the EHR. There was an association between perceived ease of use and the 3 tested staff eHLQ scales, both before and after implementation.
Conclusions
The staff eHLQ may be a good candidate for monitoring the medical staff’s digital competence in and response to the implementation of new digital solutions. This may enable those responsible for the implementation to tailor efforts to the specific needs of segments of users and inform them if the process is not going according to plan with respect to the staff’s information technology–related knowledge and skills, trust in data security, motivation, and experience of a coherent system that suits their needs and supports the workflows and data availability.
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