Instrument for Assessing Patients’ Desirability, Acceptability, and Adherence to Telemedicine in Diabetes: Development, Validity, and Reliability

Abstract

Purpose: To develop, test, and validate an instrument for assessing patients' desirability, acceptability, and adherence to telemedicine in diabetes. Patients and Methods: A group of six experts defined the components that needed to be assessed when developing telemedicine platforms aimed at improving the care of patients with diabetes. The resulting instrument was tested for reliability and construct validity of 114 patients with diabetes and re-tested for reproducibility and consistency on a sub-group of 34 patients. Based on the analysis, the questionnaire's syntax, phrasing, and flow were improved to obtain optimal assessment results. Results:The resulting questionnaire has three major sections: one for the main evaluated component (acceptability, desirability, and adherence to telemedicine in diabetes), one for collecting socio-economic and demographical information, and one for diabetes historyrelated data, respectively. The corresponding data for these sections are collected using 29 questions. The developed instrument has a good reliability (Cronbach's alpha = 0.890), reproducibility (Total score 164 vs 166 points at re-test vs test; Mann-Whitney U p-value = 0.394) and external validity (Spearman's rho = −0.580; p < 0.001 for correlation with Patient's Health Questionnaire −9; and Spearman's rho = −0.516; p < 0.001 for correlation with Generalized Anxiety Disorder -7). Conclusion:The developed questionnaire is a valid and reliable instrument in assessing the patients' acceptability, desirability, and adherence to telemedicine use in diabetes care. In addition, the use of this instrument in the development of telemedicine platforms may improve and optimize their usage by providing valuable information regarding patients' preferences and specific needs.

Factors Influencing the Desirability, Acceptability, and Adherence of Patients with Diabetes to Telemedicine

“…Considering the importance of telemedicine usage in the care of diabetes, both in special epidemiological conditions and during routine consultations—since telemedicine may enhance classical consultations and may optimize the delivery of care in these patients—and considering that the patients’ desirability, acceptance, and adherence to these solutions are the main barriers to the implementation of routine telemedicine care for patients with diabetes, there was a need for a study to evaluate these items in patients with diabetes [ 9 , 10 , 11 ]. Furthermore, the COVID-19 pandemic has been proven to strongly influence mental health, especially in patients with diabetes mellitus, since increasing knowledge—about the association of a more severe evolution of COVID-19, with high glycaemic values, and about DM being a very frequent comorbidity of COVID-19, with its complications being other risk factors—has brought fear and anxiety to these patients, in a context of unpredictability and uncertainty [ 17 , 18 , 19 , 20 , 21 , 22 ].…”

“…Therefore, the present study used, as a main evaluation tool, the first validated instrument designed specifically to assess the desirability, acceptability, and adherence of patients with diabetes to telemedicine use in their medical care: QTelemeDiab. This instrument was previously validated for the population of patients with diabetes, both type 1 as well as type 2 [ 11 ].…”

“…The desirability, acceptability, and adherence to telemedicine solutions of patients with diabetes was assessed using the QTelemeDiab instrument. QTelemeDiab is a previously validated instrument designed to evaluate the three previously mentioned items regarding telemedicine use and was designed specifically for patients with diabetes [ 11 ]. The QTelemeDiab questionnaire has 9 sections, with multiple items, all scored on a Likert scale (from the lowest value: 1 (not likely at all) to the highest: 5 (very likely)).…”

“…Regarding the use of telemedicine in diabetes, there are two main barriers: access to technology, and the patients’ desire, acceptability, and adherence to the usage of telemedicine tools for their respective care [ 9 , 10 , 11 , 12 , 13 ]. However, the beneficial effects of using telemedicine as an addition to classical medical visits are already proven and have been brought, once again, to specialists’ attention, with the onset of the COVID-19 pandemic.…”