Views of Patients on Using mHealth to Monitor and Prevent Diabetic Foot Ulcers: Qualitative Study

Abstract

Background People with diabetes are at risk for diabetic foot ulcers (DFUs), which can lead to limb loss and a significant decrease in quality of life. Evidence suggests that mHealth can be an effective tool in diabetes self-management. mHealth presents an opportunity for the prevention and monitoring of DFUs. However, there is a paucity of research that explores its effectiveness in the DFU patient population, as well as the views and attitudes of these patients toward technology and mHealth. Objective This study aimed to explore the views, attitudes, and experiences of a diabetic patient population with or at risk of DFUs regarding technology, mHealth, and the diabetic foot. Methods We used a qualitative research approach using in-depth interviews with 8 patients with DFUs. Questions were structured around experience with technology, current health practices related to diabetic foot care, and thoughts on using an mHealth device that prevents and monitors DFUs. We transcribed and thematically analyzed all interviews. Results All patients had positive responses for an mHealth intervention aimed at preventing and monitoring DFUs. We found 4 themes in the data: diversity in use of technology, feet-checking habits, 2-way communication with health care professionals (HCPs), and functionality. There were varying levels of familiarity with and dependence on technology within this patient population. These relationships correlated with distinct generations found in North America, including baby boomers and Generation X. Furthermore, we found that most patients performed daily feet checks to monitor any changes in health. However, some did not perform feet checks prior to the development of a DFU. Patients expressed interest in 2-way communication with HCPs that would allow for easier appointment scheduling, sharing of medical data, decreased number of visits, and use of alerts for when medical attention is required. Patients also identified conditions of functionality for the mHealth intervention. These included consideration of debilitating complications because of diabetes, such as retinopathy and decreased mobility; ease of use of the intervention; and implementation of virtual communities to support continued use of the intervention. Conclusions Our patient population expressed an interest in mHealth for preventing and monitoring DFUs, although some participants were not frequent users of technology. mHealth continues to show potential in improving patient outcomes, and this study provides a foundation for designing interventions specific to a DFU population. Further research is needed to confirm these findings.

Promoting Self-Care of Diabetic Foot Ulcers through a Mobile Application: A User-Centred Design and Evaluation (Preprint)

“…Despite technological advancements, and despite the burden of the complication, mobile applications are hardly used in management or prevention of DFUs. Some pilot research in this area focused on mobile applications that use thermal cameras attached to mobile phones detect signs of possible ulcers early on [22] or to manage active ulcers [23]. Unlike these mobile applications, however, our design works with standard smartphone cameras, which makes it potentially available to anyone owning such a smartphone without further cost or work.…”

“…However, they only express opinions on potential use based on trying out the app with the assistance of a researcher. Such evaluations of technology prototypes through interviews are an important step in a user-centred design process and commonly reported in the health informatics literature, including in the area of diabetes (e.g., [23,[39][40][41][42]). The critical next step is a deployment study where patients and their carers can use and evaluate the app over several weeks or months in their daily lives to evaluate the actual impact on self-care.…”

Foot thermometry with mHeath-based supplementation to prevent diabetic foot ulcers: A randomized controlled trial

“…Additionally, our system was automatic and did not allow direct bilateral communication. In a previous qualitative study from Canada, conducted to explore the views of patients in using mHealth to monitor and prevent DFU 35 , patients expressed interest in a two-way communication system to facilitate sharing of medical data, scheduling appointments and using of alerts to get access to medical attention. Also, a recent publication, evaluating 17 systematic reviews of mHealth intervention studies in diabetes and obesity 36 , showed that fewer than half of the studies included in 2 reviews (out of 7 systematic reviews that covered the topic) improved diabetes management practices or medication adherence 37 , 38 , and recommend the use of valid measures for outcomes and rigorous study designs to improve their quality.…”

The Potential Role of Sensors, Wearables and Telehealth in the Remote Management of Diabetes-Related Foot Disease

“…For people with DFD, treatment and education typically occur in an outpatient clinic weekly or bi-weekly. Although remote monitoring methods for people with DFD using smartphone applications have been developed, these are still in their infancy and have not been widely tested or implemented [85][86][87]. Despite their potential application in remote DFD monitoring, the diagnostic accuracy of mobile phone images is reported to be poor and therefore should not be used as a stand-alone diagnostic instrument for DFD [88].…”