Analysis of Effectiveness and Psychological Techniques Implemented in mHealth Solutions for Middle-Aged and Elderly Adults with Type 2 Diabetes : A Narrative Review of the Literature

Background: in diabetes, multiple mHealth solutions were produced and implemented for self-management behaviors. However, little research on the effectiveness of psychological techniques implemented within these mHealth solutions was carried out, and even less with the elderly population where technological barriers might exist. Reliable evidence generated through a comprehensive evaluation of mHealth interventions may accelerate its growth for successful long-term implementation and to help to experience mHealth benefits in an enhanced way in all ages. Objective: this study aimed to review mHealth solutions for diabetes self-management in older adults (adherence to treatments and glycemic control) by analyzing the effectiveness of specific psychological techniques implemented. Methods: a narrative review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed (Medline) and American Psychological Association (APA) PsycInfo databases were searched for published papers that addressed eHealth solutions' effectiveness for diabetes self-management. Studies in English, Spanish, and/or German of any design were screened, with no time constraints regarding the year of publication. A qualitative analysis of the selected papers was conducted in several steps. Results: this review found 38 studies setting up and analyzing mHealth solutions for older adults. Most research showed improvements in HbA1c, self-management behaviors, and medication adherence in T2DM patients post intervention. However, different mid-to-long term effects were found across studies, specifically concerning the maintenance and adherence to healthy behaviors. The most employed psychological framework was CBT, including techniques such as self-monitoring of outcome behaviors (mostly targeting glycemia measurements and healthy habits as physical activity and/or diet), tailored motivational feedback from medical staff, and psychoeducation or health coaches. The most successful mHealth intervention combined the feature of tailored feedback messages, interactive communication with healthcare professionals, and multifaceted functions. Conclusions: there is a lack of elaborate and detailed information in the literature regarding the factors considered in the design and development of mHealth solutions used as interventions for T2DM self-management in the elderly. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of useful and user-friendly self-management apps that can enhance the quality of life for diabetes patients. Further research adapting mHealth solutions to older adults' sensory deficits is necessary

Analysis of Effectiveness and Psychological Techniques Implemented in mHealth Solutions for Middle-Aged and Elderly Adults with Type 2 Diabetes: A Narrative Review of the Literature

Diabetis; Gent gran; Tècniques psicològiquesDiabetes; Elderly; Psychological techniquesDiabetes; Ancianos; Técnicas psicológicaBackground: in diabetes, multiple mHealth solutions were produced and implemented for self-management behaviors. However, little research on the effectiveness of psychological techniques implemented within these mHealth solutions was carried out, and even less with the elderly population where technological barriers might exist. Reliable evidence generated through a comprehensive evaluation of mHealth interventions may accelerate its growth for successful long-term implementation and to help to experience mHealth benefits in an enhanced way in all ages. Objective: this study aimed to review mHealth solutions for diabetes self-management in older adults (adherence to treatments and glycemic control) by analyzing the effectiveness of specific psychological techniques implemented. Methods: a narrative review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed (Medline) and American Psychological Association (APA) PsycInfo databases were searched for published papers that addressed eHealth solutions’ effectiveness for diabetes self-management. Studies in English, Spanish, and/or German of any design were screened, with no time constraints regarding the year of publication. A qualitative analysis of the selected papers was conducted in several steps. Results: this review found 38 studies setting up and analyzing mHealth solutions for older adults. Most research showed improvements in HbA1c, self-management behaviors, and medication adherence in T2DM patients post intervention. However, different mid-to-long term effects were found across studies, specifically concerning the maintenance and adherence to healthy behaviors. The most employed psychological framework was CBT, including techniques such as self-monitoring of outcome behaviors (mostly targeting glycemia measurements and healthy habits as physical activity and/or diet), tailored motivational feedback from medical staff, and psychoeducation or health coaches. The most successful mHealth intervention combined the feature of tailored feedback messages, interactive communication with healthcare professionals, and multifaceted functions. Conclusions: there is a lack of elaborate and detailed information in the literature regarding the factors considered in the design and development of mHealth solutions used as interventions for T2DM self-management in the elderly. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of useful and user-friendly self-management apps that can enhance the quality of life for diabetes patients. Further research adapting mHealth solutions to older adults’ sensory deficits is necessary.This research received no external funding

Curr Diab Rep

Purpose of ReviewTo identify a common effect of health information technologies (HIT) on the management of cardiovascular disease (CVD) risk factors among people with type 2 diabetes (T2D) across randomized control trials (RCT).Recent FindingsCVD is the most frequent cause of morbidity and mortality among patients with diabetes. HIT are effective in reducing HbA1c; however, their effect on cardiovascular risk factor management for patients with T2D has not been evaluated.SummaryWe identified 21 eligible studies (23 estimates) with measurement of SBP, 20 (22 estimates) of DBP, 14 (17 estimates) of HDL, 14 (17 estimates) of LDL, 15 (18 estimates) of triglycerides, and 10 (12 estimates) of weight across databases. We found significant reductions in SBP, DBP, LDL, and TG, and a significant improvement in HDL associated with HIT. As adjuvants to standard diabetic treatment, HIT can be effective tools for improving CVD risk factors among patients with T2D, especially in those whose CVD risk factors are not at goal.Electronic supplementary materialThe online version of this article (10.1007/s11892-019-1152-3) contains supplementary material, which is available to authorized users.1P30DK092950/National Institute of Diabetes and Digestive and Kidney Diseases/2019-04-27T00:00:00Z31030289PMC6486904628

Prospective acceptability of an mHealth intervention for self-managing gestational diabetes

Tiivistelmä – Referat – Abstract Raskausdiabetes on raskauden aikana alkava tai todettu glukoosi-intoleranssista johtuva sairaustila, joka aiheuttaa merkittäviä terveysriskejä sekä äidille että lapselle. Raskausajan diabeteksen ilmaantuvuus on maailmanlaajuisesti kasvussa ja tehokkaita interventioita tarvitaan siihen liittyvien terveysriskien pienentämiseksi. Mobiiliteknologiaa hyödyntävillä ratkaisuilla (mHealth) on potentiaalia tähän tarpeeseen vastaamisessa, sillä ne ovat kustannustehokkaita ja niillä voidaan tavoittaa potilasväestöä laajasti. mHealth-ratkaisut saattavat olla erityisen tehokkaita sellaisten kroonisten sairaustilojen hoidossa, jotka vaativat potilaan käyttäytymisen muutosta. Intervention hyväksyttävyyden tutkiminen on tärkeä askel onnistuneiden interventioiden kehittämisessä. Tämän maisterintutkielman tavoite on tutkia raskausdiabeteksen omahoitoa tukevan mHealth-intervention prospektiivista hyväksyttävyyttä sen potentiaalisten osallistujien näkökulmasta. Tutkielma pyrkii myös selvittämään, ovatko aiempi teknologinen kokemus ja kokemukset intervention hyväksyttävyydestä yhteydessä toisiinsa. Lisäksi pyritään selvittämään, miten intervention hyväksyttävyyttä voisi parantaa. Tutkielmassa käytetään aineistoa, joka on kerätty eMOM GDM -tutkimuksen ensimmäisessä vaiheessa. eMOM GDM on tutkimusprojekti, jonka tavoitteena on kehittää mobiilisovelluksen muodossa toteutettava interventio raskausajan diabeteksen omahoidon tueksi. Sovelluksen hyväksyttävyyttä tutkittiin puolistrukturoiduilla haastatteluilla. Haastatteluihin osallistui 10 raskausdiabetesdiagnoosin saanutta naista. Tieto teknologisesta kokemuksesta saatiin taustatietolomakkeesta, jonka osallistujat täyttivät osana tutkimusta. Haastatteluiden analysoinnissa käytettiin teoriaohjaavaa sisällönanalyysiä. Tulokset osoittavat, että intervention prospektiivinen hyväksyttävyys potentiaalisten osallistujien näkökulmasta on korkea. Hyväksyttävyyttä voidaan silti edelleen parantaa sen lähes kaikilla osa-alueilla ja tutkielmassa esitellään useita tapoja tämän toteuttamiseksi. Tulosten perusteella on mahdollista, että teknologinen kokemus ja mHealth-pohjaisten interventioiden hyväksyttävyys ovat yhteydessä toisiinsa. Tutkielma tukee intervention kehitystä tarjoamalla näkemystä tekijöistä, jotka vaikuttavat intervention hyväksyttävyyteen, sekä ideoita, miten hyväksyttävyyttä voidaan edelleen parantaa. Tuloksia voidaan hyödyntää myös tulevaisuudessa uusien raskausdiabeteksen hoitoon tähtäävien mHealth-interventioiden kehityksessä. Lisäksi mahdollinen yhteys aiemman teknologisen kokemuksen ja interventioiden hyväksyttävyyden välillä on kiinnostava muidenkin mHealth-interventioiden kehityksen kannalta ja sitä tulisi tutkia enemmän.Gestational diabetes mellitus (GDM) is a condition of glucose intolerance with onset or first recognition during pregnancy, and it poses multiple health risks for both the mother and the child. The prevalence of GDM is increasing globally and effective interventions are needed to reduce the associated risks. Mobile health (mHealth) solutions have a great potential in answering this need since they are cost-effective and able to reach large groups of people. mHealth solutions might be especially effective for management of chronic conditions that require patient behavior change. Investigating intervention acceptability has an important part in the process of developing successful interventions. The aim of this thesis is to investigate the prospective acceptability of an mHealth intervention for GDM from the perspective of its potential recipients. The thesis also seeks to find out whether there are any associations between technological experience and perceptions of intervention acceptability as well as ways in which the intervention acceptability could be improved. The thesis utilizes data collected in the first phase of the eMOM GDM study, a research project with the aim of developing an mHealth intervention to support the self-management of GDM. The application acceptability was studied with semi-structured interviews with 10 women currently diagnosed with GDM. Previous technological experience was self-reported by the participants in a background questionnaire. Theory-driven content analysis was used to analyze the interviews. The results show that the intervention has high prospective acceptability from the perspective of the potential participants. For most of the domains of acceptability there is still room for improvement, and several ideas for further improving the intervention’s acceptability are discussed. The results could also indicate a possible relationship between technological experience and mHealth intervention acceptability. This thesis contributes to the development of an intervention by providing insight on the factors influencing intervention acceptability and ideas on how to improve it. The results also provide valuable information for developing future mHealth solutions for GDM. The potential association between technological experience and intervention acceptability are interesting regarding all mHealth intervention development and should be studied further

MOTIBOT: IL COACH VIRTUALE PER INTERVENTI DI COPING SANO PER ADULTI CON DIABETE MELLITO

Il diabete mellito (DM) è una malattia metabolica autogestita, in cui se l'individuo non è motivato o non è in grado di gestire regolarmente il proprio DM, i risultati medici e psicosociali saranno scarsi. Il DM è più di una condizione di salute fisica: ha impatti comportamentali, fisiologici, psicologici e sociali, e richiede alti livelli di motivazione per seguire le raccomandazioni cliniche e adottare comportamenti sani. A questo scopo, le linee guida dell'American Association of Diabetes Educators (AADE) hanno introdotto il costrutto di coping sano per identificare le strategie di coping per ridurre i sintomi di depressione, ansia, stress e disagio emotivo legato al diabete, migliorando anche il benessere degli adulti con DM. In questo contesto, i Virtual Coaches (VCs) sono diventati un importante risorsa nel supporto e nella gestione delle barriere comuni nel contesto dell'aderenza ai comportamenti sani tra gli adulti con DM. Tuttavia, pochi sono i VC specificamente sviluppati a fornire supporto psicosociale agli adulti con DM. L'obiettivo principale della presente tesi è stato, infatti, lo sviluppo di un VC per fornire supporto psicosociale agli adulti con DM di tipo 1 (T1DM) o DM di tipo 2 (T2DM). Più specificamente, questo VC mirava a motivare gli adulti con DM a ridurre sintomi di depressione, ansia, stress, il disagio emotivo legato al diabete, e a migliorare il loro benessere, incoraggiandoli ad acquisire e coltivare strategie di coping psicosociale sano. Queste abilità di coping facevano riferimento alle linee guida dell'AADE e quindi alla pratica della meditazione; in questo studio è stata, infatti, applicata la Mindfulness-Based Cognitive Therapy. La presente tesi è articolata secondo tre studi. Lo studio 1 mirava a fornire prove meta-analitiche sull'efficacia degli interventi eHealth nel sostenere il benessere psicosociale e medico degli adulti con T1DM o T2DM. Lo studio 2 mirava a testare il prototipo del VC simulato, cioè Wizard of Oz (WOZ), attraverso la piattaforma di messaggistica WhatsApp per 6 settimane, con due sessioni a settimana. In particolare, questo studio ha indagato l'accettabilità preliminare e la User Experience (UX) del protocollo di intervento, che sarà incorporato nel futuro VC. Infatti, il metodo di progettazione è stato duplice. Da un lato, è stato applicato il metodo WOZ, in cui gli studenti di psicologia credevano di interagire con un VC; invece, stavano comunicando con un essere umano. Dall'altro lato, è stato utilizzato il modello Obesity-Related Behavioural Intervention Trials (ORBIT), in particolare le sue prime fasi, poiché favorisce un approccio iterativo. Lo studio 3, seguendo le fasi successive del modello ORBIT, mirava a valutare l'efficacia preliminare del VC, chiamato Motibot - abbreviazione di Motivational bot - sviluppato attraverso una combinazione di Natural Language Processing (NLU) e regole pre-strutturate. Un totale di 13 adulti italiani con DM (Mage = 30.08, SD = 10.61) hanno interagito con Motibot attraverso l'applicazione di messaggistica Telegram per 12 sessioni, in cui il paziente poteva pianificare l'appuntamento secondo le sue esigenze: ha interagito con Motibot una o due sessioni a settimana. Motibot è stato percepito come motivante, incoraggiante e capace di innescare un'auto-riflessione sulle proprie emozioni: gli utenti e i pazienti hanno riferito di aver avuto un'esperienza molto positiva con Motibot. Motibot può essere uno strumento utile per fornire supporto psicosociale agli adulti con DM; potrebbe essere prescritto dal diabetologo come misura preventiva per il benessere del paziente e/o quando il paziente presenta sintomi psicosociali lievi e moderati. L'approccio di design centrato sull'utente e il concetto di bidirezionalità tra fattori psicosociali e medici sono punti chiave nello sviluppo di un trattamento digitale personalizzato.Diabetes Mellitus (DM) is a self-managed, metabolic disease, in which if the individual is unwilling, unmotivated, or unable to regularly self-manage their DM, the medical and psychosocial outcomes will be poor. Indeed, DM is more than a physical health condition: it has behavioural, physiological, psychological, and social impacts, and demands high levels of motivation in order to follow the clinical recommendations and adopt healthy behaviours. To this end, the American Association of Diabetes Educators (AADE) guidelines introduced the healthy coping construct to identify healthy coping strategies for reducing symptoms of depression, anxiety, stress, and diabetes-related emotional distress while also improving the well-being of adults with DM. Virtual Coaches (VCs) have recently become more prevalent in the support and management of common barriers in the context of adherence to healthy behaviours among adults with DM, in particular those regarding medical and physical behaviours. However, few VCs were found to be specifically aimed at providing psychosocial support to adults with DM. The main aim of the present thesis was, indeed, the development and implementation of a VC for the provision of psychosocial support to adults with Type 1 (T1DM) or Type 2 DM (T2DM). More specifically, this VC aimed at motivating adults with DM to reduce depression, anxiety, perceived stress symptoms, diabetes-related emotional distress, and improve their well-being, by encouraging them to acquire and cultivate psychosocial healthy coping strategies. These coping skills referred to the AADE guidelines and thus to practicing meditation; in this study, the Mindfulness-Based Cognitive Therapy has been applied. The present thesis is articulated according to three studies. Study 1 aimed at providing meta-analytical evidence on the efficacy of eHealth interventions in supporting the psychosocial and medical well-being of adults with T1DM or T2DM. Study 2 aimed at testing the prototype of the simulated VC, namely Wizard of Oz (WOZ), via the WhatsApp messaging platform for 6-week, with two sessions per week. In particular, this study investigated the preliminary acceptability and the User Experience (UX) of the intervention protocol, which will be incorporated into the future VC. Indeed, the design method was two-fold. On the one hand, the WOZ method was applied, in which psychology students believed that they were interacting with a VC, instead they were communicating with a human being. On the other hand, the Obesity-Related Behavioural Intervention Trials (ORBIT) model was used, particularly its early phases, since it favours an iterative approach. Study 3, following the next phases of the ORBIT model, aimed at assessing the preliminary efficacy of the VC, called Motibot—the abbreviation for Motivational bot—developed through a combination of Natural Language Processing (NLU) and hand-crafted rules. A total of 13 Italian adults with DM (Mage = 30.08, SD = 10.61) interacted with Motibot through the Telegram messaging application for 12 sessions, in which the patient planned the appointment according to his/her needs: he/she interacted with Motibot one or two sessions per week. Therefore, Motibot was perceived as motivating, encouraging and able to trigger self-reflection on one’s own emotions: users and patients reported having a very positive experience with Motibot. Motibot, thus, can be a useful tool to provide psychosocial support to adults with DM; as such, it might be prescribed by the diabetologist as a preventive measure for the patient’s well-being and/or when the patient presents mild and moderate psychosocial symptoms. The user-centred design approach and the concept of bidirectionality between psychosocial and medical factors are key points in the development of a personalised treatment within the digital intervention

Mobile phone applications and self-management of diabetes: a systematic review with meta-analysis, meta-regression of 21 randomized trials, and GRADE

We conducted a systematic review with meta‐analysis of randomized controlled trials that evaluated the effect of diabetes apps. 1550 participants from 21 studies were included. For type 1 diabetes, a significant 0.49% reduction in HbA1c was seen (95%CI 0.04 to 0.94; I2=84%), with unexplained heterogeneity and a low GRADE of evidence. For type 2 diabetes, using diabetes apps was associated with a mean reduction of 0.57% (95%CI 0.32 to 0.82, I2=77%). The results had severe heterogeneity that was explained by the frequency of HCP feedback. In studies with no HCP feedback, low frequency, and high frequency HCP feedback, the mean reduction is 0.24% (95%CI ‐0.02 to 0.49; I2=0%), 0.33% (95%CI 0.07 to 0.59; I2=47%), and 1.12% (95%CI 0.91 to 1.32; I2=0%) respectively, with high GRADE of evidence. There is evidence that diabetes apps improve glycemic control in type 1 diabetes patients. A reduction of 0.57% in HbA1c was found in type 2 diabetes patients. However, HCP functionality is important to achieve clinical effectiveness. Futures studies need to explore the cost‐effectiveness of diabetes apps and optimal intensity of HCP feedback

Interactive remote patient monitoring devices for managing chronic health conditions: systematic review and meta-analysis

Background: Telemedicine is an expanding and feasible approach to improve medical care for patients with long-term conditions. However, there is a poor understanding of patients’ acceptability of this intervention and their rate of uptake. Objective: To systematically review the current evidence on telemonitoring in the management of patients with long-term conditions, and to evaluate the patients’ uptake and acceptability of this technology. Methods: MEDLINE, SCOPUS, and CENTRAL were searched from date of inception to 5 February 2021, with no language restrictions. Studies were eligible for inclusion if they reported any of the following outcomes: (i) intervention uptake and adherence; (ii) study retention; (iii) patient acceptability, satisfaction and experience using intervention: (iv) changes in physiological values; (v) all-cause and cardiovascular related hospitalization; (vi) all-cause and disease specific mortality; (vii) patient-reported outcome measures; (viii) quality of life. Two reviewers independently assessed articles for eligibility. Results: Ninety-six studies studies were included and fifty-eight were pooled for meta-analyses. Meta-analyses showed reduction in mortality (RR= 0.71, 95% CI 0.56 to 0.89, P=0.003, I2=0%); and improvements in BP (MD -3.85 mmHg, 95% CI -7.03 to -0.68, P<.02, I2= 100%) and HbA1c (MD -0.33, 95% CI -0.57 to -0.09, P=.008, I2= 99%); but no significant improvements in quality of life (MD 1.45, 95% CI -0.10 to 3, P=.07, I2=80%); and increased risk of hospitalization (RR 1.02, 95% CI 0.85 to 1.23, P=.81, I2=79%) with telemonitoring compared to usual care. Twelve studies reported adherence outcomes and nine on satisfaction/acceptance, however heterogeneity in the assessment methods meant meta-analysis could not be performed. Conclusion: Telemonitoring is a valid alternative to usual care, reducing mortality and improving self-management of the disease, with patients reporting good satisfaction and adherence. Further studies are required to address some potential concerns regarding higher hospitalisation rates and a lack of a positive impact on patients’ quality of life. This systematic review was registered on PROSPERO (CRD42021236291)

Evaluation of the Effect of the Clinical-Decision-Support Systems on Diabetes Management: A Multivariate Meta-Analysis Comparison with Univariate Meta-Analysis

The advantage of using meta-analysis lies in its ability in providing a quantitative summary of the findings from multiple studies. The aim of this dissertation was first to conduct a simulation study in order to understand what factors (sample size, between-study correlation, and percent of missing data) have a significant effect on meta-analysis estimates and whether using univariate or multivariate meta-analysis would produce different estimates. The second goal of this study was to evaluate the effect of clinical decision support systems CDSS on diabetes care management by conducting three separate univariate meta-analyses and one multivariate meta-analysis. CDSS are health information technology systems that analyze data within electronic health records (EHR) to help make decisions about a patient\u27s care. Several studies reported inconsistent conclusions about how effective CDSSs are on diabetes care management based on three indicators. Low-density lipoproteins (LDL), glycated hemoglobin (HbA1c), and blood pressure (PB) have been used as indicators of diabetes care management according to the National Institute for Health and Care Excellence (NICE) guidelines. To combine the results from studies that evaluate the effect of CDSSs on diabetes care management, meta-analysis was used. The results of the two univariate and multivariate meta-analyses were compared. The simulation study indicated that MVMA was less affected by missing values compared to UVMA. However, both methods performed equally when no missing data were present. The standard errors of the estimates in both methods were reduced by increasing the sample size with more reduction in standard errors found in MVMA. The results of UVMA and MVMAs of CDSSs’ effect concluded that CDSSs had a significant effect on reducing levels of HbA1c. CDSSs was only significant on LDL when UVMA was applied while pulse pressure (PP) was only affected by CDSSs in the case of MVMA with deleted missing values. CDSSs in general could have a potential effect on diabetes care management. The results of the simulation and the meta-analyses of the CDSSs indicated that MVMA performed slightly better at different sample sizes and percent of missingness levels than did UVMA

Type 2 diabetes patients assessment of the COMODITY12 mHealth system

Background: Patient acceptance is one of the major barriers toward widespread use of mHealth. The aim of this study was to assess patients’ experience with their use of COMMODITY12 telehealth system. Methods: DM2 patients assessed COMMODITY12 system after its 6 weeks’ long use within clinical trial. Patients opinions were collected with 7-item questionnaire, assessing different aspects of system use, as well as EuroQol-5D-5L generic questionnaire, assessing health-related quality of life. Results: Thirty patients (female, 13, male, 17, mean age +/- SD 59.9 +/- 5.3) completed study. All dimensions of experience with system use were assessed well, with maximum values for clearness of instructions, and ease of use (4.80, and 4.63, respectively). Health related quality of life, as assessed with general utility measure, improved significantly (P<0.05). Conclusions: Study proved that the COMODITY12 system is accepted well by type 2 diabetes patients taking part in clinical trial. Nevertheless, before future commercialisation of the system, several minor problems identified during the study need to be addressed