Data, Data Everywhere, and Still Too Hard to Link: Insights from User Interactions with Diabetes Apps

For those with chronic conditions, such as Type 1 diabetes, smartphone apps offer the promise of an affordable, convenient, and personalized disease management tool. How- ever, despite significant academic research and commercial development in this area, diabetes apps still show low adoption rates and underwhelming clinical outcomes. Through user-interaction sessions with 16 people with Type 1 diabetes, we provide evidence that commonly used interfaces for diabetes self-management apps, while providing certain benefits, can fail to explicitly address the cognitive and emotional requirements of users. From analysis of these sessions with eight such user interface designs, we report on user requirements, as well as interface benefits, limitations, and then discuss the implications of these findings. Finally, with the goal of improving these apps, we identify 3 questions for designers, and review for each in turn: current shortcomings, relevant approaches, exposed challenges, and potential solutions

Designing for Diabetes Decision Support Systems with Fluid Contextual Reasoning

Type 1 diabetes is a potentially life-threatening chronic condition that requires frequent interactions with diverse data to inform treatment decisions. While mobile technolo- gies such as blood glucose meters have long been an essen- tial part of this process, designing interfaces that explicitly support decision-making remains challenging. Dual-process models are a common approach to understanding such cog- nitive tasks. However, evidence from the first of two stud- ies we present suggests that in demanding and complex situations, some individuals approach disease management in distinctive ways that do not seem to fit well within existing models. This finding motivated, and helped frame our second study, a survey (n=192) to investigate these behaviors in more detail. On the basis of the resulting analysis, we posit Fluid Contextual Reasoning to explain how some people with diabetes respond to particular situations, and discuss how an extended framework might help inform the design of user interfaces for diabetes management

Patient attitudes about financial incentives for diabetes self-management: A survey

AIM: To study the acceptability of incentives for behavior changes in individuals with diabetes, comparing financial incentives to self-rewards and non-financial incentives. METHODS: A national online survey of United States adults with diabetes was conducted in March 2013 (n = 153). This survey was designed for this study, with iterative testing and modifications in a pilot population. We measured the demographics of individuals, their interest in incentives, as well as the perceived challenge of diabetes self-management tasks, and expectations of incentives to improve diabetes self-management (financial, non-financial and self-rewards). Using an ordered logistic regression model, we assessed the association between a 32-point score of the perceived challenge of the self-management tasks and the three types of rewards. RESULTS: Ninety-six percent of individuals were interested in financial incentives, 60% in non-financial incentives and 72% in self-rewards. Patients were less likely to use financial incentives when they perceived the behavior to be more challenging (odds ratio of using financial incentives of 0.82 (95%CI: 0.72-0.93) for each point of the behavior score). While the effectiveness of incentives may vary according to the perceived level of challenge of each behavior, participants did not expect to need large amounts to motivate them to modify their behavior. The expected average amounts needed to motivate a 5 lb weight loss in our population and to maintain this weight change for a year was $258 (interquartile range of$10-100) and $713 (interquartile range of$25-250) for a 15 lb weight loss. The difference in mean amount estimates for 5 lb and 15 lb weight loss was significant (P < 0.001). CONCLUSION: Individuals with diabetes are willing to consider financial incentives to improve diabetes self-management. Future studies are needed to explore incentive programs and their effectiveness for diabetes

Perceptions of conflicting information about long-term medications: a qualitative in-depth interview study of patients with chronic diseases in the Swiss ambulatory care system

Objective Patients with multiple long-term conditions visit various healthcare professionals and are exposed to medication information from various sources causing an increased risk of patients perceiving contradictory medication information. The aims of this study are to: (1) characterise conflicting medication information perceived by patients with long-term conditions, (2) better understand the related impact on patients’ medication self-management and healthcare system navigation and (3) explore ways in which such events could be prevented. Design This study was conducted through qualitative semistructured interviews. Data were analysed using thematic analysis. Setting Community pharmacies and medical centres in Geneva, Switzerland. Participants This study included outpatients from April 2019 to February 2020. Patients were included after participating in a quantitative survey of perceived conflicting information about medications for long-term diseases. Methods Semistructured audiotaped interviews of 20 to 60 min following a pre-established interview guide to explore participants’ perceptions of conflicting information. Interviews were transcribed verbatim, and a thematic analysis was conducted with inductive and deductive coding using MAXQDA (2018, Release 18.2.3). Results Twenty-two patients were interviewed, until data saturation, mentioning indication or need for a medication as the main topic of conflicting information between two healthcare professionals. Perceived conflicting information often resulted from insufficient information provided and poor communication leading to confusion, doubts and medication non-adherence. Patients expected more information and more interprofessional communication on their medications. As a result of conflicting information, most participants learnt or were learning to take an active role and become partners of the healthcare providers. Conclusion The need to strengthen and improve communication and interprofessional collaborative practice among healthcare professionals and with the patient is emerging to increase the quality and consistency of information about medications, and consequently, to ensure better use and experience of medications.</p

An exploration of attitudes toward the use of patient incentives to support diabetes self-management

Objective: To improve our understanding of the potential of incentives to enhance diabetes self-management (type 1 and type 2) and to integrate incentives into a conceptual model of diabetes self-management over time.Design: A qualitative analysis of in-depth individual interviews with 12 patients and 9 providers.Main outcome measures: Influence of time on patients' needs for diabetes self-management technologies and on the use of incentives to drive behavioural changes.Results: Ten of the 12 participants with diabetes (83%) were interested in using financial incentives to improve their diabetes self-management. We found that incentives can play two key roles in diabetes self-management: guide the learning phase during the creation of habits; and serve as an acknowledgement of efforts made in the stable phase, when providers typically only focus on the patients' failures at self-management.Conclusion: Patients seem receptive to the idea of financial incentives, which have the potential to support diabetes self-management through either small monetary amounts or tangible rewards. Incentives hold promise for supporting behaviour changes, especially in early stages of diabetes, but they require careful planning to avoid the undesired consequence of decreased intrinsic motivation.</p

Patients’ perceptions of conflicting information on chronic medications: a prospective survey in Switzerland

ObjectiveThe number of patients with chronic diseases and subsequent visits to various healthcare professionals has been rising over the past decades, exposing patients to potential risks of receiving conflicting medication information. This study aims to investigate the prevalence of conflicting information on medications perceived by chronic patients in Switzerland and to understand its impact on patients’ medication self-management and navigation in the healthcare system. ParticipantsThis cross-sectional study included adult patients taking at least one prescribed medication for at least 6 months, who had visited at least two physicians in the past 3 months. Main outcome measuresData on patients’ perceptions of conflicting information were collected in person through a 17-item questionnaire available on paper and electronically with four domains: (1) whether the patient had perceived any conflicting information, (2) categories of conflicting information, (3) impact and (4) sources involved in the conflicting information. ResultsOf the 405 included patients, 47% perceived conflicting information related to one or more medication topics including indication, schedule, dosage, risk, severity or duration of side effects. Patients who perceived conflicting information were prescribed more drugs than those perceiving no conflicting information (p&lt;0.01). Consequently, 65% of the participants modified their navigation of the healthcare system and 34% reported medication non-adherence. General practitioners (82%), specialist physicians (74%) and pharmacists (49%) were the healthcare professionals most often involved in conflicting information. Experience with the medication, its package insert and significant others were more frequently involved in conflicting information than internet or social media. ConclusionNearly half the patients in our study perceived conflicting information in the outpatient healthcare system, which can decrease medication effectiveness and pose safety issues. This issue is widely overlooked and unaddressed. Consistency of information among healthcare providers in partnership with patients should be reinforced through guidelines and new models of interprofessional care.</p

Are role perceptions of residents and nurses translated into action?

Abstract Background Effective interprofessional collaboration (IPC) has been shown to depend on clear role definitions, yet there are important gaps with regard to role clarity in the IPC literature. The goal of this study was to evaluate whether there was a relationship between internal medicine residents’ and nurses’ role perceptions and their actual actions in practice, and to identify areas that would benefit from more specific interprofessional education. Methods Fourteen residents and 14 nurses working in internal medicine were interviewed about their role perceptions, and then randomly paired to manage two simulated clinical cases. The authors adopted a general inductive approach to analyze the interviews. They identified 13 different role components that were then compared to data from simulations. Descriptive and kappa statistics were used to assess whether there was a relationship between role components identified in interviews and those performed in simulations. Results from these analyses guided a further qualitative evaluation of the relationship between role perceptions and actions. Results Across all 13 role components, there was an overall statistically significant, although modest, relationship between role perceptions and actions. In spite of this relationship, discrepancies were observed between role components mentioned in interviews and actions performed in simulations. Some were more frequently performed than mentioned (e.g. “Having common goals”) while others were mentioned but performed only weakly (e.g. “Providing feedback”). Conclusions Role components for which perceptions do not match actions point to role ambiguities that need to be addressed in interprofessional education. These results suggest that educators need to raise residents’ and nurses’ awareness of the flexibility required to work in the clinical setting with regard to role boundaries

Details of each case with their relative relevant diagnostic hypotheses^*.

<p>* COPD: chronic obstructive pulmonary disease; NSTEMI: non-ST elevation myocardial infarction.</p

Priority action choices across 11 short clinical scenarios.

*<p>The denominators (84, 69, 63) correspond to the number of valid responses through the cases mentioned as priority actions by the participants.</p

Residents’ and nurses’ expressions of leadership and autonomy.

<p>* i.v.: intravenous(ly).</p