Appropriation of Mobile Health for Diabetes Self-Management: Lessons From Two Qualitative Studies

Abstract

Background To achieve clarity on mobile health’s (mHealth’s) potential in the diabetes context, it is necessary to understand potential users’ needs and expectations, as well as the factors determining their mHealth use. Recently, a few studies have examined the user perspective in the mHealth context, but their explanatory value is constrained because of their limitation to adoption factors. Objective This paper uses the mobile phone appropriation model to examine how individuals with type 1 or type 2 diabetes integrate mobile technology into their everyday self-management. The study advances the field beyond mere usage metrics or the simple dichotomy of adoption versus rejection. Methods Data were gathered in 2 qualitative studies in Singapore and Germany, with 21 and 16 respondents, respectively. Conducting semistructured interviews, we asked respondents about their explicit use of diabetes-related apps, their general use of varied mobile technologies to manage their disease, and their daily practices of self-management. Results The analysis revealed that although some individuals with diabetes used dedicated diabetes apps, most used tools across the entire mobile-media spectrum, including lifestyle and messaging apps, traditional health information websites and forums. The material indicated general barriers to usage, including financial, technical, and temporal restrictions. Conclusions In sum, we find that use patterns differ regarding users’ evaluations, expectancies, and appropriation styles, which might explain the inconclusive picture of effects studies in the diabetes mHealth context.

The multi-faceted usage patterns of nutrition apps: a survey on the appropriation of nutrition apps among German-speaking users of MyFitnessPal

“…Since maintenance or achievement of health plays a major role, these users don’t need to be made aware of the relevance of a healthy lifestyle but might profit from recommendations by doctors or peers for suitable and easy-to-use apps. As Rossmann et al [ 34 ] showed in their study with diabetic patients, recommendations by doctors can be an important driver of app use. In turn, this user type will be a useful multiplier to communicate good experiences with an app to others, since interpersonal communication about the app in addition to normative and symbolic evaluations, especially the use of a cutting-edge nutrition app, are strong predictors of this appropriation pattern.…”

“…So far, the MPA model has not only been applied to study the appropriation process of the innovation bundle mobile phone in total but in its basic principles and accordingly adapted forms also to study further areas and mobile applications, such as the mobile web [ 31 ], mobile Facebook use [ 32 ], or the relationship between mobile phone appropriation and migrant acculturation [ 33 ]. In the health domain, the model has already been applied to the study of diabetes apps and has unveiled their specific appropriation patterns [ 34 ]. Hence, as suggested by Wirth et al [ 25 ], our first research question is:…”

Preferences for mHealth Technology and Text Messaging Communication in Patients With Type 2 Diabetes: Qualitative Interview Study

“…Related literature beyond text messaging programs about mobile apps reveals findings that are similar to ours. Patients have strong preferences for diabetes apps that are easy and efficient to use [43,44], and strong integration in patients' daily routines has also been noted as desired features of mobile apps [45,46]. Similarly, communication preferences themselves have been thought to be highly individual [47].…”

A qualitative evidence synthesis of users’ experience of mobile health applications in the self-management of type 2 diabetes

“…This consideration of what is "data", reflects previous methods used in framework synthesis. 26,27 In the studies including participants with both Type 1 and 2 Diabetes, 15,28,29 only data pertaining to participants with Type 2 Diabetes was included in the analysis. In addition, using the software program Microsoft® Excel®, MON and MD independently extracted pertinent information about each study's characteristics, i.e.…”

“…14 The scoping review revealed an increased recent interest in exploring people's use of mHealth apps through qualitative approaches. 15,16,17 Qualitative approaches provide rich data on consumers' experiences which can inform app innovation. 18 In this context, the aim of this qualitative evidence synthesis was to identify and synthesise qualitative research relating to experiences of using mobile health (mHealth) applications to aid selfmanagement of Type 2 Diabetes.…”