Barriers and Drivers Regarding the Use of Mobile Health Apps Among Patients With Type 2 Diabetes Mellitus in the Netherlands: Explanatory Sequential Design Study

Abstract

Background Self-monitoring of blood glucose levels, food intake, and physical activity supports self-management of patients with type 2 diabetes mellitus (T2DM). There has been an increase in the development and availability of mobile health apps for T2DM. Objective The aim of this study is to explore the actual use of mobile health apps for diabetes among patients with T2DM and the main barriers and drivers among app users and nonusers. Methods An explanatory sequential design was applied, starting with a web-based questionnaire followed by semistructured in-depth interviews. Data were collected between July and December 2020. Questionnaire data from 103 respondents were analyzed using IBM SPSS Statistics (version 25.0). Descriptive statistics were performed for the actual use of apps and items of the Unified Theory of Acceptance and Use of Technology (UTAUT). The UTAUT includes 4 key constructs: performance expectancy (the belief that an app will help improve health performance), effort expectancy (level of ease associated with using an app), social influence (social support), and facilitating conditions (infrastructural support). Differences between users and nonusers were analyzed using chi-square tests for individual items. Independent 2-tailed t tests were performed to test for differences in mean scores per the UTAUT construct. In total, 16 respondents participated in the interviews (10 users and 6 nonusers of apps for T2DM). We performed content analysis using a deductive approach on all transcripts, guided by the UTAUT. Results Regarding actual use, 55.3% (57/103) were nonusers and 44.7% (46/103) were users of apps for T2DM. The main driver for the use of apps was the belief that using apps for managing diabetes would result in better personal health and well-being. The time and energy required to keep track of the data and understand the app were mentioned as barriers. Mean scores were significantly higher among users compared with nonusers of apps for T2DM for the constructs performance expectancy (4.06, SD 0.64 vs 3.29, SD 0.89; P<.001), effort expectancy (4.04, SD 0.62 vs 3.50, SD 0.82; P<.001), social influence (3.59, SD 0.55 vs 3.29, SD 0.54; P=.007), and facilitating conditions (4.22, SD 0.48 vs 3.65, SD 0.70; P<.001). On the basis of 16 in-depth interviews, it was recognized that health care professionals play an important role in supporting patients with T2DM in using apps. However, respondents noticed that their health care professionals were often not supportive of the use of apps for managing diabetes, did not show interest, or did not talk about apps. Reimbursement by insurance companies was mentioned as a missing facilitator. Conclusions Empowering health care professionals’ engagement is of utmost importance in supporting patients with T2DM in the use of apps. Insurance companies can play a role in facilitating the use of diabetes apps by ensuring reimbursement.

App Design Features Important for Diabetes Self-management as Determined by the Self-Determination Theory on Motivation: Content Analysis of Survey Responses From Adults Requiring Insulin Therapy

“…App functions can facilitate supportive interaction by sharing data or app reports with clinicians and "loved ones" to gain support for behavior change. This is consistent with several studies that showed data sharing or showing data from the mobile devices with their clinicians during a medical visit is highly valuable for patients [50,54,55]. Greater app interactivity with a clinician appears to improve glycemic control [11,56].…”

“…Greater app interactivity with a clinician appears to improve glycemic control [11,56]. A simple explanation for this finding may be that successful diabetes self-management takes teamwork [54,55]. Informal coaching support by other people or even a virtual coach in an app is valuable.…”

Mobile Health Apps for the Control and Self-management of Type 2 Diabetes Mellitus: Qualitative Study on Users’ Acceptability and Acceptance

“…Although there is a wide array of apps currently available, they are not yet integrated in routine diabetes care. Previous studies have described that end users, staffing, technology, systems, clinical and cultural issues, and costs hinder the acceptance and implementation of mobile health apps for diabetes control and self-management in routine care [15][16][17][18].…”

Overcoming the struggle of living with type 2 diabetes – diabetes specialist nurses’ and patients’ perspectives on digital interventions

“…Most previous research in this area has focused on either the patient or DSN perspective; thus, studies that integrate aspects from both sides are lacking [14,15]. Notably, only 19 of 47 countries in Europe recognize diabetes nursing as a specialty and provide diabetes-specific education for nurses [16].…”