Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements

Abstract

BackgroundInformation technology tools such as shared patient-centered, Web-based medication platforms hold promise to support safe medication use by strengthening patient participation, enhancing patients’ knowledge, helping patients to improve self-management of their medications, and improving communication on medications among patients and health care professionals (HCPs). However, the uptake of such platforms remains a challenge also due to inadequate user involvement in the development process. Employing a user-centered design (UCD) approach is therefore critical to ensure that user’ adoption is optimal.ObjectiveThe purpose of this study was to identify what patients with type 2 diabetes mellitus (T2DM) and their HCPs regard necessary requirements in terms of functionalities and usability of a shared patient-centered, Web-based medication platform for patients with T2DM.MethodsThis qualitative study included focus groups with purposeful samples of patients with T2DM (n=25), general practitioners (n=13), and health care assistants (n=10) recruited from regional health care settings in southwestern Germany. In total, 8 semistructured focus groups were conducted. Sessions were audio- and video-recorded, transcribed verbatim, and subjected to a computer-aided qualitative content analysis.ResultsAppropriate security and access methods, supported data entry, printing, and sending information electronically, and tracking medication history were perceived as the essential functionalities. Although patients wanted automatic interaction checks and safety alerts, HCPs on the contrary were concerned that unspecific alerts confuse patients and lead to nonadherence. Furthermore, HCPs were opposed to patients’ ability to withhold or restrict access to information in the platform. To optimize usability, there was consensus among participants to display information in a structured, chronological format, to provide information in lay language, to use visual aids and customize information content, and align the platform to users’ workflow.ConclusionsBy employing a UCD, this study provides insight into the desired functionalities and usability of patients and HCPs regarding a shared patient-centered, Web-based medication platform, thus increasing the likelihood to achieve a functional and useful system. Substantial and ongoing engagement by all intended user groups is necessary to reconcile differences in requirements of patients and HCPs, especially regarding medication safety alerts and access control. Moreover, effective training of patients and HCPs on medication self-management (support) and optimal use of the tool will be a prerequisite to unfold the platform’s full potential.

Methods and Evaluation Criteria for Apps and Digital Interventions for Diabetes Self-Management: Systematic Review

“…The PRISMA diagram in Figure 1 summarizes the selection process. The confidence in the evidence was considered high in 7 articles [ 27 , 33 , 36 , 43 , 51 , 52 , 54 ]; moderate to high in 1 [ 56 ]; moderate in 17 [ 26 , 28 - 32 , 35 , 37 , 39 , 41 , 42 , 45 , 46 , 48 , 49 , 53 , 55 ], and low in 6 [ 34 , 38 , 40 , 44 , 47 , 50 ].…”

“…The number of participants in each study ranged from 7 [ 41 , 50 ] to 1041 [ 43 ]. In addition to including patients with diabetes in their evaluations, some of the studies expanded the participant group to include HCPs (8/31, 26%) [ 26 , 27 , 29 , 37 , 42 , 48 , 53 , 56 ], developers (4/31, 13%) [ 26 , 44 , 51 , 56 ], researchers (3/31, 10%) [ 29 , 38 , 44 ], informal caregivers (eg, parents, family members) (4/31, 13%) [ 29 , 44 , 53 , 56 ], and others (including experts and other unspecified individuals) (8/31, 26%) [ 26 , 29 , 32 , 37 , 38 , 48 , 55 , 56 ].…”

“…Most of the 31 included studies evaluated interventions delivered via apps (18/31, 58%) [ 29 - 34 , 36 - 39 , 41 , 46 - 49 , 52 , 54 , 56 ], followed by web (9/31, 29%) [ 27 , 28 , 35 , 43 , 45 , 50 , 51 , 53 , 55 ] and multiplatform (4/31, 13%) [ 26 , 40 , 42 , 44 ]. In the studies that conducted a randomized controlled trial, the self-management platform was the main mode of intervention compared with a standard paper diary [ 33 ], the intervention plus counseling via telephone call [ 54 ], and a plain text version of the web intervention [ 43 ] as opposed to an interactive version.…”

“…In addition, the same intervention was referred to by some of the studies: Young with Diabetes app [ 29 , 36 ], My Diabetes My Way [ 30 , 55 ], and WellDoc [ 31 , 50 ]. The evaluated digital self-management interventions targeted mostly T2D (12/31, 38%) [ 27 , 31 , 32 , 34 , 43 , 46 - 51 , 54 ], followed by T1D (7/31, 23%) [ 29 , 33 , 36 , 40 , 41 , 44 , 56 ], unspecified diabetes type (5/31, 16%) [ 26 , 37 , 39 , 53 , 55 ], gestational diabetes mellitus (4/31, 13%) [ 35 , 38 , 45 , 52 ], and T1D and T2D (3/31, 10%) [ 28 , 30 , 42 ] ( Figure 2 ).…”

“…The second most common method of evaluation was interviews (13/31 studies, 42%) [ 28 , 29 , 31 , 32 , 35 , 36 , 38 , 45 , 48 , 49 , 52 , 53 , 56 ], mainly semistructured interviews, which were used 14 times in 11 studies [ 28 , 31 , 32 , 35 , 36 , 45 , 48 , 49 , 52 , 53 , 56 ]. Other methods of evaluation that were identified in the included studies were user-group meetings (11/31, 35%) [ 26 , 27 , 29 , 37 , 40 - 42 , 45 , 47 , 48 , 56 ], health-related measures (9/31, 29%) [ 31 , 33 , 36 , 42 , 45 , 49 , 51 , 54 , 55 ], system usage analysis (8/31, 26%) [ 29 , 34 , 35 , 42 , 43 , 45 , 51 , 54 ], and other measurements (7/31, 23%) [ 26 , 37 , 38 , 44 , 48 , 51 , 55 ]. Table 1 summarizes the specific methods of evaluation, the number of times these methods were used, and the number of studies that employed these methods.…”