Differential Influences of Social Support on App Use for Diabetes Self-Management – a Mixed Methods Approach

Abstract

Background The impact of social support on diabetes management and health outcomes has been investigated comprehensively, with recent studies examining social support delivered via digital technologies. This paper argues that social support has an impact on the use of diabetes technologies. Specifically, we postulate differences between the impact of healthcare professional versus non-professional (family/friends) support on mobile app use for diabetes self-management.Methods This research employed a triangulation of methods including exploratory semi-structured face-to-face interviews (N= 21, Study 1) and an online survey (N= 65, Study 2) with adult type 1 and type 2 diabetes patients. Thematic analysis (Study 1) was used to explore the relevance of social support (by professionals versus non-professionals) for diabetes app use. Binary logistic regression (Study 2) was applied to compare healthcare decision-making, healthcare-patient communication, and the support by the personal patient network as predictors of diabetes app use, complemented by other predictors from self-management and technology adoption theory.Results The interviews (Study 1) demonstrated that (technology-supported) shared decision-making and supportive communication by healthcare professionals depended on the medical specialty of attending physicians. The personal patient network was perceived as either facilitating or hindering the use of mHealth for self-management. Binary logistic regression (Study 2) showed that the specialty of the physician significantly predicted the use of diabetes apps, with supervision by diabetes specialists increasing the likelihood of app use (as opposed to general practitioners). In addition, specialist care positively related to a higher chance of shared decision-making and better physician-patient communication. The support by the personal patient network predicted diabetes app use in the opposite direction, with lower family/friend support increasing the likelihood of app use.Conclusion The results emphasize the relevance of support by healthcare professionals and by the patient network for diabetes app use and disclose differences from existing literature. In particular, we found that the use of diabetes apps may increase in the absence of social support by family or friends (e.g., compensation for lack of support), and that use of diabetes apps may decrease when support is high (e.g., no perceived need to use technology). Implications for practice are discussed.