Evaluation of the Implementation of a Mobile Health Application to Support Dutch Primary Care for Diabetes: A Qualitative Study (Preprint)

Abstract

BACKGROUND Over 1 million Dutch people have diabetes, 90% of whom have type 2 diabetes. Studies show that lifestyle plays an important role in the course of type 2 diabetes. MiGuide is an online platform that helps people adopt and maintain lifestyle changes in their daily lives. The platform is integrated into existing diabetes care within primary care. Previous research has shown that the implementation of new (eHealth) interventions is challenging, which is at the expense of effectiveness. Mapping out the barriers and success factors of the implementation process is essential, so that eHealth interventions such as MiGuide can be used effectively in regular healthcare. OBJECTIVE This study aimed to evaluate the implementation of MiGuide within Dutch primary care. METHODS A qualitative study design was used, supplemented by quantitative data from patients. Five general practices participated. Three focus groups (at baseline, after six months and after 12 months) were conducted with three general practitioners, three focus groups with eight specialized practice nurses (divided into two separate groups with four participants per group), two focus groups (at six months and after 12 months) with five patients and two focus groups (at baseline and after 12 months) with four stakeholders from the management of the care group. The implementation process was discussed with HCPs and management, and usage and user-friendliness were discussed with patients. The Framework method was used to analyse the data. The following quantitative data were collected: patient characteristics, user data and questionnaires at baseline and six months assessing quality of life, usability and diabetes self-care. The quantitative data were examined with exploratory analyses. RESULTS Four themes were found in the qualitative data: “innovation”, “capability, motivation and opportunity”, “processes”, and “setting”. Different factors within these themes played an essential role throughout the implementation process, such as facilities, technical difficulties, motivation, COVID-19 and current work processes. Areas of improvement were also identified. The supplemented quantitative data showed that usability scored below average at six months (M=53.8, n=8). Participants had a mean score of 0.84 on the EQ-5D and 81.9 on the EQ-VAS at baseline. Moreover, the average amount of days someone exercised was 4.2 and that someone ate a generally healthy diet was 5.1. Insufficient data about the quality of life and diabetes self-care was collected at six months and therefore not presented in this study. CONCLUSIONS Implementation is a complex process with multiple barriers and facilitators. It is essential to explore the use of context-specific strategies that are aligned with the implementation process phase. Further research is needed to evaluate the next version of the MiGuide platform, which is implemented in another setting with lifestyle coaches.