Long-Term Engagement With a Mobile Self-Management System for People With Type 2 Diabetes

Abstract

BackgroundIn a growing number of intervention studies, mobile phones are used to support self-management of people with Type 2 diabetes mellitus (T2DM). However, it is difficult to establish knowledge about factors associated with intervention effects, due to considerable differences in research designs and outcome measures as well as a lack of detailed information about participants’ engagement with the intervention tool.ObjectiveTo contribute toward accumulating knowledge about factors associated with usage and usability of a mobile self-management application over time through a thorough analysis of multiple types of investigation on each participant’s engagement.MethodsThe Few Touch application is a mobile-phone–based self-management tool for patients with T2DM. Twelve patients with T2DM who have been actively involved in the system design used the Few Touch application in a real-life setting from September 2008 until October 2009. During this period, questionnaires and semistructured interviews were conducted. Recorded data were analyzed to investigate usage trends and patterns. Transcripts from interviews were thematically analyzed, and the results were further analyzed in relation to the questionnaire answers and the usage trends and patterns.ResultsThe Few Touch application served as a flexible learning tool for the participants, responsive to their spontaneous needs, as well as supporting regular self-monitoring. A significantly decreasing (P<.05) usage trend was observed among 10 out of the 12 participants, though the magnitude of the decrease varied widely. Having achieved a sense of mastery over diabetes and experiences of problems were identified as reasons for declining motivation to continue using the application. Some of the problems stemmed from difficulties in integrating the use of the application into each participant’s everyday life and needs, although the design concepts were developed in the process where the participants were involved. The following factors were identified as associated with usability and/or usage over time: Integration with everyday life; automation; balance between accuracy and meaningfulness of data with manual entry; intuitive and informative feedback; and rich learning materials, especially about foods.ConclusionMany grounded design implications were identified through a thorough analysis of results from multiple types of investigations obtained through a year-long field trial of the Few Touch application. The study showed the importance and value of involving patient-users in a long-term trial of a tool to identify factors influencing usage and usability over time. In addition, the study confirmed the importance of detailed analyses of each participant’s usage of the provided tool for better understanding of participants’ engagement over time.

Improvement in Asthma Control Using a Minimally Burdensome and Proactive Smartphone Application

“…22,23 Many users report achieving mastery of self-management content described within prior apps. 22 Others report feeling burdened by intrusive alerts, repetitive content, or faulty technical features.…”

“…22,23 Many users report achieving mastery of self-management content described within prior apps. 22 Others report feeling burdened by intrusive alerts, repetitive content, or faulty technical features. 22 Decreasing user engagement due to mastery of the app content is less concerning, and likely translates into an enduring improvement in asthma knowledge.…”

“…22 Others report feeling burdened by intrusive alerts, repetitive content, or faulty technical features. 22 Decreasing user engagement due to mastery of the app content is less concerning, and likely translates into an enduring improvement in asthma knowledge. The problem of perceived burden may be addressed through design alterations.…”

Smartphone Mobile Application Delivering Personalized, Real-Time Sun Protection Advice

“…40 In our formative research, 18 some individuals predicted that they would use the mobile app to learn sun protection and then discontinue use, a trend observed with a diabetes self-management mobile app. 41 Some participants also may have tried Solar Cell and felt they already knew its advice. Increased use of Solar Cell was associated with improvements in sun protection practices and less time spent in the midday sun, so, future research on implementation strategies for mobile interventions is an important consideration both in randomized trials and when evidence-based interventions are translated more broadly.…”

Intermittent Continuance of Smart Health Devices: A Zone-of-Tolerance Perspective

“…For example, researchers indicated that most of the users followed an intermittent continuance pattern in the long-term usage of activity tracker [4], and users were accustomed to taking short breaks when using health wearables [5]. Moreover, in terms of smart health devices with specific functions, such as mobile self-management system for people with diabetes, users were prone to gradually decrease their usage frequency, instead of completely continuance or discontinuance usage [7].…”