Design of an mHealth App for the Self-management of Adolescent Type 1 Diabetes: A Pilot Study

By J. Cafazzo, Mark J. A. Casselman, N. Hamming, D. Katzman, M. Palmert. Journal of Medical Internet Research, 2012

698 citations recorded by the source corpus.

Background The use of mHealth apps has shown improved health outcomes in adult populations with type 2 diabetes mellitus. However, this has not been shown in the adolescent type 1 population, despite their predisposition to the use of technology. We hypothesized that a more tailored approach and a strong adherence mechanism is needed for this group. Objective To design, develop, and pilot an mHealth intervention for the management of type 1 diabetes in adolescents. Methods We interviewed adolescents with type 1 diabetes and their family caregivers. Design principles were derived from a thematic analysis of the interviews. User-centered design was then used to develop the mobile app bant. In the 12-week evaluation phase, a pilot group of 20 adolescents aged 12–16 years, with a glycated hemoglobin (HbA1c) of between 8% and 10% was sampled. Each participant was supplied with the bant app running on an iPhone or iPod Touch and a LifeScan glucometer with a Bluetooth adapter for automated transfers to the app. The outcome measure was the average daily frequency of blood glucose measurement during the pilot compared with the preceding 12 weeks. Results Thematic analysis findings were the role of data collecting rather than decision making; the need for fast, discrete transactions; overcoming decision inertia; and the need for ad hoc information sharing. Design aspects of the resultant app emerged through the user-centered design process, including simple, automated transfer of glucometer readings; the use of a social community; and the concept of gamification, whereby routine behaviors and actions are rewarded in the form of iTunes music and apps. Blood glucose trend analysis was provided with immediate prompting of the participant to suggest both the cause and remedy of the adverse trend. The pilot evaluation showed that the daily average frequency of blood glucose measurement increased 50% (from 2.4 to 3.6 per day, P = .006, n = 12). A total of 161 rewards (average of 8 rewards each) were distributed to participants. Satisfaction was high, with 88% (14/16 participants) stating that they would continue to use the system. Demonstrating improvements in HbA1c will require a properly powered study of sufficient duration. Conclusions This mHealth diabetes app with the use of gamification incentives showed an improvement in the frequency of blood glucose monitoring in adolescents with type 1 diabetes. Extending this to improved health outcomes will require the incentives to be tied not only to frequency of blood glucose monitoring but also to patient actions and decision making based on those readings such that glycemic control can be improved.

Subfields: Endocrinology, Diabetes and Metabolism, General Health Professions

View Paper: https://www.semanticscholar.org/paper/9f4eca8a225564db74a3d358379964e4fa66603e

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In General Health Professions

Citations in the corpus

Mobile Applications for Diabetics: A Systematic Review and Expert-Based Usability Evaluation Considering the Special Requirements of Diabetes Patients Age 50 Years or Older (2014, background): “Within the health care sector, apps are supporting the management of illnesses, thereby promoting health awareness and well-being [3-5].”
Mobile medical and health apps: state of the art, concerns, regulatory control and certification (2014, background): “Patients with diabetes may synchronize a glucometer attachment to their mobile device to track blood glucose and share the data through an internet connection [67,68].”
A qualitative study of user perceptions of mobile health apps (2016, background): “There have been a number of intervention studies based on mobile apps and most of these focused on specific medical issues such as diabetes [3, 4], pain management [5], weight loss [6, 7], etc.”
"Working out for likes": An empirical study on social influence in exercise gamification (2015, background): “…Ziefle (2013) Exercise Kinect-based exergame – Game performance not affected by performance motivation, but by gamer type – Positive effect on perceived pain Cafazzo et al. (2012) Health Gamified mHealth application for diabetes – Increase of 50% in daily average frequency of blood glucose…”
mHealth consumer apps: the case for user-centered design. (2012, background): “6 measurements per day).(23) Although the pilot was limited to a small, single-site convenience sample with no control group, ongoing evaluation iterations combined with a randomized controlled trial will allow us to generalize the findings and determine the precise efficacy of the intervention.”
App Features for Type 1 Diabetes Support and Patient Empowerment: Systematic Literature Review and Benchmark Comparison (2018, neutral): “Ryan [17] Clemens [16] Kirwan [15] Goyal [14] Cafazzo [13] Castensøe-Seidenfaden [ Clemens and Staggs [16] reported a retrospective study on 81 youth T1DM patients who used a mobile app connected to a glucose meter, showing that data synchronizations were associated with an increased rate of SMBG…”
A game plan: Gamification design principles in mHealth applications for chronic disease management (2016, methodology): “21 Exit interviews indicated that the reward system was motivating to the participants.”
Behavioral Functionality of Mobile Apps in Health Interventions: A Systematic Review of the Literature (2015, background): “Cafazzo et al [23] reported no measurable change in HbA1c, although glucose monitoring did increase during the intervention period.”