Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers

Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 01/2012; 19(4):514-22. DOI: 10.1136/amiajnl-2011-000307
Source: PubMed


To identify and evaluate the effectiveness, clinical usefulness, sustainability, and usability of web-compatible diabetes-related tools.
Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, world wide web.
Studies were included if they described an electronic audiovisual tool used as a means to educate patients, care givers, or clinicians about diabetes management and assessed a psychological, behavioral, or clinical outcome.
Study abstraction and evaluation for clinical usefulness, sustainability, and usability were performed by two independent reviewers.
Of 12,616 citations and 1541 full-text articles reviewed, 57 studies met inclusion criteria. Forty studies used experimental designs (25 randomized controlled trials, one controlled clinical trial, 14 before-after studies), and 17 used observational designs. Methodological quality and ratings for clinical usefulness and sustainability were variable, and there was a high prevalence of usability errors. Tools showed moderate but inconsistent effects on a variety of psychological and clinical outcomes including HbA1c and weight. Meta-regression of adequately reported studies (12 studies, 2731 participants) demonstrated that, although the interventions studied resulted in positive outcomes, this was not moderated by clinical usefulness nor usability.
This review is limited by the number of accessible tools, exclusion of tools for mobile devices, study quality, and the use of non-validated scales.
Few tools were identified that met our criteria for effectiveness, usefulness, sustainability, and usability. Priority areas include identifying strategies to minimize website attrition and enabling patients and clinicians to make informed decisions about website choice by encouraging reporting of website quality indicators.

Download full-text


Available from: Michael Scott Orr
  • Source
    • "Due to different understandings and definitions of usability in literature [9] and a multitude of available methods for usability testing, it is not trivial to select appropriate methods that assess desired aspects of usability. Several authors deal with usability in context of health information on the World Wide Web (e.g., [6], [10], [11]). Studies from other fields, for example, design and usability assessment of the 'Nutrition Label' for privacy [12] offer valuable insights as well. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To facilitate use of patient-centered health IT applications in everyday life, a high degree of usability is required. Based on the example of a patient-centered web application, we propose a usability study design enabling developers and researchers to assess usability of patient-centered health IT applications and derive implications for their improvement. Our study design integrates tasks that subjects have to process, an associated questionnaire based on Perceived Ease of Use, Perceived Usefulness, Attitude Toward Using, and Behavioral Intention to Use, a System Usability Scale questionnaire, and focus groups. Application of the usability study design demonstrates its feasibility and provides insights for assessment of usability in related projects in research and practice.
    Full-text · Article · May 2014 · Studies in health technology and informatics
    • "There have been a number of investigations into the ability of Internet-based tools to facilitate diabetes self-management, and some have produced encouraging results [3,4]. Research into the use of diabetes portals has typically shown that access to information and support via online patient-centered tools is capable of improving health indicators for patients and engaging them in the management of their disease [4-6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Effective management and care of diabetes is crucial to reducing associated risks such as heart disease and kidney failure. With increasing access and use of the Internet, online chronic disease management is being explored as a means of providing patients with support and the necessary tools to monitor and manage their disease. The objective of our study was to evaluate the experience of patients and providers using an online diabetes management portal for patients. Participants were recruited from a large sample population of 887 for a follow-up questionnaire to be completed after 6 months of using the patient portal. Participants were presented with the option to participate in an additional interview and, if the participant agreed, a time and date was scheduled for the interview. A 5-item, open-ended questionnaire was used to capture providers' opinions of the patient portal. Providers included general practitioners (GPs), nurses, nurse practitioners (NPs), dieticians, diabetes educators (DECs), and other clinical staff. A total of 854 patients were consented for the questionnaire. Seventeen (8 male, 9 female) patients agreed to participate in a telephone interview. Sixty-four health care providers completed the five open-ended questions; however, an average of 48.2 responses were recorded per question. Four major themes were identified and will be discussed in this paper. These themes have been classified as: facilitators of disease management, barriers to portal use, patient-provider communication and relationship, and recommendations for portal improvements. This qualitative study shows that online chronic disease management portals increase patient access to information and engagement in their health care, but improvements in the portal itself may improve usability and reduce attrition. Furthermore, this study identifies a grey area that exists in the roles that GPs and AHPs should play in the facilitation of online disease management.
    No preview · Article · Nov 2012 · Journal of Medical Internet Research
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper presents a user-centered approach taken for a new peer-facilitated mobile self-care application called Mobile DSMS. Mobile DSMS is a mobile application based on a framework for collaborative disease management using mobile technologies. It allows users to form virtual peer-support groups using their cell phones. The paper sets the stage by presenting the different types of peer-support available and explains how the existing remote model can be extended to include interactive features through the use of mobile technologies. A research protocol, comprising individual interviews and a focus group, was conducted using 21 users of the target group. This paper presents the user perceptions of the system's design; what worked and what did not work. It identifies some of the barriers and social implications associated with adoption of this new form of remote self-care support. It concludes by explaining how the outcomes of a forthcoming field study are expected to advance the area of CDM and HCI using mobile devices.
    No preview · Conference Paper · Jan 2012
Show more