Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers
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.
[Show description] [Hide description] DESCRIPTION: The development of a comparative effectiveness study is a task of the Diabetes Literacy Project´s work package (WP) 5 (led by Ludwig Boltzmann Institute Health Promotion Research LBIHPR). The primary research question is: Are some channels for diabetes Type II patient self-management interventions more effective than others? This working paper documents the first step in answering the primary research question: The development of an outcome framework for the Diabetes Literacy project. After an initial systematic metaliterature search in PUBMED and an assessment of the retrieved literature, WP5 research team concluded that existing studies and reviews could not provide the necessary information to consistently answer the question if some interventions are more effective than others. Different studies in the field use a plethora of psychological-, social-, behavioral-, clinical- and wellbeing-outcomes. This in fact reveals not only the field´s complexity but the many different perspectives on what may or may not be regarded as desirable outcomes of DSM interventions. In order to deal with the different kinds of DSM outcomes, WP5 research team (Ludwig Boltzmann Institute Health Promotion Research) initiated an in-depth investigation of outcomes used in the DSM literature, with the aim to develop a DSM outcome framework (DSMOF) for the Diabetes Literacy Project. This framework or map was a necessary condition for the Diabetes Literacy Project to develop rationales on how to deal, not only with questions about program comparability, but also for developing an empirical research instrument and study design.
- "One review researched the effectiveness of cell phone based interventions (Krishna, Boren, 2008). One review conducted an evaluation of web accessible tools for diabetes selfmanagement and related cardiovascular risk factors (Yu, Bahniwal et al. 2012). Finally, one review researched effectiveness of web based self-management education for cancer related chronic diseases (Kuijpers, Groen et al. 2013) The PUBMED search terms were (review[ "
[Show abstract] [Hide abstract] ABSTRACT: Dietary assessment can be challenging for many reasons, including the wide variety of foods, eating patterns and nutrients to be considered. In team-based primary care practice, various disciplines may be involved in assessing diet. Electronic-based dietary assessment (e-DA) instruments available now through mobile apps or websites can potentially facilitate dietary assessment. Providers views of facilitators and barriers related to e-DA instruments and their recommendations for improvement can inform the further development of these tools. The objective of this study was to explore provider perspectives on e-DA tools in mobile apps and websites. The exploratory sequential mixed methods design included interdisciplinary focus groups followed by a web-based survey sent to Family Health Teams throughout Ontario, Canada. Descriptive and bivariate analyses were completed. Focus group transcripts contributed to web-survey content, while interpretive themes added depth and context. 11 focus groups with 50 providers revealed varying perspectives on the use of e-DA for: 1) improving patients' eating habits; 2) improving the quality of dietary assessment; and, 3) integrating e-DA into the care process. In the web-survey 191 respondents from nine disciplines in 73 FHTs completed the survey. Dietitians reported greater use of e-DA than other providers (63% vs.19%; p = .000) respectively. There was strong interest among disciplines in the use of e-DA tools for the management of obesity, diabetes and heart disease, especially for patient self-monitoring. Barriers identified were: patients' lack of comfort with using technology, misinterpretation of e-DA results by patients, time and education for providers to interpret results, and time for providers to offer counselling. e-DA tools in mobile apps and websites may improve dietary counselling over time. Addressing the identified facilitators and barriers can potentially promote the uptake of e-DA into clinical practice.
- "For successful implementation of an innovation in PC, the new tool must be easily accessible, suit providers' day-to-day practice , and provide a certain level of comfort [55,56]. For example, when web-based tools were utilized for the management of diabetes and cardiovascular disease, the main factors that increased adoption in clinical practice were the usefulness, usability and sustainability of the in- strument . Similarly, participants in our focus groups stated that they would recommend an e-DA tool only if it was user-friendly, easily accessible, free of cost, and guided patients to complete dietary assessments electronically with little or no assistance from a health provider. "
[Show abstract] [Hide abstract] ABSTRACT: Background Management of diabetes mellitus is complex and involves controlling multiple risk factors that may lead to complications. Given that patients provide most of their own diabetes care, patient self-management training is an important strategy for improving quality of care. Web-based interventions have the potential to bridge gaps in diabetes self-care and self-management. The objective of this study was to determine the effect of a web-based patient self-management intervention on psychological (self-efficacy, quality of life, self-care) and clinical (blood pressure, cholesterol, glycemic control, weight) outcomes.Methods For this cohort study we used repeated-measures modelling and qualitative individual interviews. We invited patients with type 2 diabetes to use a self-management website and asked them to complete questionnaires assessing self-efficacy (primary outcome) every three weeks for nine months before and nine months after they received access to the website. We collected clinical outcomes at three-month intervals over the same period. We conducted in-depth interviews at study conclusion to explore acceptability, strengths and weaknesses, and mediators of use of the website. We analyzed the data using a qualitative descriptive approach and inductive thematic analysis.ResultsEighty-one participants (mean age 57.2 years, standard deviation 12) were included in the analysis. The self-efficacy score did not improve significantly more than expected after nine months (absolute change 0.12; 95% confidence interval ¿0.028, 0.263; p¿=¿0.11), nor did clinical outcomes. Website usage was limited (average 0.7 logins/month). Analysis of the interviews (n¿=¿21) revealed four themes:1) mediators of website use; 2) patterns of website use, including role of the blog in driving site traffic; 3) feedback on website; and 4) potential mechanisms for website effect.ConclusionsA self-management website for patients with type 2 diabetes did not improve self-efficacy. Website use was limited. Although its perceived reliability, availability of a blog and emailed reminders drew people to the website, participants¿ struggles with type 2 diabetes, competing priorities in their lives, and website accessibility were barriers to its use. Future interventions should aim to integrate the intervention seamlessly into the daily routine of end users such that it is not seen as yet another chore.
- "Reviews of existing diabetes websites showed that they presented didactic information of variable quality, they required advanced reading levels, and they followed a static, newspaper-format display, rather than harnessing the inherent advantages of websites, such as interactive technology , social support, and problem-solving assistance [11,13] . A systematic review of electronic diabetesrelated tools found that they had moderate but inconsistent effects on a variety of psychological and clinical outcomes, including HbA1c and weight; tools that were more interactive tools were associated with continued website use and greater clinical improvement . In addition, greater website use was correlated with greater clinical improvements: regular website users had greater reductions in HbA1c compared with intermittent users. "