Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: Mixed-methods study

Background: Meaningful integration of mobile health (mHealth) applications that capture and provide feedback on important dimensions is lacking and is required to promote behavioral changes that are linked to better maternal and birth outcomes among pregnant individuals. The design and use of digital health technologies among individuals covered by public health insurance is typically overlooked and has implications for how this group can manage their health with the support of technology. Medicaid enrolled patients with type 2 diabetes (T2D) during pregnancy struggle to manage their diabetes due to clinical and social needs barriers. There is an opportunity to develop a tailored and integrated technology solution (patient mHealth application and provider dashboard) that provides a 360 degree view of the patient for this group that could improve health outcomes and address health inequities. Objective: Our objective is to describe a formative study that developed an integrated patient based mHealth and provider dashboard application system for management among Medicaid enrolled pregnant patients with T2D. Our goals were to: 1) develop a set of user specifications for the mHealth and dashboard applications; 2) develop prototypes based on user needs; and 3) collect initial impressions of the prototypes to subsequently develop refined tools that are ready for deployment. Methods: Study activities followed a double diamond framework with a participatory design mindset. We first conducted a literature review to articulate the problem. Phase I subsequently involved a qualitative inquiry of the needs faced by patients and their providers and current clinical workflows at our AMC (Discover), and brainstorming activities (Define) to ideate and define the value specifications our mHealth and dashboard applications to our end users. Phase II involved the design and development of low and high fidelity prototypes that incorporated a core set of functions based on our Phase I findings and the theoretical underpinnings of social cognitive theory (Develop). We conducted usability and cognitive tests of our high fidelity prototypes with potential users to gather feedback about the content, function, and aesthetics of the prototypes (Delivery). Results: We recruited seven patients and seven providers in our study. All participants completed Phase I, and three patients (42%) and four providers (57%) completed Phase II. We identified three themes that exemplified pregnancy experience among Medicaid enrolled individuals with T2D: managing exhaustion, adherence to a new regimen, and preparing for pregnancy. Patients expressed a core set of expected features for an mHealth application: electronically captured and managed information, access to support systems, use of diabetes technology, and help through problem solving and personalized recommendations. Providers indicated a general set of expectations for a dashboard application, including features such as dynamic and actionable data, unmet social needs, enhanced patient provider communication. We developed as is and to be swim lanes to depict clinical workflows and critical gaps, and we designed high fidelity prototypes using this information. Participants provided notable feedback to improve the mHealth application (e.g., from a content perspective, patients asked for more details about the achievement of goals) and dashboard (e.g., from a functional perspective, providers suggested to add a checklist for patient completion of educational resources related to T2D during pregnancy). For both applications, participants reported scores for the NASA Task Load Survey (TLX) that were in the 20th percentile of national TLX scores. Conclusions: Digital health tools have the ability to transform health care among Medicaid enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels, which is a precursor to experiencing a successful pregnancy and birth. Distilling patient and provider needs and preferences, and then using that information, along with prior studies and theory, to develop applications, holds great potential in tackling complicated health care issues. The methods described in our study can be used as a template for future design considerations specific to the development of digital health interventions, including those focused on understudied populations.