Mobile Health Apps for the Control and Self-Management of Diabetes Type 2: A Qualitative Study on Users’ Acceptability and Acceptance (Preprint)
Authors: Bults Marloes , van Leersum Catharina Margaretha , Olthuis Theodorus Johannes Josef , Bekhuis Robin Enya Marije , den Ouden Marjolein Elisabeth Maria 
Published: July 2022

BACKGROUND

Mobile health apps are promising tools to help patients with type 2 diabetes mellitus (T2DM) to improve their health status and thereby reach diabetes control and self-management. Although there is a wide array of mobile health apps for T2DM available at this moment, apps are not yet integrated in routine diabetes care. Acceptability and acceptance among patients with T2DM is one of the major challenges and is a prerequisite for successful implementation of apps in diabetes care.

OBJECTIVE

This study gives an in-depth understanding of both the perceptions of T2DM patients before use (acceptability) and after use (acceptance), regarding 4 different mobile health apps for diabetes control and self-management.

METHODS

A qualitative descriptive research design was applied. Participants could choose 1 of the 4 selected apps for diabetes control and self-management (i.e. Clear Bio in combination with FreeStyle Libre, mySugr, MiGuide, Selfcare). The selection was based on a systematic analysis of criteria for (functional) requirements regarding monitoring, data collection, provision of information, coaching, privacy and security. To explore the acceptability, 25 semi-structured in-depth interviews were conducted with T2DM patients before use. This was followed by 4 focus groups to discuss the acceptance after use. The study had a citizen science approach, i.e. patients with T2DM collaborated with the researchers, as co-researcher. All co-researchers actively participated in the preparation of the study, data-collection and data-analysis. Data were collected between April and September 2021. Thematic analysis was conducted using a deductive approach using AtlasTi9.

RESULTS

In total, 25 co-researchers with T2DM participated in this study. Twelve co-researchers tested Clear, 5 MiGuide, 4 mySugr, and 4 Selfcare. All co-researchers participated in the semi-structured interviews and 18 of them attended the focus groups. Personal health was the main driver to start using the apps. Most co-researchers were convinced a healthy lifestyle will improve their blood glucose levels. Although most co-researchers did not expect that they had to put much effort into using the apps, the additional effort to familiarize themselves with the app usage was experienced as quite high. None of the co-researchers had a healthcare professional who gave suggestions about using apps. Reimbursement from insurance companies and the acceptance of the apps for diabetes control and self-management by the healthcare system were mentioned as important facilitating conditions.

CONCLUSIONS

The research showed that mobile health apps provide support for diabetes control and self-management of patients with T2DM. Integrating app use in care as usual and guidelines for healthcare professionals is recommended. Future research on how to increase the implementation of mobile health applications in the current care pathways is needed. In addition, healthcare professionals need to improve their digital skills and life-long-learning is needed.