Challenges and opportunities in diabetes self-management education and support : the analyses of diabetes mobile applications and provider documentation patterns
Authors:   , Ye Qing 
Published: December 2023

Diabetes mellitus is one of the most prevalent chronic diseases in the United States. As a disease with long-term complications requiring changes in management, diabetes requires not only education at the time of diagnosis, but ongoing diabetes self-management education. The goal of this dissertation is to identify challenges and opportunities in diabetes self-management education and support through the analyses of diabetes mobile applications and provider documentation patterns. This dissertation includes three specific areas. First, we compared features of current diabetes mobile apps to the American Association of Diabetes Educators Self-Care Behaviors(TM) guidelines. A multidisciplinary team analyzed and classified the features of each eligible app based on the guidelines. The results show an unbalanced diabetes mobile apps development trend. Many apps were designed to support the behavior of Healthy Eating, Monitoring, Taking Medication and Being Active. Few apps explore the behavior of Problem Solving, Healthy Coping and Reducing Risks. Second, we identified barriers in features and usability related to the needs of older people with diabetes for diabetes self-management applications. We conducted focus groups with 10 older people with diabetes. The features that participants liked most for the diabetes self-management applications were documentation, information and goal setting. Thematic analysis revealed that usability was their primary concern about diabetes self-management applications in managing diabetes conditions. The average System Usability Scale score was 48 out of 100, which is considered not acceptable. It suggests current diabetes self-management applications do not provide evidence-based, usable features for diabetes self-management and may not fulfill the needs of older people with diabetes. Third, we collected 200 clinic notes of follow-up visits for 100 adults with diabetes and studied the History of Present Illness (HPI) and Impression and Plan (I&P) sections. The results show that Monitoring was the most common self-care behavior mentioned in both HPI and I&P sections. Being Active was the least common self-care behavior mentioned in the HPI section and Healthy Coping was the least common self-care behavior mentioned in the I&P section. We found providers delivered more information on Healthy Eating to men compared to women in I&P section. Generally, providers delivered diabetes self-management education to people with diabetes regardless of patient characteristics. It indicates a lack of patient-centered education when people with diabetes visit providers for ongoing management. In summary, the main contribution of this dissertation to the field of health informatics is the identification of challenges and opportunities in diabetes self-management education when people with diabetes, especially for older people, using diabetes mobile apps. It also provides verification whether healthcare providers deliver evidence-based and patient-centered diabetes education during follow-up visiting.