Patient empowerment is examined as a multi-dimensional factor influencing the use of diabetes self-management apps. The research design includes three studies conducted in Singapore. Study 1 examines how features of diabetes self-management apps correspond with theoretical indicators of empowerment, as well as app quality. Study 2 uses semi-structured face-to-face interviews with diabetes patients to draw first conclusions about the relevance of empowerment for diabetes app use. Study 3 includes an online patient survey, and uses cluster analytical methods to test the preliminary Study 2 results (typology of app use), as well as binary logistic regression to compare the strength of influence of various anteceding factors on the likelihood of diabetes app use. The studies show that especially the support by private social patient networks and the medical specialties of supervising physicians play a crucial role for technology-supported self-management.
The rapid adoption of smartphones and the increasing prevalence of diabetes have led to the growing interest in use of mobile devices to support diabetes self-management. In my dissertation, I present three studies to explore how smartphones can be used for diabetes management. The first study focuses on the reach of smartphones in the diabetic population, and (1) compares smartphone use in individuals with diabetes to those without diabetes, and (2) explores predictors of smartphone use among those with diabetes. Although many applications have been developed for diabetes, no reports have described smartphone use among individuals with diabetes, nor explored the characteristics of the smartphone users. Smartphone applications offer a large range of features to support diabetes. In the second study, I seek to understand how individuals with diabetes use smartphone applications to support their diabetes self-management. In particular, I focus on how needs for supportive technology evolve over time as both diabetes and diabetes self-management change with time. Finally, I explore the use of financial incentives to drive behavior change in diabetes. Patient incentives are increasingly used to increase patient engagement in health and wellness, but have not been well studied in diabetes. In the third study, I examine the acceptability of financial incentives to improve diabetes self-management among patients and providers. In the first study, I found that individuals with diabetes are less likely to use smartphones than those without diabetes, even after adjusting for age, race/ethnicity and socioeconomic factors. In my results, smartphones bear potential in reaching racial ethnic minorities who also have a higher prevalence of diabetes, as smartphone use is higher among Blacks, Asians and Hispanics. As expected, young age, high income and high education are also associated with higher smartphone use among individuals with diabetes. In the second study, I found that diabetes self-management can be framed in three stages: an initial stage (after diagnosis), a stabilization stage and a response to change stage. Many of the tracking features guide individual learning and are particularly useful in the initial stage. After creating habits, however, these features become less useful the benefits of the tedious tracking diminish during the stabilization phase. Finally, when changes occur, transitory tracking is useful to recalibrate treatments and return to the stabilization stage. In the third study, participants liked the idea of financial incentives and expected them to be useful in helping them take the small steps for behavior change. They also expected rewards to help acknowledge the constant efforts made for self-management. Yet participants also raised concerns for equity and privacy when using incentives. Compared to individuals without diabetes, those with diabetes were less likely to use smartphones in our study. This gap in smartphone use has the potential to increase disparities in diabetes care, and suggests that standard diabetes care needs to be pursued while other studies are needed to confirm and explore this gap. Future applications for diabetes need to address long-term management of diabetes, as the needs in supportive technology changes over time. Although financial incentives seem acceptable, many unresolved issues including equity and privacy still need to be addressed for the design of incentive programs. In particular, careful consideration is needed to avoid undesired consequences of decreased intrinsic motivation.
The development of the Chronic Care Model (CCM) for the care of patients with chronic diseases has focused on the integration of taking charge of the patient and his family within primary care. The major critical issues in the implementation of the CCM principles are the non-application of the best practices, defined by EBM guidelines, the lack of care coordination and active follow-up of clinical outcomes, and by inadequately trained patients, who are unable to manage their illnesses. This book focuses on these points: the value of an integrated approach to some chronic conditions, the value of the care coordination across the continuum of the illness, the importance of an evidence-based management, and the enormous value of the patients involvement in the struggle against their conditions, without forgetting the essential role of the caregivers and the community when the diseases become profoundly disabling.
Diabetes is costly and a leading cause of death and disability in the United States (CDC, 2015). There is no known cure for the disease, however, it can be managed and controlled through self-management. This process involves patients managing a complex set of distinct but related tasks including, but not limited to, monitoring health conditions, tracking medication dosages, food intake, physical activities, complying with treatment regimens, and solving problems that may arise due to illness (Clark et al., 1991; Hill-Briggs, 2003). In recent years, mobile apps and devices (henceforth labeled mobile technologies) have emerged as a promising means to help diabetics manage their conditions. While the number and variety of mobile apps and devices for diabetes self-management continue to rise, their role and effectiveness in helping diabetics self-manage their conditions are relatively unknown (Caburnay et al., 2015; Eng and Lee, 2013). The following dissertation, comprised of three essays, aims at supplying the research with answers by investigating the role of mobile technologies in diabetes self-management. To assist, technology affordances (Gibson, 1986), the self-regulation model of illness representation (Leventhal et al., 2003; 2008), and the self-care behavior framework as advocated by the American Association of Diabetes Educators (AADE7, 2010) act as theoretical foundations. The purpose of this dissertation is to advance the concept of technology affordances in the field of diabetes self-management using mobile technologies. In the first essay, we report on the development and validation of an instrument to measure Perceived and Realized Affordances of Mobile Technologies for Diabetes Self- Management (AMTDS) with a nomological network. It is argued that mobile technology affordances play a significant role in influencing a patient's perception of the usefulness and ease of using mobile technologies for diabetes management. In the second essay, using the selfregulation model of illness representation and coping behavior, two models are developed. One for users and one for non-users of mobile technologies, where a patient's illness perceptions are shown to influence their intention to adopt and continue to use mobile technologies for diabetes management. In the third essay, a model of patient empowerment has been developed where technology affordances are theorized to influence patient empowerment, which in turn influences a patient's well-being. Survey methodology is utilized to collect data and empirically test the models in all the three papers. Relyng on the data collected from over 450 diabetes patients (200 non-users and over 250 users of mobile technologies), we test the hypothesized relationships. This research contributes to the literature by supplying a new instrument for measuring the affordances of mobile technologies for diabetes management. The insights from this study also contribute to the design and development of mobile technology while offering new insights into the role of affordances in influencing a diabetic's adoption and use of mobile technologies for diabetes management. All efforts are in support of inspiring others to further explore and measure the effects of technology affordances for other chronic illnesses.
Psychosocial Care for People with Diabetes describes the major psychosocial issues which impact living with and self-management of diabetes and its related diseases, and provides treatment recommendations based on proven interventions and expert opinion. The book is comprehensive and provides the practitioner with guidelines to access and prescribe treatment for psychosocial problems commonly associated with living with diabetes.
Diabetes Digital Health brings together the multifaceted information surrounding the science of digital health from an academic, regulatory, industrial, investment and cybersecurity perspective. Clinicians and researchers who are developing and evaluating mobile apps for diabetes patients will find this essential reading, as will industry people whose companies are developing mobile apps and sensors. Provides valuable information for clinicians, researchers and industry about the design and evaluation of patient-facing diabetes adherence technologies Highlights cutting-edge topics that are presented and discussed at the Digital Diabetes Congress
Many patients with diabetes are not able to manage their disease effectively because they do not have a full understanding of their diagnosis and how their lifestyle choices and medication decisions impact their risk for developing complications (Bodenheimer, Lorig and Holman, et al, 2010). Ineffective self-management leads to the development of complications including neuropathy, nephropathy, hypertension, gastroparesis, and glaucoma, and increases the risk for infection (American Diabetes Association, 2014). Research demonstrates that diabetes self management education is an effective method of improving disease management and leads to better patient outcomes (Kent et al, 2013). Implementing a diabetes self-management education program in the primary-care setting is an effective method of empowering patients to manage their disease effectively. A team-based approach with the patient as the central figure in the decision-making process has been shown to improve patient outcomes. Both knowledge and understanding are key, particularly for newly diagnosed patients. Implementation of the diabetes self-management program at a community health center involves a team-based approach to healthcare. The patient, physicians, nurses and other healthcare professionals work together to develop an individualized plan care to meet the needs of the patient. Patient involvement is key and self-management education is critical for improving patient outcomes. Patient self-efficacy is also an important factor in determining changes in behavior that will impact health (Riverside Community Health Foundation, 2002). Comprehensive and ongoing patient self-management education with a multidisciplinary team will effectively meet the needs of patients and will improve patient self-management of diabetes. Teamwork, collaboration and improving patient self-efficacy are integral aspects of the program.
This open access textbook represents a vital contribution to global health education, offering insights into health promotion as part of patient care for bachelor’s and master’s students in health care (nurses, occupational therapists, physiotherapists, radiotherapists, social care workers etc.) as well as health care professionals, and providing an overview of the field of health science and health promotion for PhD students and researchers. Written by leading experts from seven countries in Europe, America, Africa and Asia, it first discusses the theory of health promotion and vital concepts. It then presents updated evidence-based health promotion approaches in different populations (people with chronic diseases, cancer, heart failure, dementia, mental disorders, long-term ICU patients, elderly individuals, families with newborn babies, palliative care patients) and examines different health promotion approaches integrated into primary care services. This edited scientific anthology provides much-needed knowledge, translating research into guidelines for practice. Today’s medical approaches are highly developed; however, patients are human beings with a wholeness of body-mind-spirit. As such, providing high-quality and effective health care requires a holistic physical-psychological-social-spiritual model of health care is required. A great number of patients, both in hospitals and in primary health care, suffer from the lack of a holistic oriented health approach: Their condition is treated, but they feel scared, helpless and lonely. Health promotion focuses on improving people’s health in spite of illnesses. Accordingly, health care that supports/promotes patients’ health by identifying their health resources will result in better patient outcomes: shorter hospital stays, less re-hospitalization, being better able to cope at home and improved well-being, which in turn lead to lower health-care costs. This scientific anthology is the first of its kind, in that it connects health promotion with the salutogenic theory of health throughout the chapters. the authors here expand the understanding of health promotion beyond health protection and disease prevention. The book focuses on describing and explaining salutogenesis as an umbrella concept, not only as the key concept of sense of coherence.
Although Outcome Measurement has become an important tool in the evaluation of health promotion patient education and other health services interventions, problems remain in locating reliable measurements and scales. This book provides a unique compilation of more than 50 self-administered scales for measuring health behaviors, health status, self-efficacy, and health-care utilization.
The number of patients with diabetes continues to rise in the United States, resulting in increased morbidity and mortality, decreased quality of life, and massive financial costs. The prevalence and deleterious effects of diabetes is especially prominent in underserved populations. As a result, there is a great need for cheap and implementable preventative health solutions. The Chronic Care Model, which has been shown to be successful in managing patients with obesity and diabetes, suggests that the use of self---monitoring or tracking systems for diet, physical activity, weight, and chronic disease metrics might serve this role. The UCSD Student---Run Free Clinic Project employs the Chronic Care Model, but lacks a consistent personal self---monitoring tool. I researched, designed and implemented a foldable paper self---monitoring tool called "My Diabetes: a Self Care Tracking Tool" in English and Spanish with the purpose of empowering underserved patients to better understand and self---manage their diabetes. I also created a diabetes preventive health chart as a companion guide for students and providers employing the self---monitoring tool. Finally, I recruited a junior medical student to continue implementation of the project and develop separate studies of its effect on patient empowerment.
