Mobile Self-management Research Articles

Design and Development of the EMPOWER-SUSTAIN Prototype Web- Based Self-Management Mobile Apps: A Novel Empowerment Tool for Patients with Metabolic Syndrome

Introduction: Given the proliferation of mobile phone users with accessibility to the internet, web-enabled mobile-based self-management intervention system is a potential solution to improve self-management behaviour among patients especially in the younger age groups.Objective: This study aimed to design and develop the EMPOWER-SUSTAIN prototype webbased self-management mobile apps for patients with Metabolic Syndrome (MetS), to empower them with knowledge and skills to take charge of their health.Methods: Iterative Model was chosen as the software development model for this study. Content from the newly revised EMPOWER-SUSTAIN Global Cardiovascular Risks Self- Management Booklet© was evaluated for its suitability to be included in the prototype. A storyboard was designed to create the flow of prototype usage by Primary Care Physicians and patients during follow-up clinic and at home. In the pre-alpha stage, wireframe was designed to describe and visualize the user interface in static draft layouts based on the content and structure of information. Based on the wireframe, a mock prototype was designed to demonstrate the graphic representations of the content and function. Using the iterative model of the software development life cycle (SDLC), a working prototype was developed based on the mock prototype.Results: High-fidelity mock-up static graphic diagrams demonstrating the content and function divided into eight sections were designed. The sections included My Profile, My Cardiovascular Risks, My Treatment Targets, My Check-Up, My Weight Management, My Smoking Habit, My Self-Management and My Medication. Based on the graphic diagrams, a working prototype of the EMPOWER-SUSTAIN web-based self-management mobile apps were developed using the iterative model of the SDLC.Conclusion: The EMPOWER-SUSTAIN prototype web-based self-management was developed using a robust software development method. It is currently undergoing the alpha (utility) testing by medical experts and beta (usability) testing by patients with MetS.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 48

Breast Cancer Self-Management Mobile Care Application Intervention in the Quality of Life

Breast Cancer Self-Management Mobile Care Application Intervention in the Quality of Life

GERI-MOBILE HEALTH: DEVELOPMENT AND FEASIBILITY OF A PROGRAM TO HELP OLDER VETERANS USE VA MENTAL HEALTH MOBILE APPS

VA mental health self-management mobile applications (apps) teach evidence-based skills such as mindfulness and behavior activation. Older Veterans are likely to benefit from learning these skills, but many need assistance learning to use their mobile devices. To bridge this knowledge gap, we developed a clinical program (Geri-Mobile Health) and accompanying patient education materials to help older Veterans use apps to meet their mental health and well-being goals. The program provides personalized coaching support consisting of (1) teaching basic mobile device use; (2) selecting a goal-consistent app; and (3) encouraging behavior change using the app. The presentation will describe the preliminary outcomes and implementation process. Initial results suggest that the program is feasible, acceptable, and may increase mobile device proficiency for novice users. Additionally, we disseminated 1,418 sets of education materials to providers in 21 states. Challenges and successes at the local and national levels will be discussed.

A usability study to test the effectiveness, efficiency and simplicity of a newly developed Internet-based Exercise-focused Health App for Lung cancer survivors (iEXHALE): Protocol paper.

The Internet-based Exercise-focused Health App for Lung cancer survivors (iEXHALE) is a mobile web app being developed to provide lung cancer survivors with an algorithm-based, tailor-made, self-management programme to inform their exercise choices and improve symptom severity. The aim of this protocol paper is to detail the plan for conducting the usability study to test the effectiveness, efficiency and simplicity of an exercise-focused self-management mobile web app for lung cancer survivors. The mixed methods study will consist of three consecutive phases, each interspersed with elements of data analysis and app prototype redevelopment. The study will take place in Oxford, United Kingdom. Ethical approvals have been obtained. The study will contribute to lung cancer survivorship research and is important in the app developmental process. This study contributes to the international forum for the exchange of practice, innovation and research, increases transparency in mobile health developmental processes and contributes to the methodological evidence base.

A Patient-Centered Mobile Phone App (iHeartU) With a Virtual Human Assistant for Self-Management of Heart Failure: Protocol for a Usability Assessment Study.

BackgroundHeart failure (HF) causes significant economic and humanistic burden for patients and their families, especially those with a low income, partly due to high hospital readmission rates. Optimal self-care is considered an important nonpharmacological aspect of HF management that can improve health outcomes. Emerging evidence suggests that self-management assisted by smartphone apps may reduce rehospitalization rates and improve the quality of life of patients. We developed a virtual human–assisted, patient-centered mobile health app (iHeartU) for patients with HF to enhance their engagement in self-management and improve their communication with health care providers and family caregivers. iHeartU may help patients with HF in self-management to reduce the technical knowledge and usability barrier while maintaining a low cost and natural, effective social interaction with the user.ObjectiveWith a standardized systematic usability assessment, this study had two objectives: (1) to determine the obstacles to effective and efficient use of iHeartU in patients with HF and (2) to evaluate of HF patients’ adoption, satisfaction, and engagement with regard to the of iHeartU app.MethodsThe basic methodology to develop iHeartU systems consists of a user-centric design, development, and mixed methods formative evaluation. The iterative design and evaluation are based on the guidelines of the American College of Cardiology Foundation and American Heart Association for the management of heart failure and the validated “Information, Motivation, and Behavioral skills” behavior change model. Our hypothesis is that this method of a user-centric design will generate a more usable, useful, and easy-to-use mobile health system for patients, caregivers, and practitioners.ResultsThe prototype of iHeartU has been developed. It is currently undergoing usability testing. As of September 2018, the first round of usability testing data have been collected. The final data collection and analysis are expected to be completed by the end of 2019.ConclusionsThe main contribution of this project is the development of a patient-centered self-management system, which may support HF patients’ self-care at home and aid in the communication between patients and their health care providers in a more effective and efficient way. Widely available mobile phones serve as care coordination and “no-cost” continuum of care. For low-income patients with HF, a mobile self-management tool will expand their accessibility to care and reduce the cost incurred due to emergency visits or readmissions. The user-centered design will improve the level of engagement of patients and ultimately lead to better health outcomes. Developing and testing a novel mobile system for patients with HF that incorporates chronic disease management is critical for advancing research and clinical practice of care for them. This research fills in the gap in user-centric design and lays the groundwork for a large-scale population study in the next phase.International Registered Report Identifier (IRRID)DERR1-10.2196/13502

Implementing a self-management mobile app for spinal cord injury during inpatient rehabilitation and following community discharge: A feasibility study

Objective: To determine the feasibility of implementing and evaluating a self-management mobile app for spinal cord injury (SCI) during inpatient rehabilitation and following community discharge. Design: Pilot feasibility study. Setting: Rehabilitation hospital and community. Participants: Inpatients from rehabilitation hospital following admission for their first SCI. Intervention: A mobile app was developed to facilitate self-management following SCI. The app consisted of 18 tools focusing on goal setting, tracking various health aspects, and identifying confidence regarding components of self-management. In-person training and follow-up sessions were conducted during inpatient rehabilitation and follow-up calls were provided after participants were discharged into the community. Main outcome measures: Participants completed outcome measures at baseline, community discharge, and 3-months post discharge. This study focused on feasibility indicators including recruitment, retention, respondent characteristics, adherence, and app usage. Additionally, participants’ self-management confidence relating to SCI (e.g. medication, skin, bladder, pain) was evaluated over time. Results: Twenty participants (median age 39, IQR: 31 years, 85% male) enrolled in the study. Participants’ Spinal Cord Injury Independence Measure (SCIM-III) median score was 23 and IQR was 33 (range: 7–84), which did not correlate with app usage. Retention from admission to discharge was 85% and 70% from discharge to 3-months post discharge. Individuals in the study who used the app entered data an average of 1.7x/day in rehabilitation (n = 17), and 0.5x/day in the community (n = 7). Participants’ bowel self-management confidence improved between admission and discharge (P < 0.01). Conclusions: Feasibility indicators support a larger clinical trial during inpatient rehabilitation; however, there were challenges with retention and adherence following community discharge.

Enhanced Self-Efficacy and Behavioral Changes Among Patients With Diabetes: Cloud-Based Mobile Health Platform and Mobile App Service.

BackgroundThe prevalence of chronic disease is increasing rapidly. Health promotion models have shifted toward patient-centered care and self-efficacy. Devices and mobile app in the Internet of Things (IoT) have become critical self-management tools for collecting and analyzing personal data to improve individual health outcomes. However, the precise effects of Web-based interventions on self-efficacy and the related motivation factors behind individuals’ behavioral changes have not been determined.ObjectiveThe objective of this study was to gain insight into patients' self-efficacy with newly diagnosed diabetes (type 2 diabetes mellitus) and analyze the association of patient-centered health promotion behavior and to examine the implications of the results for IoT and mobile health mobile app features.MethodsThe study used data from the electronic health database (n=3128). An experimental design (n=121) and randomized controlled trials were employed to determine patient preferences in the health promotion program (n=62) and mobile self-management education (n=28). The transtheoretical model was used as a framework for observing self-management behavior for the improvement of individual health, and the theory of planned behavior was used to evaluate personal goals, execution, outcome, and personal preferences. A mobile app was used to determine individualized health promotion interventions and to apply these interventions to improve patients’ self-management and self-efficacy.ResultsMobile questionnaires were administered for pre- and postintervention assessment through mobile app. A dynamic questionnaire allocation method was used to follow up and monitor patient behavioral changes in the subsequent 6 to 18 months. Participants at a high risk of problems related to blood pressure (systolic blood pressure ≥120 mm Hg) and body mass index (≥23 kg/m2) indicated high motivation to change and to achieve high scores in the self-care knowledge assessment (n=49, 95% CI −0.26% to −0.24%, P=.052). The associated clinical outcomes in the case group with the mobile-based intervention were slightly better than in the control group (glycated hemoglobin mean −1.25%, 95% CI 6.36 to 7.47, P=.002). In addition, 86% (42/49) of the participants improved their health knowledge through the mobile-based app and information and communications technology. The behavior-change compliance rate was higher among the women than among the men. In addition, the personal characteristics of steadiness and dominance corresponded with a higher compliance rate in the dietary and wellness intervention (83%, 81/98). Most participants (71%, 70/98) also increased their attention to healthy eating, being active, and monitoring their condition (30% 21/70, 21% 15/70, and 20% 14/70, respectively).ConclusionsThe overall compliance rate was discovered to be higher after the mobile app–based health intervention. Various intervention strategies based on patient characteristics, health care–related word-of-mouth communication, and social media may be used to increase self-efficacy and improve clinical outcomes. Additional research should be conducted to determine the most influential factors and the most effective adherence management techniques.

Development of a Self-Management App for People with Spinal Cord Injury.

With decreasing inpatient rehabilitation lengths of stay, there may be a greater risk of spinal cord injury (SCI) populations being discharged into the community without the self-management skills needed to prevent secondary complications. Recent advancements in mobile health has made mobile apps a feasible method of delivering population-based, self-management interventions to address SCI-specific secondary complications. The objective of this study is to describe stakeholder perspectives on the development of a functional mobile app to facilitate self-management skills needed to prevent secondary complications following recent SCI during inpatient rehabilitation. A user-centered design approach was used that involved an evolving mobile app and the collection of prospective qualitative data. Stakeholders from three groups were enrolled in the study: individuals admitted for rehabilitation following SCI (n = 20) and informal (n = 7) and formal (n = 48) caregivers. Iterative feedback was gathered from rehabilitation inpatients during ongoing interactions and via post-discharge exit questionnaires, from informal caregivers via one-on-one interviews, and from formal caregivers via series of focus groups at various phases throughout the design process. Three main themes emerged from the analysis: (1) being individualized and user friendly (i.e., developing an app that is simple and easy to use to facilitate universal uptake), (2) targeting goals to promote self-management (i.e., adopting self-management skills relative to personal goals and confidence), and (3) increasing participation and support-seeking to facilitate lifestyle change (i.e., encouraging leisure activities to facilitate community integration). Key stakeholder perspectives contributed to the development of a self-management mobile app that will be evaluated in future research.

A Systematic Literature Review of the Design Approach and Usability Evaluation of the Pain Management Mobile Applications

The increasing popularity of mHealth is a promising opportunity for pain self-management. Mobile apps can be easily developed, but understanding the design and usability will result in apps that can retain more users. This research aims at identifying, analyzing, and synthesizing the current state-of-the-art of: (a) the design approach and (b) usability assessment of pain management mobile applications. A systematic literature review was conducted on 27 studies retrieved from Medline, PubMed, EMBASE, Web of Science, and Scopus. The review revealed that most of the apps were for chronic pain. No app was specifically for men or for the elderly. None of the studies involved expert-based system inspection methods. Only one study used two different approaches of automated and empirical evaluation. We mapped the identified usability issues to ISO 9241-11 and ISO/IEC 25010, and aggregated the recommendations for improvement. Moreover, we also identified certain issues that are solely concerned with the patient’s behavior. We organized the issues into taxonomies of design considerations for building usable pain self-management mobile applications. As pain is prevalent among the elderly, pain management will be much needed while moving toward an aging society. However, we found that the involvement of the elderly in the development of pain management mobile apps is very minimal, which may affect the utility and usability of the apps.

I have most of my asthma under control and I know how my asthma acts: Users' perceptions of asthma self-management mobile app tailored for adolescents.

Asthma continues to be the leading chronic condition among US adolescents. Despite medical advances, many adolescents face uncontrolled asthma mainly due to insufficient self-management skills. Mobile apps pose a promising adjunct to in-clinic asthma care. However, little is known about the usability and effectiveness of such technology. In all, 20 adolescents participated in a 3-month trial to test an asthma app tailored to their age. Qualitative data on adolescents' experience with the app were inquired. Overall, participants thought the app was functional and user-friendly. The majority expressed that the app assisted them with asthma self-management through tracking of asthma status and text reminders to test their peak flow regularly. They indicated external factors that limited app use and suggested improvements to make the app more engaging and appealing to adolescents. The tested app provides a feasible means to assist adolescent in developing self-management skills, tracking disease status, and communicating with healthcare providers.

Qualitative study to elicit patients’ and primary care physicians’ perspectives on the use of a self-management mobile health application for knee osteoarthritis

ObjectiveTo elicit perspectives of family physicians and patients with knee osteoarthritis (KOA) on KOA, its treatment/management and the use of a mobile health application (app) to help patients self-manage their...

Improving Self-Management Skills Among People With Spinal Cord Injury: Protocol for a Mixed-Methods Study.

BackgroundMost people with spinal cord injury will develop secondary complications with potentially devastating consequences. Self-management is a key prevention strategy for averting the development of secondary complications and their recurrence. Several studies have shown that self-management programs improve self-management behaviors and health outcomes in individuals living with chronic conditions such as asthma, diabetes, hypertension, and arthritis. Given the burgeoning health care costs related to secondary complications, we developed an alternative electronic health–based implementation to facilitate the development of self-management skills among people with spinal cord injury.ObjectiveThis study aims to evaluate the efficacy of a self-management app in spinal cord injury populations. The primary outcome is attainment of self-selected, self-management goals. Secondary outcomes include increases in general and self-management self-efficacy and reductions in self-reported health events, health care utilization, and secondary complications related to spinal cord injury. This study also aims to explore how the intervention was implemented and how the app was experienced by end users.MethodsThis study will employ a mix of qualitative and quantitative methods. The quantitative portion of our study will involve a rater-blinded, randomized controlled trial with a stepped wedge design (ie, delayed intervention control group). The primary outcome is successful goal attainment, and secondary outcomes include increases in self-efficacy and reductions in self-reported health events, health care utilization, and secondary conditions related to spinal cord injury. The qualitative portion will consist of semistructured interviews with a subsample of the participants.ResultsWe expect that the mobile self-management app will help people with spinal cord injury to attain their self-management goals, improve their self-efficacy, reduce secondary complications, and decrease health care utilization.ConclusionsIf the results are positive, this study will produce credible new knowledge describing multiple outcomes that people with spinal cord injury realize from an app-based self-management intervention and support its implementation in clinical practice.Trial RegistrationClinicalTrials.gov NCT03140501; http://clinicaltrials.gov/ct2/show/NCT03140501 (Archived by WebCite at http://www.webcitation.org/73Gw0ZlWZ)International Registered Report Identifier (IRRID)PRR1-10.2196/11069

Using an mHealth App to Transition Care of Type 1 Diabetes from Parents to Teens: Protocol for a Pilot Study.

BackgroundType 1 diabetes mellitus (T1DM) afflicts approximately 154,000 people under the age of 20 in the United States. Most people with T1DM are diagnosed at a young age, and parents have to take on the responsibility of T1DM management. Eventually, the child must begin to transition to self-management. Adolescents often struggle to take on responsibility for all the necessary tasks to successfully self-manage their T1DM. In fact, approximately three-quarters of adolescents are not achieving American Diabetes Association–recommended glycated hemoglobin (HbA1c) targets. This lack of adherence can lead to negative health outcomes.ObjectiveThe goals of this interdisciplinary proposal are as follows: (1) to develop a unique and theory-driven technology using a mobile phone app to promote self-management behaviors for adolescents aged 10-15 years with T1DM and their parents and (2) to explore the feasibility and impact of the self-management mobile app.MethodsThis study has two phases: app development and pilot testing. In the app development phase, the app will be conceptualized and a prototype will be tested. In Phase 2, the mobile app will undergo pilot testing to determine its feasibility and impact on diabetes self-management.ResultsThe pilot test was launched in September 2017. Data collection for the final pilot test is underway, and results are forthcoming.ConclusionsAdolescents with T1DM and their parents can have a difficult time managing the transition of diabetes care. It is hoped that this app can help. The focus groups and prototype testing have indicated promising outcomes of app use.Trial RegistrationClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 (Archived by WebCite at http://www.webcitation.org/72tHXTE2Z)International Registered Report Identifier (IRRID)RR1-10.2196/10803

Feasibility and usability of an ontology-based mobile intervention for patients with hypertension

BackgroundLifestyle changes and the adoption of healthy behaviours are well established recommendations for the management of hypertension—a risk factor for cardiovascular and kidney disease. Mobile health interventions offer unique advantages and novel approaches to helping individuals make and maintain such behaviour changes; however, current interventions often lack theoretical and scientific grounding. ObjectiveThe goal of this study is to effectively model the knowledge, concepts and relationships relevant to the management of a chronic illness like hypertension, and to implement this knowledge model within a mobile self-management application that can be used by patients. MethodsA behaviour modification approach based on COM-B (capability, opportunity, motivation, behaviour) Model and the associated Behaviour Change Wheel was developed. An ontology-based knowledge model was implemented to formally conceptualise relevant knowledge in hypertension clinical practice guidelines, behaviour change models and associated behaviour change strategies. A hypertension management decision support framework was designed and implemented as a proof-of-concept mobile phone application (EmpowerBP) using the aforementioned model. The usability of this pilot application was tested using think-aloud protocol by eight individuals with hypertension while performing predefined tasks. Thematic analysis with inductive thematic coding was performed to identify specific feedback and areas for improvement. ResultsThe most common positive feedback included participants finding application resources interesting or helpful and liking the user interface. The most common negative feedback was finding the included salt calculator confusing or laborious to use and finding the profile creation questionnaire too long. The derived themes were: features, profile creation, resources, scenario, usability, user interface. ConclusionsThe ontology knowledge model formalises variables, properties, and relationships such that they can be used for problem solving. By integrating and computerising complex knowledge from clinical practice guidelines, behaviour change theories, and associated behaviour change strategies, it is possible to model existing information about the management of hypertension as an ontology. This proof-of-concept application creates clinical and behavioural profiles of a user to provide them with personalised management strategies, rooted in established behaviour change theory, that will engage and empower them to manage their condition. Given the nature of ontological models, this approach can be easily modified to address a variety of chronic illnesses.

Considerations for the Development of Mobile Phone Apps to Support Diabetes Self-Management: Systematic Review.

BackgroundThere is increased research interest in the use of mobile phone apps to support diabetes management. However, there are divergent views on what constitute the minimum standards for inclusion in the development of mobile phone apps. Mobile phone apps require an evidence-based approach to development which will consequently impact on their effectiveness. Therefore, comprehensive information on developmental considerations could help designers and researchers to develop innovative and effective patient-centered self-management mobile phone apps for diabetes patients.ObjectiveThis systematic review examined the developmental considerations adopted in trials that engaged mobile phone applications for diabetes self-management.MethodsA comprehensive search strategy was implemented across 5 electronic databases; Medline, Scopus, Social Science Citation Index, the Cochrane Central Register of Controlled Trials and Cumulative Index of Nursing and Allied Health Literature (CINALHL) and supplemented by reference list from identified studies. Study quality was evaluated using the Joanna Briggs Critical appraisal checklist for trials. Information on developmental factors (health behavioral theory, functionality, pilot testing, user and clinical expert involvements, data privacy and app security) were assessed across experimental studies using a template developed for the review.ResultsA total of 11 studies (10 randomized controlled trials and 1 quasi-experimental trial) that fitted the inclusion criteria were identified. All the included studies had the functionality of self-monitoring of blood glucose. However, only some of them included functions for data analytics (7/11, 63.6%), education (6/11, 54.5%) and reminder (6/11, 54.5%). There were 5/11(45.5%) studies with significantly improved glycosylated hemoglobin in the intervention groups where educational functionality was present in the apps used in the 5 trials. Only 1 (1/11, 9.1%) study considered health behavioral theory and user involvement, while 2 (2/11, 18.1%) other studies reported the involvement of clinical experts in the development of their apps. There were 4 (4/11, 36.4%) studies which referred to data security and privacy considerations during their app development while 7 (7/12, 63.6%) studies provided information on pilot testing of apps before use in the full trial. Overall, none of the studies provided information on all developmental factors assessed in the review.ConclusionsThere is a lack of elaborate and detailed information in the literature regarding the factors considered in the development of apps used as interventions for diabetes self-management. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of practical and user-friendly self-management apps that can enhance the quality of life for diabetes patients.

Experience of diabetes self-management with mobile applications: a focus group study among older people with diabetes

Background: The number of mobile diabetes self-management applications (apps) has risen. However, it is not certain whether these apps provide effective diabetes self-management for older people with diabetes. In this study, we aim to identify barriers in features and usability related to the needs of older people with diabetes for diabetes self-management applications.Methods: We conducted focus groups with 10 older people with diabetes (mean age = 69 years old). Based on the data saturation theory, there were 2 focus groups. Participants completed a set of diabetes self-management tasks using 9 representative diabetes self-management applications on iPads. We collected information regarding demographics, diabetes history, health literacy and prior experience using mobile devices and diabetes self-management applications. We asked participants’ preferences, concerns and needs for diabetes self-management application features. The System Usability Scale (0-100) measured overall usability. Thematic analysis identified the barriers that older participants encountered as they interacted with the diabetes self-management applications.Results: Participants found mobile applications inadequate for features on Healthy Coping and Problem Solving. 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.Conclusions: This study 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.

Integration of Peer Philosophy into a Standardized Self-Management Mobile Health Intervention.

Description of certified peer specialists integration of peer philosophy into the delivery of a self-management intervention enhanced with mobile health. Qualitative examination of peer case notes that were routinely entered on a peer care management electronic dashboard. This study included consumers with serious mental illness (N= 8) with a mean age of 68.8years (SD= 4.9). Certified peer specialists (N= 3) were all female and aged 55years or older. Peers entered 146 case notes on the peer care management notes dashboard. Five themes emerged including encouragement of self-determination, bio-psychosocial-spiritual framework guides practice, sharing lived experience to teach self-management skills, personalized text messages to reinforce self-management skill development, and identifying unmet needs and advocating for human rights. Peers unique perspectives and expertise was complemented with the standardized delivery of evidence-based intervention enhanced with mobile health.

Development of the IMB Model and an Evidence-Based Diabetes Self-management Mobile Application.

ObjectivesThis study developed a diabetes self-management mobile application based on the information-motivation-behavioral skills (IMB) model, evidence extracted from clinical practice guidelines, and requirements identified through focus group interviews (FGIs) with diabetes patients.MethodsWe developed a diabetes self-management (DSM) app in accordance with the following four stages of the system development life cycle. The functional and knowledge requirements of the users were extracted through FGIs with 19 diabetes patients. A system diagram, data models, a database, an algorithm, screens, and menus were designed. An Android app and server with an SSL protocol were developed. The DSM app algorithm and heuristics, as well as the usability of the DSM app were evaluated, and then the DSM app was modified based on heuristics and usability evaluation.ResultsA total of 11 requirement themes were identified through the FGIs. Sixteen functions and 49 knowledge rules were extracted. The system diagram consisted of a client part and server part, 78 data models, a database with 10 tables, an algorithm, and a menu structure with 6 main menus, and 40 user screens were developed. The DSM app was Android version 4.4 or higher for Bluetooth connectivity. The proficiency and efficiency scores of the algorithm were 90.96% and 92.39%, respectively. Fifteen issues were revealed through the heuristic evaluation, and the app was modified to address three of these issues. It was also modified to address five comments received by the researchers through the usability evaluation.ConclusionsThe DSM app was developed based on behavioral change theory through IMB models. It was designed to be evidence-based, user-centered, and effective. It remains necessary to fully evaluate the effect of the DSM app on the DSM behavior changes of diabetes patients.

The Effectiveness of Self-Management Mobile Health Technology in Chronic Disease: A Systematic Review

The Effectiveness of Self-Management Mobile Health Technology in Chronic Disease: A Systematic Review

Patients' Perceptions and Experiences of a mHealth Diabetes Self-management System.

Chronic diseases, including diabetes, constitute a substantial disease burden around the world. Mobile self-management systems now play a significant and increasingly important role in patients' disease management. Yet, patients' perceptions of these systems after longer-term use are largely unexplored. A random sample of 10 diabetes patients was assessed immediately after they exited a larger, 6-month randomized controlled trial on the use of a mHealth system called Care4Life. This descriptive, exploratory study assessed patients' perceptions and experiences of mHealth using a questionnaire and semistructured interview whose development was guided by the Technology Acceptance Model. Results indicated that patients saw clear benefits in using the technology and had favorable behavioral disease outcomes after using Care4Life. Suggestions for improving the system were highly individual despite the apparent homogeneity of the patient group. The study begins to fill the gap about the longer-term use of mHealth systems in chronic disease management and reflects the significance of individual needs for mHealth systems.