Evaluation of a Mobile Diabetes Self-Management Platform: A Pilot Case Study with Pediatric Users

T. Tran,¹K. Rudolph,¹PORBETA,¹S. Jaladi,¹S. Kumar,¹S. Kim,¹ R. Padman^1 
1Carnegie Mellon University, Pittsburgh, PA

Journal MTM 1:4S:35-36, 2012
DOI:10.7309/jmtm.58

Abstract

This study summarizes a multidimensional, scalable pilot evaluation of a diabetes self-management platform combining mobile technology with social networking to capture four key metrics of diabetes self-management, associated social interactions, and gaming features providing targeted feedback to 8 pediatric users. Based on their 2-month interaction with the application, we analyze click-stream data from interactions, key metrics, text comments, and usability and satisfaction surveys to evaluate engagement with the platform and effectiveness in controlling blood glucose.

Introduction:  According to the American Diabetes Association, increasing pediatric obesity leading to diabetes requires effective interventions to be designed and implemented to counteract the long term negative health outcomes and high costs associated with the disease. Market growth for mobile applications to facilitate chronic disease management has resulted in increasingly innovative solutions, including social media, to increase compliance with best practices and engagement with disease self-management. Recognizing the cost savings potential and opportunity for improvements in health status for diabetes patients through wide spread adoption and use of a diabetes self-management mobile application, Patient Health Recording for Quality of Life (PHRQL) has developed a unique application for smart phones that offers an innovative platform for recording and capturing essential diabetes self-management information while also continually engaging users through social networking and gaming components. Eight pediatric users were enrolled in a pilot study to evaluate PHRQL along three key dimensions of product, process, and program, to assess and understand the usage, effectiveness and value of the platform [1].

Methods: Product evaluation assessed the usability and functionality of the application via benchmarking and technology assessment. Process evaluation mapped the status quo and desired process models underlying the use of PHRQL and measured impact of the application on the self-management habits of a user, while also developing a “best-practice” use model for the application. Finally, the program evaluation assessed the overall value of PHRQL in controlling diabetes along two different dimensions – user engagement and effectiveness at lowering blood glucose variability. We analyzed click-stream data of user interactions with the application, their documentations of key metrics and sharing of this information with peers via social networking and gaming using descriptive statistics, first order Markov models, and multidimensional scaling and annealing methods.

Results: The product evaluation identified game mechanics and social media features as key factors driving user engagement. The process evaluation detected high variability in users’ interactions with the application and a lack of compliance with best practices, likely due to the short time span and small number of participants, but a reassuring trend towards better self- management habits over the duration of the study. Due to the limited number of study participants, while the program evaluation could not conclusively demonstrate that PHRQL usage decreased users’ blood glucose levels, positive trends were observed in user engagement and blood glucose variability, and increased satisfaction with their diabetes management. Ongoing studies with a larger user population will use this framework to draw actionable insights about the use of the application as an intervention and self-management tool with pediatric as well as adult users.

Acknowledgement: We are grateful to the entire PHRQL team for the opportunity to study this innovative platform.

References1: R. Padman, T. Tran, K. Rudolph, S. Jaladi, P. Orbeta, S. Kim, S. Kumar (2011). Diabetes Self-Management Mobile Application Evaluation Study. Working Paper, The Heinz College, Carnegie Mellon University.

Smartphone-delivered mobile HIV Risk Reduction Education in Opioid Dependent Individuals

Karran A Phillips,¹David H Epstein,¹Jia-Ling Lin,¹Mustapha Mezghanni,¹Massoud Vahabzadeh,¹Kenzie L Preston,^1
1National institute on Drug Abuse, Baltimore, USA

Journal MTM 1:4S:34, 2012
DOI:10.7309/jmtm.57

Abstract

Background: Computer-based HIV education has been shown effective and is preferred over counselor-delivered education. Previous studies have shown significant increases in risk-reduction behaviors after participation in a computerized HIV risk reduction (HIVRR) intervention. Whether delivery of mobile HIVRR (mHIVRR) education via smartphone is also effective at increasing knowledge and decreasing risk behavior has yet to be determined.

Purpose:  To develop and deploy an interactive mHIVRR software program to deliver HIV/STD education on smartphones and determine whether it reduces HIV/STD-related risk via increased HIV/STD knowledge.

Methods: We developed mHIVRR modules using video components of pre-existing evidence-based programs. Each module consists of a 5-10¬–minute video component followed by an 11-item usability/acceptability questionnaire and a 3-item knowledge questionnaire. New modules were downloaded onto smartphones weekly. Participants completed questionnaires after each viewing of ≥75% of the video component. Prior week modules were moved to the “Library” and available for repeated viewing. Acceptability of mHIVRR modules was defined as a median score of ≤2.5 (1-very easy/effective to 5-very hard/not at all effective) for each usability/acceptability question. Effectiveness was defined as ≥80% of participants scoring >65% on the knowledge questions.

Results: 78% of video modules attempted were completed. Average usability/acceptability questionnaire responses were all ≤2.5 (range 1.3 to 2.1). Video module length was “just right” according to 72% of participants. Only 16% thought the mHIVRR module information would have been better suited for printed material and 28% for computer-based delivery. 25% of participants would have preferred a text-based smartphone module compared to the video-based smartphone module. 100% of participants scored >65% on the knowledge questions, with an average overall knowledge score of 82%.

Conclusions: Video-based mHIVRR education delivered via smartphone appears to be acceptable, and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge, are needed to confirm these findings.

Effect of Home Blood Glucose Telemonitoring with Self-Care Support on Glycemic Control in Pregnancy

AG Lagain,¹DS Feig,²R Fung,³I. Bahinskaya,⁴D. Ng,⁵P. Picton,⁶JA Cafazzo^6
1Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute of the Mount Sinai Hospital ²Departments of Medicine of the Mount Sinai Hospital and University of Toronto³Department of Medicine, Toronto East General Hospital 4Institute of Health Policy, Management, and Evaluation, University of Toronto ⁵Institute of Biomaterials and Biomedical Engineering, University of Toronto ⁶Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada

Journal MTM 1:4S:32, 2012
DOI:10.7309/jmtm.54

Abstract

The Office of Cyber Infrastructure and Computational Biology (OCICB) of the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH has been developing a solution that complies with current guidance frameworks and regulatory requirements while leveraging the potentials offered by mHealth technologies for data collection. OCICB has designed an mHealth solution that maps to the paper processes developed over the past century for clinical research. We designed the system for use in regions of low to middle-income countries where the patients often have no other clinical record. For our pilot, we selected a natural history study that does not have the same regulatory requirements as an Investigational New Drug (IND) study. We retained our existing paper-based clinical data capture management system in order to compare quality control reports between paper-based and mobile electronic capture methods. The solution complies with regulatory frameworks and requirements such as Good Clinical Practices and 21 CFR Part 11, which requires full audit trails of the data collection process at the source and the validation stages. It also provides the capacity for workflows that support the data validation process within the field research framework. We expect to show that the accuracy of data collection improves using mobile source data collection. This will reduce the time and cost of validating the collected data before final analysis for clinical research while maintaining the regulatory framework that protects patient interests. The solution will further provide clinical monitors with the ability to remotely access the source data and thus reduce the cost of travel for monitoring as well as reducing the impact on patients due to mistakes made while entering the data.

High Tuberculosis Treatment Adherence Obtained Using Mobile Phones for Video Directly Observed Therapy: Results of a Binational Pilot Study

Richard Garfein,¹Kelly Collins,¹Fatima Munoz¹Kathleen Moser,²Paris Cerecer-Callu,³  Mark Sullivan,⁴ Ganz Chokalingam,⁴ Phillip Rios,⁴ Maria Luisa Zuniga,¹  Jose Luis Burgos,¹  Timothy Rodwell,¹  Maria Gudelia Rangel,⁵ Kevin Patrick^6
1UCSD, School of Medicine, Division of Global Public Health, San Diego CA²San Diego County Health and Human Services Agency, ³ISESALUD, Secretaría de Salud del Estado de Baja California, ⁴UCSD, California Institute of Telecommunications and Information Technology, San Diego, CA, ⁵US/Mexico Border Health Commission, Tijuana, BC, Mexico, ⁶UCSD, Department of Family and Preventive Medicine, San Diego, CA

Journal MTM 1:4S:30, 2012
DOI:10.7309/jmtm.52

Abstract

Over 8.8 million people become ill and1.4 million people die annually from tuberculosis (TB). TB is treatable with antibiotics; however,poor adherence to daily medication regimens lasting >6 months promotes ongoing disease transmission, higher mortality, and development of drug resistance. “Directly observed therapy” (DOT) is recommended to minimize these problems. DOT healthcare providers watch patients take each dose of medication, hence DOT is costly, time consuming, invasive for patients, and is limited to patients who live near a health center. Informed by focus groups and expert opinions among patients and providers, we developed and pilot- tested a method called Video DOT (VDOT) whereby patients use mobile phones to record and securely transfer time-stamped videos of themselves taking their medications, which are then watched remotely by their provider. The study was conducted in San Diego, CA (n=43) and Tijuana, Mexico(n=9). To date, 38 patients have completed TB treatment using VDOT. Patient ages ranged from 18 to 86 years, 54% were male, and 77% were non-white. Overall, 90% and 97% of the expected videos were received on-schedule from patients in San Diego and Tijuana respectively. Post-treatment interview responses were similar across cities. Patients and providers easily adopted the technology. Patients required only 3 training sessions on average before being able to perform VDOT independently. Overall, 89% of patients reported never or rarely having problems recording videos, 92% preferred VDOT over in-person DOT, and 81% thought VDOT was more confidential. All patients said they would recommend VDOT to other TB patients. Three participants were more compliant after switching to in-person DOT, suggesting the need for both DOT options. VDOT provides a promising mobile solution to the high cost and burden of in-person DOT for monitoring TB and other conditions that require strict treatment adherence.

Evaluation of a SMS Medication Reminder System to Improve Medication Adherence in African Americans with Uncontrolled Hypertension

Lorraine Buis,¹ Loren Schwiebert,² Nancy Artinian,¹ Hossein Yarandi,¹  Lindsey Hirzel,¹ Rachelle Dawood,³ Lynn Marie Mango,³ Phillip Levy^3
1Wayne State University, College of Nursing, ²Wayne State University, Department of Computer Science, ³Wayne State University, School of Medicine, Department of Emergency Medicine

Journal MTM 1:4S:29, 2012
DOI:10.7309/jmtm.51

Abstract

African Americans are disproportionately more susceptible to Hypertension (HTN) than non-Hispanic Whites, which is a leading cause of cardiovascular disease. Poor adherence to prescribed medication regimens is a major contributor to HTN, as only about half of patients are adherent. Moreover, while the majority of HTN treatment is delivered in primary care settings, a sizable proportion of care is provided in the emergency department (ED), particularly within low income communities. Short Message Service (SMS) text messaging may offer a simple, non-labor intensive strategy for improving medication adherence among African Americans in both primary care and ED settings, as text message use within this population is widely integrated into everyday life, even among the lowest income levels. The goal of this evaluation is to determine intervention efficacy, as well as to establish the feasibility and acceptability of using an automated SMS intervention to improve medication adherence in African Americans with uncontrolled HTN in these settings.

We recently launched two randomized controlled trials (RCTs) of uncontrolled hypertensive African Americans in Detroit, MI; one with participants from primary care clinics, and one with participants from an ED. The primary outcome measure is change in medication adherence from baseline to one-month follow-up. Secondary outcome measures include changes in blood pressure and medication self-efficacy, participant satisfaction and acceptability, and feasibility of use in our target population. We have currently enrolled 9 participants in the primary care RCT and 7 participants in the ED RCT (target n=70 in each RCT) and preliminary evaluation results are forthcoming. Although the evaluation is ongoing, several lessons regarding the conduct of mHealth research within limited resource settings have been learned including overcoming recruitment and enrollment barriers, challenges associated with utilizing SMS-based interventions with low-income targeted mobile phone carriers, and strategies for retaining participants from baseline to one-month follow-up.