JMIR Publications

ABSTRACT

Background:

Self-management is a substantial part of the treatment for patients with type-2 diabetes (T2D). Modern digital technology, being small, available and ubiquitous has promising properties that might work well in supporting self-management. This study follows the process of developing a pilot implementation of an eHealth service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations which can serve as guides in development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce.

Objective:

The aim of this paper was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources i.e. interviews, observations, focus groups and mentimeter survey among stakeholders representing various perspectives of T2D.

Methods:

A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews and observations. The different data sources enabled a triangulation of data.

Results:

Results show that user needs related to an eHealth service for person-centered T2D self-management support is multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge that indicated that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention towards changing the organization of work to fully support a new eHealth service.

Conclusions:

Three overarching challenges, flexible access, reducing administrative tasks and patient empowerment, each having significant impact on design are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies on the patient context of use and everyday life experience is identified to better support the implementation of technology that fulfills patient needs and with the potential to soften the impact on the healthcare organization. Clinical Trial: This study is a preparatory part of a larger randomized intervention project aimed at designing and implementing person-centered interactive self-management support (iSMS) in primary healthcare in northern Sweden. The overall project has a user-centered design, as described in this paper and the project is registered at ClinicalTrials.gov, Identifier NCT03165084.