JMIR Publications

ABSTRACT

Background:

Non-communicable diseases are the leading cause of death in Kosovo, with up to 60% of users of primary healthcare (PHC) self-reporting diabetes. Globally, diabetes is expected to affect 1 in 8 people worldwide by 2050. In Kosovo, low PHC usage and poor self-management result in a high burden of diabetes complications and frequent hospitalisation of persons with diabetes.

Objective:

This pilot study aimed to introduce and assess MonitorIM, a digital self-management application for diabetes, in a close-to real-world setting in Kosovo, examining its usability, acceptability and implementation, and to gather preliminary insights on potential effectiveness to inform a future effectiveness study and possible role-out.

Methods:

A pilot digital intervention was developed combining a patient-facing app for self-monitoring and information retrieval, and a provider interface for remote monitoring. Intervention development was done iteratively with users to assess functionality, usability, acceptability, implementation and early potential effectiveness in a close-to real-world setting, based on a national Technical Working Group. The pilot enrolled patients previously hospitalized in relation to diabetes, and healthcare providers involved in diabetes care at secondary level. Participants used the application for at least two months. Afterwards, interviews and focus group discussions were conducted with patients, healthcare providers, and caregivers. The Diabetes Self-Management Questionnaire (Revised) (DSMQ-R) was administered to patients before being introduced to the application, and at the endline interviews, in order to validate the questionnaire and estimate effect size for a potential future effectiveness study. Application usage data and the issue log were also examined.

Results:

A total of 18 patients completed the study. The application was appreciated by patients, caregivers and healthcare providers and seen to support improved monitoring practices, communication and patient engagement. Concerns were raised about an increased burden on healthcare providers that would be problematic at scale, highlighting the need for improved workflow integration. Twelve of the 18 patients had improved DSMQ-R scores after using the app for two months with a mean difference of 0.42. Cronbach-alpha tests showed internal consistency, validating it for use in this setting.

Conclusions:

The application was acceptable and feasible, and showed potential for improvement of self-management behaviour and clinical outcomes. The DSMQ was validated for use in this context. The intervention package will be further refined with a view of integration into the national digital health ecosystem.