JMIR Publications

ABSTRACT

Background:

Patient-reported outcomes (PROs) are increasingly being used in management of type 2 diabetes (T2D) to integrate data on patients’ perspective into clinical care. To date, majority of PRO tools have lacked patient and provider involvement in their development thus, they fail to meet the unique needs of end-users, and lack the technical infrastructure to be integrated into the clinic workflow.

Objective:

To apply a systematic, user-centered design approach to develop i-Matter, a theory-driven, mobile PRO system for patients with T2D and their primary care providers.

Methods:

i-Matter combines text messaging with dynamic data visualizations that can be integrated into electronic health records (EHRs) and personalized patient reports. To build i-Matter, we conducted: semi-structured group and individual interviews with T2D patients and providers; a design thinking workshop to refine initial ideas and design the prototype; and user testing sessions of prototypes using a rapid-cycle design (i.e., design-test-modify-retest).

Results:

Using an iterative user-centered process resulted in the identification of the six PRO messages that were relevant to patients and providers: medication adherence; dietary behaviors; physical activity; sleep quality; quality of life; and healthy living goals. In user testing, patients recommended improvements to the wording and timing of the PRO text messages to increase clarity and response rates. Patients also recommended including motivational text messages to help sustain engagement with the program. The personalized report was regarded as a key tool for diabetes self-management by patients and providers because it aided in the identification of longitudinal patterns in the PRO data, which increased patient awareness of their need to adopt more healthful behaviors. Patients recommended adding individualized tips to the journal on how they can improve their behaviors. Providers preferred having a separate tab built into the EHR that included the personalized report and highlighted key trends in patients’ PRO data across the past three months.

Conclusions:

PRO tools that capture patients’ well-being and the behavioral aspects of T2D management are most important to patients and providers. A clinical trial will test the efficacy of i-Matter in 282 patients with uncontrolled T2D. Clinical Trial: Clinicaltrials.gov NCT03652389