JMIR Publications

ABSTRACT

Background:

Self-monitoring is key to successful behavior change in diabetes and obesity, and using the traditional paper-based methods of self-monitoring may be time-consuming and burdensome.

Objective:

Thus, we aim to explore participant experiences while using technology assisted self-monitoring for multiple behaviors, weight, and blood glucose in overweight or obese adults with type 2 diabetes by analyzing 6-week and 6-month time point focus group discussions during a lifestyle intervention.

Methods:

The study analyzed qualitative data collected from the intervention group of a 6 month, three-arm (control group, paper diary group, and technology assisted self-monitoring group) randomized clinical trial. The study participants in the intervention group were instructed to use technology assisted self-monitoring of diet, exercise, and weight using the LoseIt! application, and self-monitoring of blood glucose using the Diabetes Connect application. Semi-structured group discussions were conducted at 6 weeks (one focus group discussion, n=10) from the initiation of the behavioral lifestyle intervention, and again at 6 months, aligning with the end of the intervention (a focus group discussion, n=9; and one make-up individual interview, n=1). All group and make-up individual discussions were audio-taped and transcribed verbatim. Using a combination of thematic and comparative analysis approaches, two trained professionals coded the transcriptions independently, then discussed and concluded common themes for 6-week and 6-month discussions, respectively.

Results:

The sample (N=10), primarily African Americans (n=7) and female (n=8), had a mean age of 59.4 years old and average body mass index (BMI) of 37.9. Eight major themes emerged from the interview data: 1) Perceived Benefits of Technology Assisted Self-Monitoring, 2) Perceived Ease of Use, 3) Use of Technology Assisted Self-Monitoring, 4) Facilitators of Engaging in Healthy Lifestyle Behaviors, 5) Barriers of Engaging in Healthy Lifestyle Behaviors, 6) Positive Lifestyle Change, 7) Learning Curve, and 8) Monitored Data Sharing. The first six of the eight themes were shared between the 6-week and 6-month timepoints, but the codes within these themes were not all the same and differed slightly between the two timepoints. These differences give insight into the evolution of participant thoughts and perceptions on using technology for self-monitoring and subsequent behavioral lifestyle change, while participating in the lifestyle intervention. The findings from the 6-week and 6-month discussions helped to paint the picture of participant comfortability and integration of technology and knowledge overtime and overall lent itself to participant attitudes, difficulties, behavioral processes/modifications, and health indicators that were experienced throughout the study.

Conclusions:

Though with some barriers, participants were able to identify various individual and external strategies to adjust to and engage in technology assisted self-monitoring, and concluded that the technology assisted self-monitoring was beneficial, safe and feasible to use for positive lifestyle change. These patient perspectives need to be considered for future research studies in investigating the effectiveness of using technology assisted self-monitoring, as well as in clinical practice when recommending technology assisted self-monitoring for lifestyle and health indicators to improve health outcomes.