JMIR Publications

ABSTRACT

Background:

Self-monitoring of blood glucose levels, food intake and physical activity supports self-management of patients with Type 2 Diabetes Mellitus (T2DM). There has been a rise in the development and availability of mobile health applications (apps) for T2DM.

Objective:

The aim of this study was to explore the actual use of diabetes mobile health applications among patients with T2DM and main barriers and drivers among app-users and non-users.

Methods:

An explanatory sequential design was applied, starting with a web-based questionnaire followed by semi-structured in-depth interviews. Data were collected between July and December 2020. Questionnaire data from 103 respondents were analyzed using IBM SPSS Statistics 25.0. Descriptive statistics were performed for actual use of apps and items of the Unified Theory of Acceptance and Use of Technology (UTAUT). The UTAUT includes four key constructs: performance expectancy (belief that an app will help improve health performance), effort expectancy (level of ease associated with using an app), social influence (social support) and facilitating conditions (infrastructural support). Differences between users and non-users were analyzed using chi-square tests for the individual items. Independent t-tests were performed to test for differences in mean scores per UTAUT-construct. Sixteen respondents contributed to the interviews (ten users and six non-users of T2DM-apps). Content analysis using a deductive approach was performed on all transcripts guided by the UTAUT.

Results:

Regarding actual use, 55% (57/103) were non-users and 45% (46/103) were users of apps for T2DM. Main driver for the use of apps was the belief that using diabetes-apps would result in better personal health and well-being. Time and energy required to keep track of data and understand the app were mentioned as barriers. Mean scores were significantly higher among users compared to non-users of apps for T2DM for the constructs performance expectancy (4.06 vs. 3.29; P<.001), effort expectancy (4.04 vs. 3.50; P<.001), social influence (3.59 vs. 3.29; P=.007) and facilitating conditions (4.22 vs. 3.65; P<.001). Based on sixteen in-depth interviews, it was recognized that health-care professionals play an important role in supporting patients with T2DM in using apps. However, respondents noticed that their health-care professionals were often not supportive regarding the use of diabetes-apps, did not show interest or did not talk about apps or acquired data. Reimbursement by insurance companies was mentioned as a missing facilitator.

Conclusions:

One of the main drivers for use was the belief that using diabetes-apps would result in better personal health and well-being. Time and energy needed to keep track of data and understand the app were mentioned as barriers. Empowering health-care professionals’ engagement is of utmost importance in supporting patients with T2DM in the use of apps. Insurance companies can play a role in facilitating the use of diabetes apps by assuring reimbursement.