JMIR Publications

ABSTRACT

Background:

The Diabetes Questionnaire is a digital patient-reported outcome and experience measure for adults living with diabetes. The Diabetes Questionnaire is intended for use in routine clinical visits in diabetes care, and to enable patient perspectives to be integrated into the Swedish National Diabetes Register. The Diabetes Questionnaire was developed on the basis of patients’ perspectives and evidence for its measurement qualities has been demonstrated. Patients receive an invitation to complete the questionnaire before clinical visits and the patient and health care professional can discuss the findings, which are instantly displayed during the visit. Implementation processes for new tools in routine care need to be studied to understand the influence of contextual factors, the support needed, and how patients and healthcare professionals experience clinical use.

Objective:

The aim of this study was to describe patients’ and healthcare professionals’ experiences of initiating the use of the digital Diabetes Questionnaire as a clinical tool in routine diabetes care, supported by a structured implementation strategy involving initial education, local facilitators, and regular follow-ups.

Methods:

In this qualitative study, semi-structured focus group discussions were held 12 months after the use of the Diabetes Questionnaire was initiated. Participants were diabetes specialist nurses and medical doctors (20 participants in four groups) at outpatient hospital-based clinics or primary health care clinics, and adults with type 1 or type 2 diabetes (15 participants in four groups). The audio-taped transcripts were analyzed using inductive qualitative content analysis.

Results:

The results revealed two main categories that integrated patients’ and healthcare professionals’ experiences, which together formed an overarching theme: “While implementation demands new approaches, the Diabetes Questionnaire provides a broader perspective.” The first main category (“The Diabetes Questionnaire supports person-centered clinical visits”) comprised comments expressing that the digital Diabetes Questionnaire can initiate and encourage reflection in preparation for clinical visits, bring important topics to light during clinical visits, and broaden the scope of discussion by providing additional information. The second main category (“The process of initiating the implementation of the Diabetes Questionnaire”) comprised comments that described differences in engagement among health care professionals and their managers, challenges of establishing new routines, experiences of support during implementation, thoughts about the Diabetes Questionnaire itself and the need to change local administrative routines, as well as opportunities and concerns for continued use.

Conclusions:

The Diabetes Questionnaire can broaden the scope of health data in routine diabetes care. While implementation demands new approaches, patients and health care professionals saw potential positive impacts of using the questionnaire on both the individual and group levels. Our results can inform further development of implementation strategies to support clinical use of the questionnaire.