JMIR Publications

ABSTRACT

Background:

Type 2 diabetes is becoming more prevalent around the world, including in Singapore. Diabetes education programs have been proven to be effective in improving health outcomes and diabetes self-management skills. Several effective approaches to diabetes education in patients with type 2 diabetes have been established, including the use of mobile health applications. Despite strong evidence of their efficacy, these apps are not always well-utilized or accepted by the target population. End-user feedback is essential for designing a feasible and acceptable app that can improve outcomes for chronic disease populations.

Objective:

We applied a mixed-methods, end-user-engaged approach to co-design an education app prototype for patients with type 2 diabetes to explore their perceptions, acceptance and usability of the prototype, as well their diabetes experience and perspectives on digital diabetes education.

Methods:

The study was conducted between August 2021 and January 2022. Participants were eight diabetic patients recruited from diabetes management Facebook groups. A total of six data points were collected: four web-based surveys and two structured interviews via Zoom. Descriptive statistics and thematic analyses of discussion and iterative feedback on the app prototype were used to assess perceptions of living with diabetes, attitudes toward digital diabetes education, and acceptance of the prototype.

Results:

The data collected were grouped into 3 deductive themes: (1) challenges of living with diabetes, (2) validation, acceptability, and usability of diabetes education app prototype, and (3) perspectives on digital diabetes education. The first theme highlighted the importance and burden of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second indicated that the diabetes education app prototype is acceptable, with information being the key, power of appearance, ambivalent and polarized opinions toward the chatbot, and potential impact of the app on self-management. The third theme comprised the necessity of utilizing a variety of information seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based, gamification, guidance, integration, personalization, and up-to-date.

Conclusions:

Our findings could be used for the development of apps to address the health needs of patients with type 2 diabetes. They also add context for understanding type 2 diabetes patients in Singapore, including challenges in self-management and perspectives on diabetes education.