JMIR Publications

ABSTRACT

Background:

Globally diabetes affects approximately 500 million people and is predicted to affect up to 700 million people by 2045. In Australia, the ongoing impact of colonisation produces inequity in healthcare delivery and inequality in healthcare outcomes for First Nations Peoples with rates of diabetes four times that of non-Indigenous Australians. Evidence-based clinical practice has been shown to reduce complications of diabetes-related foot disease, including ulceration and amputation by 50%. However, factors such as a lack of access to culturally safe care, geographical remoteness, and high cost associated with in-person care are key barriers for First Nations Peoples in accessing evidence-based care. This has led to the development of innovative mobile health (mHealth) applications as a way to increase access to health services and improve knowledge and self-care management for people living with diabetes.

Objective:

To evaluate studies investigating the use of mHealth applications for the assessment and management of diabetes-related foot health in First Nations Peoples in Australian and non-Indigenous populations globally.

Methods:

PubMed, Informit Indigenous Collection databases, Ovid MEDLINE, Embase, CINAHL Complete and Scopus were searched from inception to 8th September 2022. Hand searches of grey literature and reference lists of included studies were conducted. Studies describing mHealth applications developed for the assessment and management of diabetes-related foot disease were eligible. Studies had to include an evaluation (qualitative or quantitative) of the mHealth application. No language, publication date, or publication status restrictions were used.

Results:

No studies in First Nations Peoples in Australia were identified. Six studies in non-Indigenous populations with a total of 361 participants were included. Foot care education was the main component of all the mHealth applications. Two of the mHealth applications provided functionality for participants to enter health-related data and one included a messaging interface. Length of follow-up ranged from one to six months. One study reported high levels of acceptability of the mHealth application content for self-care by people living with diabetes and diabetes specialists. The remaining five studies reported that participants had improved diabetes-related knowledge and self-management skills following the use of their mHealth application.

Conclusions:

The findings from this systematic review provide an overview of the features deployed in mHealth applications and indicate that this type of intervention can improve knowledge and self-care management skills in non-Indigenous people living with diabetes. Future research needs to focus on mHealth applications for populations where there is inadequate or ineffective service delivery including for First Nations people and those in geographically remote areas as well as evaluating direct effects on diabetes-related foot disease outcomes.