JMIR Publications

ABSTRACT

Background:

A prevalent and serious complication of diabetes mellitus is the development of diabetic foot ulcers (DFU). There’s a need for effective solutions that help prevent DFU to support our increasingly stressed healthcare systems. The use of mHealth tools has been shown to improve awareness and effective self-care management skills in people at risk of developing diabetic foot ulceration.

Objective:

In this study, we aimed to investigate the perceived usefulness, engagement and the overall user experience of a self-monitoring mHealth application for people at risk of DFU.

Methods:

A total of 24 participants (mean age 71, SD 8.6 years) with Diabetes Mellitus Type 2 at risk of developing diabetic foot ulceration completed a 3-month evaluation period (70 recruited, 36 included, 12 dropped out) of a self-monitoring mobile application called Feetchecker App. A mixed methods approach was used to collect quantitative insights from application usage and combined with qualitative insights from a pre- and post-survey as well as interviews with participants and involved podiatrists. Data was analyzed using descriptive statistics and thematic analysis. We evaluated overall use of the application, participant engagement and user experiences.

Results:

Participants who fully completed the study conducted 393 Feet Checks. In total 7 participants sent in 9 pictures, all 7 were called for follow-up by the podiatrists. Participants generally had a positive experience with the application and perceived the Feetchecker App as a valuable tool to monitor their feet for potential risk factors of DFU. Ease of use in performing a feetcheck and sending the podiatrist a picture were described as important features. Three main types of engagement with the Feetchecker App emerged: continuous, frequent and no to little engagement. These patterns highlight enablers for self-monitoring such as ease-of-use, easy access to a podiatrist and social support, as well as barriers such as digital skills and sustained engagement. Podiatrists highlighted the benefits of having patients report potential issues quicker than waiting for consultations and the ability to monitor their patients remotely. Challenges remain in integrating the promotion of the Feetchecker App in their consultations.

Conclusions:

The Feetchecker App supported patients in self-monitoring risk factors associated with DFU through routine checks and quick contact with a healthcare professional in case of a potential issue. Overall, patients described a positive user experience and considered the application helpful. While mHealth tools are not for everyone, user engagement for many participants was high and shows that such applications can offer support for people able to use them. Future research should focus on improving usability and engagement with the app as well as extend the way patients can communicate with healthcare professionals beyond a picture.