Participatory development of an integrated, eHealth supported, educational care pathway (the Diabetes Box) for people with type 2 diabetes: Development and Usability Study (Preprint)

Abstract

Type 2 diabetes (T2D) tremendously affects patient health and healthcare globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioural, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change health behaviour and improve glucose regulation. Digital tools are effective in areas of self-mangement and have great potential to support patient self-management due to low costs, 24/7 availability and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and to use a structured approach to guide the development team in planning, coordinating and executing the development process.

Taking this into account, we aimed to develop an integrated, eHealth-supported, educational care pathway for people with T2D.

The educational care pathway was developed using the first three phases of the CeHRes Roadmap; the contextual inquiry, the value specification and the design phase. Following this roadmap we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with healthcare professionals and a patient panel, to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box and consisted of personalized education, online educational material, self-measurements of glucose, blood pressure, activity and sleep, and a smartphone application to bring it all together.

The scoping review highlights the importance of self-management education, and the potential of telemonitoring and mobile apps for blood glucose regulation in T2D patients. Focus groups with healthcare professionals revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualisation and that insulin use should be incorporated into the app. Both patients and healthcare professionals stressed the importance of direct automated feedback in the Diabetes Box.

After developing the Diabetes Box prototype using the CeHReS Roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible, and that direct automated feedback and education on stress and sleep are essential. To assess feasibility, acceptability and usefulness in more detail, a pilot study is planned.