Exploring opportunities and challenges for the spread, scale-up and sustainability of mobile health apps for self-management of patients with type 2 diabetes mellitus in the Netherlands: a citizen science approach (Preprint)

Abstract

Technologies evolve at a breakneck pace and the success of mHealth for people with type 2 diabetes mellitus (T2DM) depends on whether healthcare professionals, care management, government regulators, and consumers will adopt the technology as a viable solution to enhance patient self-management.

In the present study we explored the challenges of the implementation of mobile health apps in care for patients with T2DM, and determined to what extent these challenges complicate the dissemination, limit scale-up, and influence sustainability of technological interventions for T2DM.

The Non-adoption, Abandonment, and challenges to Scale-up, Spread and Sustainability (NASSS) framework served as the basis for our study. The seven domains of the NASSS framework were explored using questionnaires, interviews, and focus groups together with patients with T2DM, care professionals, technology developers, policy officers, and patient organisation.

Regarding the domain “condition”, being aware of their condition and changing lifestyle were crucial for patients with T2DM to get grips on their life. The rapid development of health apps for T2DM was highlighted in the domain “technology”. Users should be aware of these apps and know how to use them. The domain “value proposition” included the patient perspective and elaborated on personal values, and care professionals who focus on personalised care and pressure on healthcare. Regarding the “adopters”, it is crucial to know who needs to use and introduce the apps. Responsibility, a shared vision, and resistance among care professionals were mentioned as important determinants for “organisation”. Finally, the domain “wider system” showed the importance of involving multiple institutes, care guidelines, and reimbursements.

This study emphasized the added value to discuss the implementation of mobile health apps in an early stage of the implementation process with patients and professionals. They are key users and attribute to the possibilities and limitations of the implementation. A clear vision for an organisational perspective and specific prerequisites for implementation is crucial to develop responsible implementation strategies at micro and meso level. At the national level, guidelines for regulations, privacy, and security are essential, as well as the integration of mHealth into T2DM care guidelines and sufficient reimbursement by health insurers.