Analysis of Healthy Coping Feedback Messages from Diabetes Mobile Apps: Validation Against an Evidence-Based Framework

Abstract

Background: In this study, we focused on Healthy Coping, a key principle of ADCES7 Self-Care Behaviors® (ADCES7®) that enables people with diabetes to achieve health goals for self-care. We aimed to validate Healthy Coping-related feedback messages from diabetes mobile apps against the framework based on behavioral change theories. Methods: We searched apps using the search terms: “diabetes,” “blood sugar,” “glucose,” and “mood” from iTunes and Google Play stores. We entered a range of values on 3 Healthy Coping domains: (1) diabetes-related measures including blood glucose, blood pressure, HbA1c, weight, (2) physical exercise/activity, and (3) mood to generate feedback messages. We used a framework by adopting validated behavioral change theory-based models to evaluate the feedback messages against 3 dimensions of timing, intention, and content (feedback purpose and feedback response). The feedback purposes in this study were categorized into 7 purposes; warning, suggestion, self-monitoring, acknowledging, reinforcement, goal setting, and behavior contract. Results: We identified 1,749 apps from which 156 diabetes mobile apps were eligible and generated 473 feedback messages. The majority of generated feedback messages were related to blood sugar measurement. Only feedback messages on blood sugar under diabetes-related measures and mood domains encompassed all 7 feedback purposes under the content dimension. Conclusions: Many feedback messages neither supported Healthy Coping domains nor followed the behavioral theory-based framework. It is important that feedback messages be structured around the dimensions of the behavioral theory-based framework to promote behavior change. Furthermore, our framework had the generalizability that can be used in other clinical areas.