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Research into the needs and barriers of diabetic type 2 patients concerning lifestyle monitoring and coaching, in order to improve a web based eHealth platform Floor.

Kocabiyik, T. (2018) Research into the needs and barriers of diabetic type 2 patients concerning lifestyle monitoring and coaching, in order to improve a web based eHealth platform Floor.

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Abstract:Background: Diabetes is a so-called metabolic disease. It affects the way the body processes glucose. Diabetes occurs when the pancreas does not produce (enough) insulin, or when the body cannot effectively use the insulin it produces [WHO, 2016]. Diabetes Mellitus is a fast-growing disease. According to the Dutch National Institute for Public Health and Environment (RIVM) the amount of patients will increase to 1.3 million in the year 2025. Diabetes is a chronic disease that requires continuous treatment. Diabetes treatment is mainly focused on preventing complications by keeping the glucose concentration of a patient within normal range. For diabetes patients, self-management and a change of lifestyle is important for the prevention or treatment of Diabetes. To improve self-management among diabetes type 2 patients, health coaching can be a great benefit (Huffman, 2007). Technology can play an important role in health coaching and helping patients develop competence for self- management and behavior change. Technology in the field of health is often called eHealth (Gemert-Pijnen, 2013). eHealth can play in important role in providing online support, coaching and monitoring. (Gemert-Pijnen, 2013). Many eHealth technologies are designed for diabetic patients. Most technologies aiming at lifestyle changes used mobile eHealth interventions, in which patients received feedback on for instance their blood glucose levels, medication or pedometer data. Yet none of these technologies seem to have led to long-term usage. It is known from previous research that long-term changes in nutrition and exercise are difficult to maintain for most diabetes type 2 patients (Klein et al., 2004). Adherence is very difficult to realize. According to van Gemert-Pijnen (2013) eHealth technologies should be persuasive to increase adherence. Technology should contain persuasive elements and triggers to stimulate users to persist and stick to their behaviour change programs and continue using this (Van Gemert-Pijnen, 2013). Floor is an eHealth application that is designed for Diabetic Type 2 patients to help them change behaviour, to gain a healthier lifestyle. Floor is developed by Nedap Healthcare. Objective: The aim of this research is to gain more insight in the needs and barriers of the patients in the current care and their experiences and expectations with online coaching. Furthermore, the persuasiveness of the eHealth application Floor will be assessed by using the Perceived Persuasiveness Questionnaire (PPQ). Lastly, the eHealth application Floor will be heuristically analyzed whether the elements of the Persuasive System Design (PSD) model are applied or not. Method: To investigate the needs and barriers of patients (N=6), a qualitative semi-structured interview was held. The topics for the interview were based on lifestyle, experiences with the current care, the needs and barriers, support from family and friends and expectations from online coaching. The interviews were inductive coded and analyzed in several steps. Eventually several themes were found. Another research method was the Perceived Persuasiveness Questionnaire (PPQ) which was completed by 5 users of Floor. This questionnaire has been used to analyze the persuasiveness of the current eHealth application Floor. The PPQ has been analyzed by calculating the mean for each item of the PPQ per respondent. This is calculated from the numbers that patients graded for each question on a 5-points Liker scale (1 for totally not agree and 5 for totally agree). Lastly, a heuristic evaluation of the eHealth application Floor is done by evaluating the Persuasive System Design principles of Oinas-Kukkonen & Harjumaa (2009). The main goal of heuristic evaluation is to identify any problems associated with the design of user interfaces. The simplicity of heuristic evaluation is beneficial at the early stages of design (Nielsen & Molich, 1990). These design principles in this evaluation are: primary task support, dialogue support, system credibility, and social support. For each principle the author has reviewed whether the given design principle is already implemented in Floor or not. And if the principle is not implemented in Floor yet, a short advice is given on how it could be implemented in Floor. Results: The results of the interviews showed that the patients have need for clear advice on nutrition. Also they have the need for social support, mental support and professional support. The barriers that patients are facing currently are: difficulties in social pressure, difficulties in cooking healthy, traditional approach of dieticians that does not work and asking help from families is a barrier. The expectations of patients from online coaching: personal advice/guidelines on nutrition and exercise, “just in time care” (support on difficult times and 24/7 support). The barriers that were mentioned are: language barriers for patients that do not speak Dutch very well, patients that do not use internet. Lastly adherence was mentioned as a barrier: patients mentioned it is too much effort to use an app daily. The persuasiveness of Floor was scored on average by the users, which is 2.8 (minimum score was 1 and maximum was 5). Lowest score was for the element perceived effort (2.4) and unobtrusiveness (2.5). None of the categories were scored high (>3.5). All other categories scored on average (2.5>3.5): primary task support, perceived credibility, perceived persuasiveness, dialogue support. The results of the heuristic evaluation can be found in the results section. Conclusion: Patients need personal and just in time care. The current traditional approach does not work, which means that it does not help them to change their lifestyle. In their daily life they have need for support (social, mental and professional support). Therefore, they expect from online coaching that it is personal, available 24/7 and does not ask too much effort. Currently the persuasiveness of Floor has been scored on average by the patients. Patients scored the perceived effort as the lowest. This might be understandable since Floor expects that patients fill in their daily satisfaction. To use an application daily could be experienced as much effort. Lastly according to heuristic evaluation, different elements of the PSD model are applied in Floor. The primary task support is clear for users; it is tunneled and tailored for only DM 2 patients. However the application is not much personalized and there is no option for self-monitoring. In dialogue support Floor can gain more. There are very less praise, rewards, reminders and suggestions. Patients only receive a daily SMS as a reminder to fill in their satisfaction in Floor. On system credibility Floor can reach more by other authorities, third party endorsements. However, the system already looks very professional and trustful. Lastly, on social support Floor tries to give support via buddy (friend/family that the user invites through the system). But there is no peer support, social learning or comparison, cooperation, competition or recognition of a user.
Item Type:Essay (Master)
Clients:
Nedap, Groenlo, Netherlands
Faculty:TNW: Science and Technology
Subject:01 general works
Programme:Health Sciences MSc (66851)
Link to this item:http://purl.utwente.nl/essays/75017
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