Efficacy Study of Interactive Web Application for Problem Solving in Diabetes Management
| Status: | Completed |
|---|---|
| Conditions: | Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 4/17/2018 |
| Start Date: | December 2013 |
| End Date: | August 2017 |
Randomized Clinical Trial of Health Information Technology for Problem Solving in Diabetes Management
The main hypothesis of this research is that use of an informatics intervention for
problem-solving in diabetes management, Mobile Diabetes Detective (MoDD), by individuals with
type 2 diabetes will lead to positive improvements on a number of primary and secondary
outcomes related to their health and their management of diabetes. The primary outcomes are a
reduction in individuals' glycolated hemoglobin (HbA1c), improvement in their problem-solving
abilities, and self-care behaviors. Secondary outcomes include a reduction in individuals'
fasting blood glucose (BG); improvement in individuals' self-efficacy, and in emotional
aspect of living with diabetes. We hypothesize that primary and secondary outcome effects
will be sustained at three months and twelve months. Exploratory outcomes include a decrease
in individuals' Cardiovascular Risk (Body Mass Index, Blood Pressure, Total, low-density
lipoprotein (LDL) and high-density lipoprotein (HDL) Cholesterol levels, and Framingham
Cardiovascular Risk Score). We also hypothesize that improvements in clinical outcomes
(HbA1c, fasting BG and Cardiovascular Risk) will be mediated by the improvements in
problem-solving abilities and self-efficacy.
problem-solving in diabetes management, Mobile Diabetes Detective (MoDD), by individuals with
type 2 diabetes will lead to positive improvements on a number of primary and secondary
outcomes related to their health and their management of diabetes. The primary outcomes are a
reduction in individuals' glycolated hemoglobin (HbA1c), improvement in their problem-solving
abilities, and self-care behaviors. Secondary outcomes include a reduction in individuals'
fasting blood glucose (BG); improvement in individuals' self-efficacy, and in emotional
aspect of living with diabetes. We hypothesize that primary and secondary outcome effects
will be sustained at three months and twelve months. Exploratory outcomes include a decrease
in individuals' Cardiovascular Risk (Body Mass Index, Blood Pressure, Total, low-density
lipoprotein (LDL) and high-density lipoprotein (HDL) Cholesterol levels, and Framingham
Cardiovascular Risk Score). We also hypothesize that improvements in clinical outcomes
(HbA1c, fasting BG and Cardiovascular Risk) will be mediated by the improvements in
problem-solving abilities and self-efficacy.
Well-developed problem-solving is essential to successful diabetes management results in
better diabetes self-care behaviors, and leads to improvements in clinical outcomes.
Problem-solving is central to many self-management and behavior change programs; the American
Diabetes Association (ADA) includes problem-solving as a critical self-care behavior. Given
the importance of problem solving skills, innovative diabetes education programs, such as
Discovering Diabetes, have been developed and shown to be effective in fostering independent
problem-solving.
At the same time, many care management programs and diabetes education centers struggle with
staffing shortages, limited funding, and competitive time demands. As a result, 50 to 80% of
individuals with diabetes experience significant knowledge and skill deficits. Health
Information Technology (HIT) can make successful interventions available to more diverse
populations. At present, however, many HIT interventions target improved patient-clinician
communication and logging and monitoring, rather than focusing more specifically on fostering
problem-solving skills. Moreover, few HIT interventions have been rigorously evaluated in
controlled trials. The main contribution of this research is a theoretically-grounded HIT
intervention, Mobile Diabetes Detective (MoDD), that incorporates best practices and current
guidelines for supporting and fostering individuals' problem-solving skills in context of
diabetes self-management. In our prior work we developed and evaluated a mobile application
for reflection and discovery in diabetes management, MAHI (Mobile Access to Health
Information). MAHI helped individuals with diabetes capture diabetes-related experiences and
reflect on them under a supervision of a diabetes educator. The proposed intervention, MoDD
will further extend this prior work, specifically focusing on guided problem-solving through
experimentation. The intervention will utilize an open source platform for disease
self-management developed by the research team.
If the results are achieved, the project will have significant impact both locally and
globally. Locally, diabetes continues to be a major problem in NYC, particularly among
disadvantaged populations, many of whom are served by the Health Resources and Services
Administration (HRSA) funded Community Health Centers (CHCs) participating in this study. In
the past 10 years, the number of people with diabetes in NYC has more than doubled. An
estimated 530,000 adult New Yorkers have been diagnosed with diabetes, with another 265,000
having diabetes but are unaware. In the HRSA funded CHCs in New York State, 8% of the adult
patients have a diagnosis of diabetes. At the same time, our prior studies showed that
despite such barriers as low health literacy or lower socio-economic status, disadvantaged
populations in NYC can greatly benefit from informatics interventions that target health and
wellness. The proposed research will use HIT to partially assuage the ongoing challenge of
control and management of diabetes. The expected improvement in problem-solving skills has
been shown to lead to improved self-care behaviors, such as a more careful diet and
appropriate level of exercise, and significant reduction in HbA1c7, which in turn has been
linked to reduction in diabetes-related complications. Thinking more broadly, this research
can provide new insights into facilitating problem-solving in diabetes management with HIT,
as an alternative to more traditional staff-intensive interventions.
better diabetes self-care behaviors, and leads to improvements in clinical outcomes.
Problem-solving is central to many self-management and behavior change programs; the American
Diabetes Association (ADA) includes problem-solving as a critical self-care behavior. Given
the importance of problem solving skills, innovative diabetes education programs, such as
Discovering Diabetes, have been developed and shown to be effective in fostering independent
problem-solving.
At the same time, many care management programs and diabetes education centers struggle with
staffing shortages, limited funding, and competitive time demands. As a result, 50 to 80% of
individuals with diabetes experience significant knowledge and skill deficits. Health
Information Technology (HIT) can make successful interventions available to more diverse
populations. At present, however, many HIT interventions target improved patient-clinician
communication and logging and monitoring, rather than focusing more specifically on fostering
problem-solving skills. Moreover, few HIT interventions have been rigorously evaluated in
controlled trials. The main contribution of this research is a theoretically-grounded HIT
intervention, Mobile Diabetes Detective (MoDD), that incorporates best practices and current
guidelines for supporting and fostering individuals' problem-solving skills in context of
diabetes self-management. In our prior work we developed and evaluated a mobile application
for reflection and discovery in diabetes management, MAHI (Mobile Access to Health
Information). MAHI helped individuals with diabetes capture diabetes-related experiences and
reflect on them under a supervision of a diabetes educator. The proposed intervention, MoDD
will further extend this prior work, specifically focusing on guided problem-solving through
experimentation. The intervention will utilize an open source platform for disease
self-management developed by the research team.
If the results are achieved, the project will have significant impact both locally and
globally. Locally, diabetes continues to be a major problem in NYC, particularly among
disadvantaged populations, many of whom are served by the Health Resources and Services
Administration (HRSA) funded Community Health Centers (CHCs) participating in this study. In
the past 10 years, the number of people with diabetes in NYC has more than doubled. An
estimated 530,000 adult New Yorkers have been diagnosed with diabetes, with another 265,000
having diabetes but are unaware. In the HRSA funded CHCs in New York State, 8% of the adult
patients have a diagnosis of diabetes. At the same time, our prior studies showed that
despite such barriers as low health literacy or lower socio-economic status, disadvantaged
populations in NYC can greatly benefit from informatics interventions that target health and
wellness. The proposed research will use HIT to partially assuage the ongoing challenge of
control and management of diabetes. The expected improvement in problem-solving skills has
been shown to lead to improved self-care behaviors, such as a more careful diet and
appropriate level of exercise, and significant reduction in HbA1c7, which in turn has been
linked to reduction in diabetes-related complications. Thinking more broadly, this research
can provide new insights into facilitating problem-solving in diabetes management with HIT,
as an alternative to more traditional staff-intensive interventions.
Inclusion Criteria:
- Age 18-65 years
- A diagnosis of Type 2 Diabetes with HbA1c ≥ 8.0. A patient of the health center for at
least 6 months
- Has participated in at least one diabetes education session at the participating site
in the last 6 months
- Proficient in either English or Spanish
- Must own a basic cell phone
Exclusion Criteria:
- Pregnancy
- Presence of serious illness (e.g. cancer diagnosis with active treatment, advanced
stage heart failure, multiple sclerosis)
- Presence of cognitive impairment
- Plans for leaving the community health center (CHC) in the next 12 months
- Does not have a computer and/or Internet access
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