Smartphone apps for type 2 diabetes self-management and medication adherence : a multi-method study

• Main Author: Huang, Zhilian
• Other Authors: Josip Car
• Format: Thesis-Doctor of Philosophy
• Language: English
• Published: Nanyang Technological University 2020
• Subjects: Science::Medicine
• Online Access: https://hdl.handle.net/10356/137883
• Institution: Nanyang Technological University

Type 2 diabetes (T2D) is a growing public health problem for many countries. Smartphone apps are increasingly used to assist in T2D self-management due to their convenience, ubiquity, and emerging positive evidence. Currently, the rate of diabetes apps production far outpaces their adoption. There is a lack of evidence on the quality, utility, and clinical relevance of health apps and whether these apps meet the users’ needs. This dissertation investigated the quality and clinical relevance of apps for diabetes mellitus (DM) management through three sub-studies: (1) An assessment of the clinical relevance of DM self-management apps in ten languages of countries with the highest prevalence of diabetes; (2) a systematic assessment of the medication management features of apps for people with T2D against its (i) congruence with international diabetes and medication management guidelines, and (ii) the quality of health information disseminated; and (3) a pilot assessing the feasibility and impact of a smartphone app in improving medication adherence in people with T2D in Singapore. The global assessment of DM self-management apps showed that apps in English and Mandarin dominated the app market. Although highly downloaded apps had more clinically relevant app features, they still lacked important features for DM self-management, such as information provision, physical activity tracking, diet modification, medication management, and risk reduction strategies. Next, the systematic assessment of the medication management features of apps for people with T2D identified essential gaps in (i) app features for enhancing medication adherence and safety, such as the ability to enter medication-taking instructions, and (ii) variable adherence to the transparency and reliability of health information disseminated via these apps. Finally, the feasibility pilot showed that a smartphone app intervention for (self-reported) medication non-adherent T2D patients was acceptable, improved awareness of medication adherence, and reduced self-reported barriers to medication adherence. Access to high-quality diabetes apps is unequal across populations. Apart from English and Mandarin DM apps, those in other major languages lacked comprehensive features for self-management. Of concern is the paucity of medication management features in T2D apps elicited via the in-depth assessment. The assessment criteria from this research could be used as a checklist for app development and selection for usage to raise the standard of future DM apps. A good app should possess essential evidence-based features, safeguard data privacy and security, disseminate accurate and high-quality content, and be easy to use.