Investigation of a Mobile Health Texting Tool for Embedding Patient-Reported Data Into Diabetes Management (i-Matter): Development and Usability Study

Antoinette Schoenthaler, Jocelyn Cruz, Leydi Payano, Marina Rosado, Kristen Labbe, Chrystal Johnson, Javier Gonzalez, Melissa Patxot, Smit Patel, Eric Leven, Devin Mann, Antoinette Schoenthaler, Jocelyn Cruz, Leydi Payano, Marina Rosado, Kristen Labbe, Chrystal Johnson, Javier Gonzalez, Melissa Patxot, Smit Patel, Eric Leven, Devin Mann

Abstract

Background: Patient-reported outcomes (PROs) are increasingly being used in the management of type 2 diabetes (T2D) to integrate data from patients' perspective into clinical care. To date, the majority of PRO tools have lacked patient and provider involvement in their development, thus failing to meet the unique needs of end users, and lack the technical infrastructure to be integrated into the clinic workflow.

Objective: This study aims to apply a systematic, user-centered design approach to develop i-Matter (investigating a mobile health [mHealth] texting tool for embedding patient-reported data into diabetes management), a theory-driven, mobile PRO system for patients with T2D and their primary care providers.

Methods: i-Matter combines text messaging with dynamic data visualizations that can be integrated into electronic health records (EHRs) and personalized patient reports. To build i-Matter, we conducted semistructured group and individual interviews with patients with T2D and providers, a design thinking workshop to refine initial ideas and design the prototype, and user testing sessions of prototypes using a rapid-cycle design (ie, design-test-modify-retest).

Results: Using an iterative user-centered process resulted in the identification of 6 PRO messages that were relevant to patients and providers: medication adherence, dietary behaviors, physical activity, sleep quality, quality of life, and healthy living goals. In user testing, patients recommended improvements to the wording and timing of the PRO text messages to increase clarity and response rates. Patients also recommended including motivational text messages to help sustain engagement with the program. The personalized report was regarded as a key tool for diabetes self-management by patients and providers because it aided in the identification of longitudinal patterns in the PRO data, which increased patient awareness of their need to adopt healthier behaviors. Patients recommended adding individualized tips to the journal on how they can improve their behaviors. Providers preferred having a separate tab built into the EHR that included the personalized report and highlighted key trends in patients' PRO data over the past 3 months.

Conclusions: PRO tools that capture patients' well-being and the behavioral aspects of T2D management are important to patients and providers. A clinical trial will test the efficacy of i-Matter in 282 patients with uncontrolled T2D.

Trial registration: ClinicalTrials.gov NCT03652389; https://ichgcp.net/clinical-trials-registry/NCT03652389.

Keywords: mobile health; patient-reported outcome measures; type 2 diabetes.

Conflict of interest statement

Conflicts of Interest: DM, JC, LP, MR, KL, CJ, and JG have no competing interests or financial disclosures to declare. AS is a consultant for Rip Road, Inc. MP, SP, and EL were paid as consultants to develop the mHealth intervention for this project.

©Antoinette Schoenthaler, Jocelyn Cruz, Leydi Payano, Marina Rosado, Kristen Labbe, Chrystal Johnson, Javier Gonzalez, Melissa Patxot, Smit Patel, Eric Leven, Devin Mann. Originally published in JMIR Formative Research (http://formative.jmir.org), 31.08.2020.

Figures

Figure 1
Figure 1
i-Matter study flow.
Figure 2
Figure 2
Example of a final personalized report after two rounds of user testing.
Figure 3
Figure 3
Screenshot of i-Matter Epic integration.

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