The Motivating Function of Healthcare Professional in eHealth and mHealth Interventions for Type 2 Diabetes Patients and the Mediating Role of Patient Engagement

Guendalina Graffigna, Serena Barello, Andrea Bonanomi, Julia Menichetti, Guendalina Graffigna, Serena Barello, Andrea Bonanomi, Julia Menichetti

Abstract

eHealth and mHealth interventions for type 2 diabetes are emerging as useful strategies to accomplish the goal of a high functioning integrated care system. However, mHealth and eHealth interventions in order to be successful need the clear endorsement from the healthcare professionals. This cross-sectional study included a sample of 93 Italian-speaking type 2 diabetes patients and demonstrated the role of the perceived ability of healthcare professionals to motivate patients' initiative in improving the level of their engagement and activation in type 2 diabetes self-management. The level of type 2 diabetes patients' activation resulted also in being a direct precursor of their attitude to the use of mHealth and eHealth. Furthermore, patient engagement has been demonstrated to be a mediator of the relationship between the perceived ability of healthcare professionals in motivating type 2 diabetes patients and patients' activation. Finally, type 2 diabetes patients adherence did not result in being a direct consequence of the frequency of mHealth and eHealth use. Patient adherence appeared to be directly influenced by the level of perceived healthcare professionals ability of motivating patients' autonomy. These results offer important insights into the psychosocial and organizational elements that impact on type 2 diabetes patients' activation in self-management and on their willingness to use mHealth and eHealth devices.

Figures

Figure 1
Figure 1
Structural Equation Model 1.
Figure 2
Figure 2
Structural Equation Model 2.

References

    1. Committee on Quality of Health Care in America IoM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC, USA: National Academy Press; 2001.
    1. American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37:14–80.
    1. Ministero della Salute. Piano sulla Malattia Diabetica. DG Programmazione Sanitaria—Commissione Nazionale Diabete; 2012.
    1. Gröne O., Garcia-Barbero M. Integrated care: a position paper of the WHO European Office for Integrated Health Care Services. International Journal of Integrated Care. 2001;1, article e21
    1. Bellardita L., Graffigna G., Donegani S., et al. Patient's choice of observational strategy for early-stage prostate cancer. Neuropsychological Trends. 2012;12(1):107–116. doi: 10.7358/neur-2012-012-bell.
    1. Renders C. M., Valk G. D., Griffin S. J., Wagner E. H., Van Eijk J. T. M., Assendelft W. J. J. Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care. 2001;24(10):1821–1833. doi: 10.2337/diacare.24.10.1821.
    1. Ouwens M., Wollersheim H., Hermens R., Hulscher M., Grol R. Integrated care programmes for chronically ill patients: a review of systemic reviews. International Journal for Quality in Health Care. 2005;17(2):141–146. doi: 10.1093/intqhc/mzi016.
    1. Goodwin N., Smith J., Davies A., et al. Integrated Care for Patients and Populations: Improving Outcomes by Working Together. London, UK: King's Fund; 2012.
    1. Bousquet J., Anto J. M., Sterk P. J., et al. Systems medicine and integrated care to combat chronic noncommunicable diseases. Genome Medicine. 2011;3, article 43:12. doi: 10.1186/gm259.
    1. Bosio C., Graffigna G., Scaratti G. Knowing, learning and acting in health care organizations and services: challenges and opportunities for qualitative research. Qualitative Research in Organizations and Management: An International Journal. 2012;7(3):256–274. doi: 10.1108/17465641211279743.
    1. Graffigna G., Barello S., Triberti S., Wiederhold B. K., Bosio A. C., Riva G. Enabling eHealth as a pathway for patient engagement: a toolkit for medical practice. Studies in Health Technology and Informatics. 2014;199:13–21.
    1. Kodner D. L., Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications—a discussion paper. International Journal of Integrated Care. 2002;2, article e12
    1. Vrijhoef H. J. M., Berbee R., Wagner E. H., Steuten L. M. G. Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments. Health Expectations. 2009;12(4):417–429. doi: 10.1111/j.1369-7625.2009.00557.x.
    1. Graffigna G., Barello S., Riva G., Bosio A. C. Active Ageing and Healthy Living: A Human Centered Approach in Research and Innovation as Source of Quality of Life. Vol. 203. IOS Press; 2014. Patient engagement: the key to redesign the exchange between the demand and supply for healthcare in the era of active ageing; pp. 85–95.
    1. Graffigna G., Barello S., Libreri C., Bosio C. A. How to engage type-2 diabetic patients in their own health management: implications for clinical practice. BMC Public Health. 2014;14(1, article 648) doi: 10.1186/1471-2458-14-648.
    1. Epping-Jordan J. E., Pruitt S. D., Bengoa R., Wagner E. H. Improving the quality of health care for chronic conditions. Quality and Safety in Health Care. 2004;13(4):299–305. doi: 10.1136/qshc.2004.010744.
    1. Barello S., Graffigna G., Vegni E., Savarese M., Lombardi F., Bosio A. C. ‘Engage me in taking care of my heart’: a grounded theory study on patient-cardiologist relationship in the hospital management of heart failure. BMJ Open. 2015;5(3) doi: 10.1136/bmjopen-2014-005582.e005582
    1. Crawford M. J., Rutter D., Manley C., et al. Systematic review of involving patients in the planning and development of health care. BMJ Open. 2002;325, article 1263
    1. Carman K. L., Dardess P., Maurer M., et al. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Affairs. 2013;32(2):223–231. doi: 10.1377/hlthaff.2012.1085.
    1. Hibbard J. H., Mahoney E. R., Stock R., Tusler M. Do increases in patient activation result in improved self-management behaviors? Health Services Research. 2007;42(4):1443–1463. doi: 10.1111/j.1475-6773.2006.00669.x.
    1. Lubetkin E. I., Lu W.-H., Gold M. R. Levels and correlates of patient activation in health center settings: building strategies for improving health outcomes. Journal of Health Care for the Poor and Underserved. 2010;21(3):796–808. doi: 10.1353/hpu.0.0350.
    1. Barello S., Graffigna G. Engaging patients to recover life projectuality: an Italian cross-disease framework. Quality of Life Research. 2014;24(5):1087–1096. doi: 10.1007/s11136-014-0846-x.
    1. Manary M. P., Boulding W., Staelin R., Glickman S. W. The patient experience and health outcomes. The New England Journal of Medicine. 2013;368(3):201–203. doi: 10.1056/nejmp1211775.
    1. Hibbard J. H., Greene J., Overton V. Patients with lower activation associated with higher costs; delivery systems should know their patients' ‘scores’. Health Affairs. 2013;32(2):216–222. doi: 10.1377/hlthaff.2012.1133.
    1. Lee E. O., Emanuel E. J. Shared decision making to improve care and reduce costs. The New England Journal of Medicine. 2013;368(1):6–8. doi: 10.1056/nejmp1209500.
    1. Weber V., Bloom F., Pierdon S., Wood C. Employing the electronic health record to improve diabetes care: a multifaceted intervention in an integrated delivery system. Journal of General Internal Medicine. 2008;23(4):379–382. doi: 10.1007/s11606-007-0439-2.
    1. Aikens J. E., Zivin K., Trivedi R., Piette J. D. Diabetes self-management support using mHealth and enhanced informal caregiving. Journal of Diabetes and its Complications. 2014;28(2):171–176. doi: 10.1016/j.jdiacomp.2013.11.008.
    1. Norman C. D., Skinner H. A. eHealth literacy: essential skills for consumer health in a networked world. Journal of Medical Internet Research. 2006;8(2, article e9) doi: 10.2196/jmir.8.2.e9.
    1. Jordan J. E., Briggs A. M., Brand C. A., Osborne R. H. Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach. Medical Journal of Australia. 2008;189(10) supplement:S9–S13.
    1. Castelnuovo G., Manzoni G. M., Pietrabissa G., et al. Obesity and outpatient rehabilitation using mobile technologies: the potential mHealth approach. Frontiers in Psychology. 2014;5, article 559 doi: 10.3389/fpsyg.2014.00559.
    1. Or C. K. L., Tao D. Does the use of consumer health information technology improve outcomes in the patient self-management of diabetes? A meta-analysis and narrative review of randomized controlled trials. International Journal of Medical Informatics. 2014;83(5):320–329. doi: 10.1016/j.ijmedinf.2014.01.009.
    1. Wojcicki J. M., Ladyzynski P., Krzymien J., et al. What we can really expect from telemedicine in intensive diabetes treatment: results from 3-year study on type 1 pregnant diabetic women. Diabetes Technology & Therapeutics. 2001;3(4):581–589. doi: 10.1089/15209150152811207.
    1. Shetty A. S., Chamukuttan S., Nanditha A., Raj R. K. C., Ramachandran A. Reinforcement of adherence to prescription recommendations in Asian Indian diabetes patients using short message service (SMS)—a pilot study. Journal of Association of Physicians of India. 2011;59(11):711–714.
    1. Cotter A. P., Durant N., Agne A. A., Cherrington A. L. Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence. Journal of Diabetes and its Complications. 2013;28(2):243–251. doi: 10.1016/j.jdiacomp.2013.07.003.
    1. Holtz B., Lauckner C. Diabetes management via mobile phones: a systematic review. Telemedicine and e-Health. 2012;18(3):175–184. doi: 10.1089/tmj.2011.0119.
    1. Lorig K., Ritter P. L., Laurent D. D., et al. Online diabetes self-management program: a randomized study. Diabetes Care. 2010;33(6):1275–1281. doi: 10.2337/dc09-2153.
    1. Newton P., Asimakopoulou K., Scambler S. A qualitative exploration of motivation to self-manage and styles of self-management amongst people living with type 2 diabetes. Journal of Diabetes Research. 2015;2015:9. doi: 10.1155/2015/638205.638205
    1. Herzlinger R. E. Why innovation in health care is so hard. Harvard Business Review. 2006;84(5):58–66.
    1. Graffigna G., Barello S., Bonanomi A., Lozza E. Measuring patient engagement: development and psychometric properties of the Patient Health Engagement (PHE) scale. Frontiers in Psychology. 2015;6, article 274 doi: 10.3389/fpsyg.2015.00274.
    1. Hibbard J. H., Stockard J., Mahoney E. R., Tusler M. Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Services Research. 2004;39(4):1005–1026. doi: 10.1111/j.1475-6773.2004.00269.x.
    1. Graffigna G., Barello S., Bonanomi A., Lozza E., Hibbard J. Measuring patient activation in Italy: translation, adaptation and validation of the Italian version of the patient activation measure 13 (PAM13-I) BMC Medical Informatics and Decision Making. 2015;15(1, article 109):1–13. doi: 10.1186/s12911-015-0232-9.
    1. Fabbrini G., Abbruzzese G., Barone P., et al. Adherence to anti-Parkinson drug therapy in the ‘rEASON’ sample of Italian patients with Parkinson's disease: the linguistic validation of the Italian version of the ‘Morisky Medical Adherence Scale-8 Items’. Neurological Sciences. 2013;34(11):2015–2022. doi: 10.1007/s10072-013-1438-1.
    1. Williams G. C., Grow V. M., Freedman Z. R., Ryan R. M., Deci E. L. Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social Psychology. 1996;70(1):115–126. doi: 10.1037/0022-3514.70.1.115.
    1. Williams G. C., Freedman Z. R., Deci E. L. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care. 1998;21(10):1644–1651. doi: 10.2337/diacare.21.10.1644.
    1. Bonanomi A., Cantaluppi G., Ruscone M. N., Osmetti S. A. A new estimator of Zumbo's Ordinal Alpha: a copula approach. Quality & Quantity. 2015;49(3):941–953. doi: 10.1007/s11135-014-0114-8.
    1. Jöreskog K. G., Yang F. Advanced Structural Equation Modeling: Issues and Techniques. Lawrence Erlbaum Associates; 1996. Nonlinear structural equation models: the Kenny-Judd model with interaction effects; pp. 57–88.
    1. Bentler P. M. Comparative fit indexes in structural models. Psychological Bulletin. 1990;107(2):238–246. doi: 10.1037/0033-2909.107.2.238.
    1. Smith S. G., Pandit A., Rush S. R., Wolf M. S., Simon C. The association between patient activation and accessing online health information: results from a national survey of US adults. Health Expectations. 2015;18(6):3262–3273. doi: 10.1111/hex.12316.
    1. Crouch P. C. B., Rose C. D., Johnson M., Janson S. L. A pilot study to evaluate the magnitude of association of the use of electronic personal health records with patient activation and empowerment in HIV-infected veterans. PeerJ. 2015;3, article e852
    1. Menichetti J., Libreri C., Lozza E., Graffigna G. Giving patients a starring role in their own care: a bibliometric analysis of the on-going literature debate. Health Expectations. 2014 doi: 10.1111/hex.12299.
    1. Aung E., Donald M., Coll J. R., Williams G. M. Association between patient activation and patient-assessed quality of care in type 2 diabetes: results of a longitudinal study. Health Expectations. 2015 doi: 10.1111/hex.12359.
    1. Solomon M., Wagner S. L., Goes J. Effects of a Web-based intervention for adults with chronic conditions on patient activation: online randomized controlled trial. Journal of Medical Internet Research. 2012;14(1, article e32) doi: 10.2196/jmir.1924.
    1. Barello S., Graffigna G., Meyer E. C. Ethics and etiquette in neonatal intensive care: the value of parents' engagement in everyday ethics and recommendations for further advancing the field. JAMA Pediatrics. 2015;169(2, article 190)
    1. Greenhalgh T., Robert G., Macfarlane F., Bate P., Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly. 2004;82(4):581–629. doi: 10.1111/j.0887-378x.2004.00325.x.
    1. Manzoni G. M., Pagnini F., Corti S., Molinari E., Castelnuovo G. Internet-based behavioral interventions for obesity: an updated systematic review. Clinical Practice and Epidemiology in Mental Health: CP & EMH. 2011;7:19–28. doi: 10.2174/1745017901107010019.
    1. Lamiani G., Barello S., Browning D. M., Vegni E., Meyer E. C. Uncovering and validating clinicians' experiential knowledge when facing difficult conversations: a cross-cultural perspective. Patient Education and Counseling. 2012;87(3):307–312. doi: 10.1016/j.pec.2011.11.012.
    1. Anglada-Martinez H., Riu-Viladoms G., Martin-Conde M., Rovira-Illamola M., Sotoca-Momblona J. M., Codina-Jane C. Does mHealth increase adherence to medication? Results of a systematic review. International Journal of Clinical Practice. 2015;69(1):9–32. doi: 10.1111/ijcp.12582.
    1. Iverson S. A., Howard K. B., Penney B. K. Impact of internet use on health-related behaviors and the patient-physician relationship: a survey-based study and review. Journal of the American Osteopathic Association. 2008;108(12):699–711.
    1. Laugesen J., Hassanein K., Yuan Y. The impact of internet health information on patient compliance: a research model and an empirical study. Journal of Medical Internet Research. 2015;17(6, article e143) doi: 10.2196/jmir.4333.
    1. Parchman M. L., Zeber J. E., Palmer R. F. Participatory decision making, patient activation, medication adherence, and intermediate clinical outcomes in type 2 diabetes: a starnet study. The Annals of Family Medicine. 2010;8(5):410–417. doi: 10.1370/afm.1161.
    1. Sorrentino M., Guglielmetti C., Gilardi S., Marsilio M. Health care services and the coproduction puzzle filling in the blanks. Administration & Society. 2015 doi: 10.1177/0095399715593317.
    1. Moja L., Liberati E. G., Galuppo L., et al. Barriers and facilitators to the uptake of computerized clinical decision support systems in specialty hospitals: protocol for a qualitative cross-sectional study. Implementation Science. 2014;9, article 105 doi: 10.1186/s13012-014-0105-0.
    1. Barello S., Graffigna G. Patient engagement in healthcare: pathways for effective medical decision making. Neuropsychogical Trends. 2015;17:53–65.
    1. Sturgis P. Survey and sampling. In: Breakwell G. M., Hamond S., Fife-Schaw C., Smith J. A., editors. Research Methods in Psychology. London, UK: Sage; 2006.
    1. Lozza E., Libreri C., Bosio A. C. Temporary employment, job insecurity and their extraorganizational outcomes. Economic and Industrial Democracy. 2013;34(1):89–105. doi: 10.1177/0143831x12436617.
    1. Graffigna G., Barello S., Triberti S. Patient Engagement: A Consumer-Centered Model to Innovate Healthcare. Varsavia, Poland: DeGruyter Open; 2015.
    1. Mosen D. M., Schmittdiel J., Hibbard J., Sobel D., Remmers C., Bellows J. Is patient activation associated with outcomes of care for adults with chronic conditions? The Journal of Ambulatory Care Management. 2007;30(1):21–29. doi: 10.1097/00004479-200701000-00005.
    1. Greene J., Hibbard J. H. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. Journal of General Internal Medicine. 2012;27(5):520–526. doi: 10.1007/s11606-011-1931-2.
    1. Barello S., Graffigna G., Savarese M. Engaging patients in health management: towards a preliminary theoretical conceptualization. Psicologia della Salute. 2014;23:11–33.
    1. Bos-Touwen I., Schuurmans M., Monninkhof E. M., et al. Patient and disease characteristics associated with activation for self-management in patients with diabetes, chronic obstructive pulmonary disease, chronic heart failure and chronic renal disease: a cross-sectional survey study. PLoS ONE. 2015;10(5) doi: 10.1371/journal.pone.0126400.e0126400
    1. Graffigna G., Barello S., Riva G. How to make health information technology effective: the challenge of patient engagement. Archives of Physical Medicine and Rehabilitation. 2013;94(10):2034–2035. doi: 10.1016/j.apmr.2013.04.024.
    1. Graffigna G., Barello S., Riva G. Technologies for patient engagement. Health Affairs. 2013;32(6, article 1172) doi: 10.1377/hlthaff.2013.02789.

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