Influence of Patient Characteristics and Psychological Needs on Diabetes Mobile App Usability in Adults With Type 1 or Type 2 Diabetes: Crossover Randomized Trial

Helen Nc Fu; Terrence J Adam; Joseph A Konstan; Julian A Wolfson; Thomas R Clancy; Jean F Wyman

doi:10.2196/11462

Influence of Patient Characteristics and Psychological Needs on Diabetes Mobile App Usability in Adults With Type 1 or Type 2 Diabetes: Crossover Randomized Trial

JMIR Diabetes. 2019 Apr 30;4(2):e11462. doi: 10.2196/11462.

Authors

Helen Nc Fu¹, Terrence J Adam^{2

3}, Joseph A Konstan⁴, Julian A Wolfson⁵, Thomas R Clancy⁶, Jean F Wyman¹

Affiliations

¹ Center for Aging Science and Care Innovation, School of Nursing, University of Minnesota, Minneapolis, MN, United States.
² Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, MInneapolis, MN, United States.
³ Institute of Health Informatics, University of Minnesota, Minneapolis, MN, United States.
⁴ Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States.
⁵ School of Public Health, University of Minnesota, Minneapolis, MN, United States.
⁶ Center for Nursing Informatics, School of Nursing, University of Minnesota, Minneapolis, MN, United States.

PMID: 31038468
PMCID: PMC6660121
DOI: 10.2196/11462

Abstract

Background: More than 1100 diabetes mobile apps are available, but app usage by patients is low. App usability may be influenced by patient factors such as age, sex, and psychological needs.

Objective: Guided by Self-Determination Theory, the purposes of this study were to (1) assess the effect of patient characteristics on app usability, and (2) determine whether patient characteristics and psychological needs (competence, autonomy, and connectivity)-important for motivation in diabetes care-are associated with app usability.

Methods: Using a crossover randomized design, 92 adults with type 1 or 2 diabetes tested two Android apps (mySugr and OnTrack) for seven tasks including data entry, blood glucose (BG) reporting, and data sharing. We used multivariable linear regression models to examine associations between patient characteristics, psychological needs, user satisfaction, and user performance (task time, success, and accuracy).

Results: Participants had a mean age of 54 (range 19-74) years, and were predominantly white (62%, 57/92), female (59%, 54/92), with type 2 diabetes (70%, 64/92), and had education beyond high school (67%, 61/92). Participants rated an overall user satisfaction score of 62 (SD 18), which is considered marginally acceptable. The satisfaction mean score for each app was 55 (SD 18) for mySugr and 68 (SD 15) for OnTrack. The mean task completion time for all seven tasks was 7 minutes, with a mean task success of 82% and an accuracy rate of 68%. Higher user satisfaction was observed for patients with less education (P=.04) and those reporting more competence (P=.02), autonomy (P=.006), or connectivity with a health care provider (P=.03). User performance was associated with age, sex, education, diabetes duration, and autonomy. Older patients required more time (95% CI 1.1-3.2) and had less successful task completion (95% CI 3.5-14.3%). Men needed more time (P=.01) and more technical support than women (P=.04). High school education or less was associated with lower task success (P=.003). Diabetes duration of ≥10 years was associated with lower task accuracy (P=.02). Patients who desired greater autonomy and were interested in learning their patterns of BG and carbohydrates had greater task success (P=.049).

Conclusions: Diabetes app usability was associated with psychological needs that are important for motivation. To enhance patient motivation to use diabetes apps for self-management, clinicians should address competence, autonomy, and connectivity by teaching BG pattern recognition and lifestyle planning, customizing BG targets, and reviewing home-monitored data via email. App usability could be improved for older male users and those with less education and greater diabetes duration by tailoring app training and providing ongoing technical support.

Keywords: Self-Determination Theory; diabetes; mHealth; mobile apps; self-management; usability; user satisfaction.

©Helen NC Fu, Terrence J Adam, Joseph A Konstan, Julian A Wolfson, Thomas R Clancy, Jean F Wyman. Originally published in JMIR Diabetes (http://diabetes.jmir.org), 30.04.2019.