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Published in: BMC Medical Informatics and Decision Making 1/2014

Open Access 01-12-2014 | Research article

User-centered design of a web-based self-management site for individuals with type 2 diabetes – providing a sense of control and community

Authors: Catherine H Yu, Janet A Parsons, Susan Hall, David Newton, Aleksandra Jovicic, Danielle Lottridge, Baiju R Shah, Sharon E Straus

Published in: BMC Medical Informatics and Decision Making | Issue 1/2014

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Abstract

Background

To design and test a web-based self-management tool for patients with type 2 diabetes for its usability and feasibility.

Methods

An evidence-based, theory-driven website was created for patients with type 2 diabetes. Twenty-three patients with type 2 diabetes aged ≥ 25 years were recruited from 2 diabetes care centers in Toronto, Canada. We employed focus group methodology to assess acceptability, sustainability, strengths and weaknesses of the self-management website. Based on these results, revisions were made to the website. Three cycles of individual usability testing sessions using cognitive task analysis were conducted with patients with type 2 diabetes. Revisions to the website were made based on results from this testing.

Results

We identified five themes concerning participants’ experiences of health care and related unmet needs: 1) Desire for information and for greater access to timely and personalized care to gain a sense of control of their disease; 2) Desire for community (sharing experiences with others) to fulfill practical and emotional needs; 3) Potential roles of an online self-management website in self-empowerment, behavior change, self-management and health care delivery; 4) Importance of a patient-centered perspective in presenting content (e.g. common assumptions, medical nomenclature, language, messaging, sociocultural context); 5) Barriers and facilitators to use of a self-management website (including perceived relevance of content, incorporation into usual routine, availability for goal-directed use, usability issues).

Conclusions

Participants outlined a series of unmet health care needs, and stated that they wanted timely access to tailored knowledge about their condition, mechanisms to control and track their disease, and opportunities to share experiences with other patients. These findings have implications for patients with type 2 diabetes of diverse ages, socioeconomic backgrounds, and disease severity, as well as to the design of other computer-based resources for chronic disease management.
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Literature
2.
go back to reference American Diabetes Association: Standards of Medical Care in Diabetes 2013. Diabetes Care. 2013, 36: S11-S66.CrossRef American Diabetes Association: Standards of Medical Care in Diabetes 2013. Diabetes Care. 2013, 36: S11-S66.CrossRef
3.
go back to reference Anderson RM, Funnell MM: Patient empowerment: Reflections on the challenge of fostering the adoption of a new paradigm. Patient Educ Couns. 2005, 57: 153-157. 10.1016/j.pec.2004.05.008.CrossRefPubMed Anderson RM, Funnell MM: Patient empowerment: Reflections on the challenge of fostering the adoption of a new paradigm. Patient Educ Couns. 2005, 57: 153-157. 10.1016/j.pec.2004.05.008.CrossRefPubMed
5.
go back to reference Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW: Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005, 294: 716-724. 10.1001/jama.294.6.716.CrossRefPubMed Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW: Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005, 294: 716-724. 10.1001/jama.294.6.716.CrossRefPubMed
6.
go back to reference Funnell MM, Haas LB: National Standards for Diabetes Self-Management Education Programs. Diabetes Care. 1995, 18: 100-116.CrossRefPubMed Funnell MM, Haas LB: National Standards for Diabetes Self-Management Education Programs. Diabetes Care. 1995, 18: 100-116.CrossRefPubMed
7.
go back to reference Cauch-Dudek K, Victor JC, Sigmond M, Shah BR: Disparities in attendance at diabetes self-management education programs after diagnosis in Ontario, Canada: a cohort study. BMC Public Health. 2013, 13: 85-10.1186/1471-2458-13-85.CrossRefPubMedPubMedCentral Cauch-Dudek K, Victor JC, Sigmond M, Shah BR: Disparities in attendance at diabetes self-management education programs after diagnosis in Ontario, Canada: a cohort study. BMC Public Health. 2013, 13: 85-10.1186/1471-2458-13-85.CrossRefPubMedPubMedCentral
8.
go back to reference Norris SL, Engelgau MM, Narayan KM: Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001, 24: 561-587. 10.2337/diacare.24.3.561.CrossRefPubMed Norris SL, Engelgau MM, Narayan KM: Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001, 24: 561-587. 10.2337/diacare.24.3.561.CrossRefPubMed
9.
go back to reference Jeste DV, Dunn LB, Folsom DP, Zisook D: Multimedia educational aids for improving consumer knowledge about illness management and treatment decisions: a review of randomized controlled trials. J Psychiatr Res. 2008, 42: 1-21. 10.1016/j.jpsychires.2006.10.004.CrossRefPubMed Jeste DV, Dunn LB, Folsom DP, Zisook D: Multimedia educational aids for improving consumer knowledge about illness management and treatment decisions: a review of randomized controlled trials. J Psychiatr Res. 2008, 42: 1-21. 10.1016/j.jpsychires.2006.10.004.CrossRefPubMed
10.
go back to reference Murray E, Burns J, See TS, Lai R, Nazareth I: Interactive Health Communication Applications for people with chronic disease. Cochrane Database Syst Rev. 2005, 4: 004274- Murray E, Burns J, See TS, Lai R, Nazareth I: Interactive Health Communication Applications for people with chronic disease. Cochrane Database Syst Rev. 2005, 4: 004274-
11.
go back to reference Yu CH, Bahniwal R, Laupacis A, Leung E, Orr MS, Straus SE: Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers. J Am Med Inform Assoc. 2012, 19: 514-522. 10.1136/amiajnl-2011-000307.CrossRefPubMedPubMedCentral Yu CH, Bahniwal R, Laupacis A, Leung E, Orr MS, Straus SE: Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers. J Am Med Inform Assoc. 2012, 19: 514-522. 10.1136/amiajnl-2011-000307.CrossRefPubMedPubMedCentral
12.
go back to reference Seidman JJ, Steinwachs D, Rubin HR: Design and testing of a tool for evaluating the quality of diabetes consumer-information Web sites. J Med Internet Res. 2003, 5: e30-10.2196/jmir.5.4.e30.CrossRefPubMedPubMedCentral Seidman JJ, Steinwachs D, Rubin HR: Design and testing of a tool for evaluating the quality of diabetes consumer-information Web sites. J Med Internet Res. 2003, 5: e30-10.2196/jmir.5.4.e30.CrossRefPubMedPubMedCentral
13.
go back to reference Bull SS, Gaglio B, McKay HG, Glasgow RE: Harnessing the potential of the internet to promote chronic illness self-management: diabetes as an example of how well we are doing. Chronic Illness. 2005, 1: 143-155. 10.1177/17423953050010021101.CrossRefPubMed Bull SS, Gaglio B, McKay HG, Glasgow RE: Harnessing the potential of the internet to promote chronic illness self-management: diabetes as an example of how well we are doing. Chronic Illness. 2005, 1: 143-155. 10.1177/17423953050010021101.CrossRefPubMed
14.
go back to reference Kok G, Van den Borne B, Mullen P: Effectiveness of health education and health promotion: meta-analyses of effect studies and determinants of effectiveness. Patient Educ Couns. 1997, 30: 19-27. 10.1016/S0738-3991(96)00953-6.CrossRefPubMed Kok G, Van den Borne B, Mullen P: Effectiveness of health education and health promotion: meta-analyses of effect studies and determinants of effectiveness. Patient Educ Couns. 1997, 30: 19-27. 10.1016/S0738-3991(96)00953-6.CrossRefPubMed
15.
go back to reference Teo HH, Oh LB, Liu C, Wei KK: An empirical study of the effects of interactivity on web user attitude. Int J Hum Comput Stud. 2003, 58: 281-305. 10.1016/S1071-5819(03)00008-9.CrossRef Teo HH, Oh LB, Liu C, Wei KK: An empirical study of the effects of interactivity on web user attitude. Int J Hum Comput Stud. 2003, 58: 281-305. 10.1016/S1071-5819(03)00008-9.CrossRef
16.
go back to reference Yu C, Parsons J, Mamdani M, Lebovic G, Shah BR, Bhattacharyya O, Laupacis A, Straus SE: Designing and evaluating a web-based selfmanagement site for patients with type 2 diabetes - systematic website development and study protocol. BMC Med Inform Decis Mak. 2012, 12: 57-10.1186/1472-6947-12-57.CrossRefPubMedPubMedCentral Yu C, Parsons J, Mamdani M, Lebovic G, Shah BR, Bhattacharyya O, Laupacis A, Straus SE: Designing and evaluating a web-based selfmanagement site for patients with type 2 diabetes - systematic website development and study protocol. BMC Med Inform Decis Mak. 2012, 12: 57-10.1186/1472-6947-12-57.CrossRefPubMedPubMedCentral
17.
go back to reference Webb TL, Joseph J, Yardley L, Michie S: Using the Internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2012, 12: e4-CrossRef Webb TL, Joseph J, Yardley L, Michie S: Using the Internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2012, 12: e4-CrossRef
18.
go back to reference Bandura A: Self-efficacy: the exercise of control. 1997, New York: W.H. Freeman Bandura A: Self-efficacy: the exercise of control. 1997, New York: W.H. Freeman
19.
go back to reference Longo DR, Schubert SL, Wright BA, LeMaster J, Williams CD, Clore JN: Health information seeking, receipt, and use in diabetes self-management. Ann Fam Med. 2010, 8: 334-340. 10.1370/afm.1115.CrossRefPubMedPubMedCentral Longo DR, Schubert SL, Wright BA, LeMaster J, Williams CD, Clore JN: Health information seeking, receipt, and use in diabetes self-management. Ann Fam Med. 2010, 8: 334-340. 10.1370/afm.1115.CrossRefPubMedPubMedCentral
20.
go back to reference Nakahara R, Yoshiuchi K, Kumano H, Hara Y, Suematsu H, Kuboki T: Prospective study on influence of psychosocial factors on glycemic control in Japanese patients with type 2 diabetes. Psychosomatics. 2006, 47: 240-245. 10.1176/appi.psy.47.3.240.CrossRefPubMed Nakahara R, Yoshiuchi K, Kumano H, Hara Y, Suematsu H, Kuboki T: Prospective study on influence of psychosocial factors on glycemic control in Japanese patients with type 2 diabetes. Psychosomatics. 2006, 47: 240-245. 10.1176/appi.psy.47.3.240.CrossRefPubMed
21.
go back to reference Gallegos EC, Ovalle-Berumen F, Gomez-Meza MV: Metabolic control of adults with type 2 diabetes mellitus through education and counseling. J Nurs Scholarsh. 2006, 38: 344-351. 10.1111/j.1547-5069.2006.00125.x.CrossRefPubMed Gallegos EC, Ovalle-Berumen F, Gomez-Meza MV: Metabolic control of adults with type 2 diabetes mellitus through education and counseling. J Nurs Scholarsh. 2006, 38: 344-351. 10.1111/j.1547-5069.2006.00125.x.CrossRefPubMed
22.
go back to reference Lorig KR, Ritter PL, Jacquez A: Outcomes of border health Spanish/English chronic disease self-management programs. Diabetes Educ. 2005, 31: 401-409. 10.1177/0145721705276574.CrossRefPubMed Lorig KR, Ritter PL, Jacquez A: Outcomes of border health Spanish/English chronic disease self-management programs. Diabetes Educ. 2005, 31: 401-409. 10.1177/0145721705276574.CrossRefPubMed
23.
go back to reference Howorka K, Pumprla J, Wagner-Nosiska D, Grillmayr H, Schlusche C, Schabmann A: Empowering diabetes out-patients with structured education: Short-term and long-term effects of functional insulin treatment on perceived control over diabetes. J Psychosom Res. 2000, 48: 37-44. 10.1016/S0022-3999(99)00074-4.CrossRefPubMed Howorka K, Pumprla J, Wagner-Nosiska D, Grillmayr H, Schlusche C, Schabmann A: Empowering diabetes out-patients with structured education: Short-term and long-term effects of functional insulin treatment on perceived control over diabetes. J Psychosom Res. 2000, 48: 37-44. 10.1016/S0022-3999(99)00074-4.CrossRefPubMed
24.
go back to reference Corbett CF: Research-based practice implications for patients with diabetes. part II: Diabetes self-efficacy. Home Healthcare Nurse. 1999, 17: 587-596. 10.1097/00004045-199909000-00010.CrossRefPubMed Corbett CF: Research-based practice implications for patients with diabetes. part II: Diabetes self-efficacy. Home Healthcare Nurse. 1999, 17: 587-596. 10.1097/00004045-199909000-00010.CrossRefPubMed
25.
go back to reference Anderson RM, Funnell MM, Butler PM, Arnold MS, Fitzgerald JT, Feste CC: Patient empowerment: results of a randomized controlled trial. Diabetes Care. 1995, 18: 943-949. 10.2337/diacare.18.7.943.CrossRefPubMed Anderson RM, Funnell MM, Butler PM, Arnold MS, Fitzgerald JT, Feste CC: Patient empowerment: results of a randomized controlled trial. Diabetes Care. 1995, 18: 943-949. 10.2337/diacare.18.7.943.CrossRefPubMed
26.
go back to reference Reichard P, Toomingas B, Rosenqvist U: Changes in conceptions and attitudes during five years of intensified conventional insulin treatment in the stockholm diabetes intervention study (SDIS). Diabetes Educ. 1994, 20: 503-508. 10.1177/014572179402000607.CrossRefPubMed Reichard P, Toomingas B, Rosenqvist U: Changes in conceptions and attitudes during five years of intensified conventional insulin treatment in the stockholm diabetes intervention study (SDIS). Diabetes Educ. 1994, 20: 503-508. 10.1177/014572179402000607.CrossRefPubMed
27.
go back to reference Glasgow RE, Toobert DJ, Hampson SE, Brown JE, Lewinsohn PM, Donnelly J: Improving self-care among older patients with type II diabetes: The “sixty something…” study. Patient Educ Couns. 1992, 19: 61-74. 10.1016/0738-3991(92)90102-O.CrossRefPubMed Glasgow RE, Toobert DJ, Hampson SE, Brown JE, Lewinsohn PM, Donnelly J: Improving self-care among older patients with type II diabetes: The “sixty something…” study. Patient Educ Couns. 1992, 19: 61-74. 10.1016/0738-3991(92)90102-O.CrossRefPubMed
28.
go back to reference Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C: How we design feasibility studies. Am J Prev Med. 2009, 36: 452-457. 10.1016/j.amepre.2009.02.002.CrossRefPubMedPubMedCentral Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C: How we design feasibility studies. Am J Prev Med. 2009, 36: 452-457. 10.1016/j.amepre.2009.02.002.CrossRefPubMedPubMedCentral
29.
go back to reference Rogers Y, Preece J, Sharp H: Interaction Design: Beyond Human-Computer Interaction. 2007, West Sussex: Wiley, John & Sons, Incorporated, 2 Rogers Y, Preece J, Sharp H: Interaction Design: Beyond Human-Computer Interaction. 2007, West Sussex: Wiley, John & Sons, Incorporated, 2
30.
go back to reference Kuzel AJ: Sampling in qualitative inquiry. Doing Qualitative Research. Edited by: Crabtree BF, Miller W. 1999, Thousand Oaks: Sage Publications, 33-45. Kuzel AJ: Sampling in qualitative inquiry. Doing Qualitative Research. Edited by: Crabtree BF, Miller W. 1999, Thousand Oaks: Sage Publications, 33-45.
31.
go back to reference Poland BP: Transcription Quality as an Aspect of Rigor in Qualitative Research. Qual Inq. 1995, 1: 290-310. 10.1177/107780049500100302.CrossRef Poland BP: Transcription Quality as an Aspect of Rigor in Qualitative Research. Qual Inq. 1995, 1: 290-310. 10.1177/107780049500100302.CrossRef
32.
go back to reference Sandelowski M: Focus on Research Methods-Whatever Happened to Qualitative Description?. Res Nurs Health. 2000, 23: 334-340. 10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G.CrossRefPubMed Sandelowski M: Focus on Research Methods-Whatever Happened to Qualitative Description?. Res Nurs Health. 2000, 23: 334-340. 10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G.CrossRefPubMed
33.
go back to reference Sandelowski B: What’s in a name: Qualitative description revisited. Res Nursing Health. 2010, 33: 77-84. Sandelowski B: What’s in a name: Qualitative description revisited. Res Nursing Health. 2010, 33: 77-84.
34.
go back to reference Morse JM, Richards L: Read Me First for a User’s Guide to Qualitative Methods. 2002, Thousand Oaks: Sage Publications Morse JM, Richards L: Read Me First for a User’s Guide to Qualitative Methods. 2002, Thousand Oaks: Sage Publications
35.
go back to reference Borkan J: Immersion/Crystallization. Doing Qualitative Research. Edited by: Miller BCW. 1999, Thousand Oaks: Sage Publications, Inc, 179-194. 2 Borkan J: Immersion/Crystallization. Doing Qualitative Research. Edited by: Miller BCW. 1999, Thousand Oaks: Sage Publications, Inc, 179-194. 2
36.
go back to reference Kushniruk AW, Patel VL: Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Inform. 2004, 37: 56-76. 10.1016/j.jbi.2004.01.003.CrossRefPubMed Kushniruk AW, Patel VL: Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Inform. 2004, 37: 56-76. 10.1016/j.jbi.2004.01.003.CrossRefPubMed
37.
go back to reference Nielsen J: Iterative User Interface Design. IEEE Computer. 1993, 26: 32-41.CrossRef Nielsen J: Iterative User Interface Design. IEEE Computer. 1993, 26: 32-41.CrossRef
38.
go back to reference Nielsen J, Landauer TK: A mathematical model of the finding of usability problems. ACM INTERCHI’93 Conference. 1993, Amsterdam, The Netherlands: ACM, 206-213. Nielsen J, Landauer TK: A mathematical model of the finding of usability problems. ACM INTERCHI’93 Conference. 1993, Amsterdam, The Netherlands: ACM, 206-213.
39.
go back to reference Bryman A: Quantity and Quality. Social Research. 1988, London: Routledge Bryman A: Quantity and Quality. Social Research. 1988, London: Routledge
40.
go back to reference Corbin JM, Strauss A: Managing Chronic Illness at Home: Three Lines of Work. Qual Sociol. 1985, 8: 224-247. 10.1007/BF00989485.CrossRef Corbin JM, Strauss A: Managing Chronic Illness at Home: Three Lines of Work. Qual Sociol. 1985, 8: 224-247. 10.1007/BF00989485.CrossRef
41.
go back to reference Beeney LJ, Bakry AA, Dunn SM: Patient psychological and information needs when the diagnosis is diabetes. Patient Educ Couns. 1996, 29: 109-116. 10.1016/0738-3991(96)00939-1.CrossRefPubMed Beeney LJ, Bakry AA, Dunn SM: Patient psychological and information needs when the diagnosis is diabetes. Patient Educ Couns. 1996, 29: 109-116. 10.1016/0738-3991(96)00939-1.CrossRefPubMed
42.
go back to reference Bensley RJ, Brusk JJ, Rivas J: Key principles in internet-based weight management systems. Am J Health Behav. 2010, 34: 206-213.CrossRefPubMed Bensley RJ, Brusk JJ, Rivas J: Key principles in internet-based weight management systems. Am J Health Behav. 2010, 34: 206-213.CrossRefPubMed
43.
go back to reference Maher CA, Lewis LK, Ferrar K, Marshall SW, De Bourdeaudhuij I, Vandelanotte C: Are health behavior change interventions that use online social networks effective? a systematic review. J Med Internet Res. 2014, 16: e40-10.2196/jmir.2952.CrossRefPubMedPubMedCentral Maher CA, Lewis LK, Ferrar K, Marshall SW, De Bourdeaudhuij I, Vandelanotte C: Are health behavior change interventions that use online social networks effective? a systematic review. J Med Internet Res. 2014, 16: e40-10.2196/jmir.2952.CrossRefPubMedPubMedCentral
44.
go back to reference Eakin JM, Mykhalovsky E: Reframing the evaluation of qualitative health research: reflections on a review of appraisal guidelines in the health sciences. J Eval Clin Pract. 2003, 9: 187-194. 10.1046/j.1365-2753.2003.00392.x.CrossRefPubMed Eakin JM, Mykhalovsky E: Reframing the evaluation of qualitative health research: reflections on a review of appraisal guidelines in the health sciences. J Eval Clin Pract. 2003, 9: 187-194. 10.1046/j.1365-2753.2003.00392.x.CrossRefPubMed
45.
go back to reference Kvale S: InterViews: An Introduction to Qualitative Research Interviewing. 1996, Thousand Oaks: Sage Publications Kvale S: InterViews: An Introduction to Qualitative Research Interviewing. 1996, Thousand Oaks: Sage Publications
Metadata
Title
User-centered design of a web-based self-management site for individuals with type 2 diabetes – providing a sense of control and community
Authors
Catherine H Yu
Janet A Parsons
Susan Hall
David Newton
Aleksandra Jovicic
Danielle Lottridge
Baiju R Shah
Sharon E Straus
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2014
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/1472-6947-14-60

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