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  • 1. Capozza, Korey
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Black, Jeff
    Bello, Nelly
    Lence, Clare
    Oostema, Steve
    North, Christie
    Going Mobile With Diabetes Support: A Randomized Study of a Text Message–Based Personalized Behavioral Intervention for Type 2 Diabetes Self-Care2015In: Diabetes Spectrum, ISSN 1040-9165, E-ISSN 1944-7353, Vol. 28, no 2, p. 83-91Article in journal (Refereed)
    Abstract [en]

    Objective. Patients with type 2 diabetes often fail to achieve self-management goals. This study tested the impact on glycemic control of a two-way text messaging program that provided behavioral coaching, education, and testing reminders to enrolled individuals with type 2 diabetes in the context of a clinic-based quality improvement initiative. The secondary aim examined patient interaction and satisfaction with the program.

    Methods. Ninety-three adult patients with poorly controlled type 2 diabetes (A1C >8%) were recruited from 18 primary care clinics in three counties for a 6-month study. Patients were randomized by a computer to one of two arms. Patients in both groups continued with their usual care; patients assigned to the intervention arm also received from one to seven diabetes-related text messages per day depending on the choices they made at enrollment. At 90 and 180 days, A1C data were obtained from the electronic health record and analyzed to determine changes from baseline for both groups. An exit survey was used to assess satisfaction. Enrollment behavior and interaction data were pulled from a Web-based administrative portal maintained by the technology vendor.

    Results. Patients used the program in a variety of ways. Twenty-nine percent of program users demonstrated frequent engagement (texting responses at least three times per week) for a period of ≥90 days. Survey results indicate very high satisfaction with the program. Both groups’ average A1C decreased from baseline, possibly reflecting a broader quality improvement effort underway in participating clinics. At 90 and 180 days, there was no statistically significant difference between the intervention and control groups in terms of change in A1C (P >0.05).

    Conclusions. This study demonstrated a practical approach to implementing and monitoring a mobile health intervention for self-management support across a wide range of independent clinic practices.

  • 2.
    Ekerot, Amanda
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Gemfeldt, Lisa
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Diabetes typ 2 och följsamheten till fysisk aktivitet: En litteraturstudie2018Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Diabetes typ 2 är en kronisk sjukdom som obehandlad eller dåligt skött, kan leda till svåra komplikationer. Emellertid är det en av få sjukdomar som till viss mån, går att kontrollera och styra med livsstilsförändringar, däribland fysisk aktivitet. Sjuksköterskans roll är att stötta, informera och ge individen råd, dock ligger mycket på personens egna vilja, drivkraft och motivation till att genomföra en förändring till ökad motion.

    Syfte: Syftet var att belysa följsamheten till fysisk aktivitet hos personer med diabetes typ 2.

    Metod: En kvalitativ litteraturstudie baserad på 15 vetenskapliga artiklar med kvalitativ ansats. Artiklarna analyserades med Graneheim och Lundmans tolkning av en kvalitativ innehållsanalys.

    Resultat: I resultatet framkom huvudkategorierna brist på motivation och egen drivkraft som motivation med tillhörande underkategorier hotande egenvårdskapacitet, avsaknad av socialt stöd, upplevelsen av att vara begränsad och miljöns betydelse respektive att förstå sin sjukdom, att leva med en rädsla för komplikationer, behov av stöd samt behov av kunskap.

    Slutsats: Det huvudsakliga fyndet som framkom i litteraturstudien berörde motivationens betydelse för följsamheten till fysisk aktivitet, hos personer med diabetes typ 2.

     

  • 3.
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Weir, Charlene
    A Modified User-Oriented Heuristic Evaluation of a Mobile Health System for Diabetes Self-management Support2016In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 34, no 2, p. 77-84Article in journal (Refereed)
    Abstract [en]

    Mobile health platforms offer significant opportunities for improving diabetic self-care, but only if adequate usability exists. Expert evaluations such as heuristic evaluation can provide distinct usability information about systems. The purpose of this study was to complete a usability evaluation of a mobile health system for diabetes patients using a modified heuristic evaluation technique of (1) dual-domain experts (healthcare professionals, usability experts), (2) validated scenarios and user tasks related to patients' self-care, and (3) in-depth severity factor ratings. Experts identified 129 usability problems with 274 heuristic violations for the system. The categories Consistency and Standards dominated at 24.1% (n = 66), followed by Match Between System and Real World at 22.3% (n = 61). Average severity ratings across system views were 2.8 (of 4), with 9.3% (n = 12) rated as catastrophic and 53.5% (n = 69) as major. The large volume of violations with severe ratings indicated clear priorities for redesign. The modified heuristic approach allowed evaluators to identify unique and important issues, including ones related to self-management and patient safety. This article provides a template for one type of expert evaluation adding to the informaticists' toolbox when needing to conduct a fast, resource-efficient and user-oriented heuristic evaluation. 

  • 4.
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Quantifying usability: an evaluation of a diabetes mHealth system on effectiveness, efficiency, and satisfaction metrics with associated user characteristics2016In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, Vol. 23, no 1, p. 5-11Article in journal (Refereed)
    Abstract [en]

    Objective Mobile health (mHealth) systems are becoming more common for chronic disease management, but usability studies are still needed on patients' perspectives and mHealth interaction performance. This deficiency is addressed by our quantitative usability study of a mHealth diabetes system evaluating patients' task performance, satisfaction, and the relationship of these measures to user characteristics. Materials and Methods We used metrics in the International Organization for Standardization (ISO) 9241-11 standard. After standardized training, 10 patients performed representative tasks and were assessed on individual task success, errors, efficiency (time on task), satisfaction (System Usability Scale [SUS]) and user characteristics. Results Tasks of exporting and correcting values proved the most difficult, had the most errors, the lowest task success rates, and consumed the longest times on task. The average SUS satisfaction score was 80.5, indicating good but not excellent system usability. Data trends showed males were more successful in task completion, and younger participants had higher performance scores. Educational level did not influence performance, but a more recent diabetes diagnosis did. Patients with more experience in information technology (IT) also had higher performance rates. Discussion Difficult task performance indicated areas for redesign. Our methods can assist others in identifying areas in need of improvement. Data about user background and IT skills also showed how user characteristics influence performance and can provide future considerations for targeted mHealth designs. Conclusion Using the ISO 9241-11 usability standard, the SUS instrument for satisfaction and measuring user characteristics provided objective measures of patients' experienced usability. These could serve as an exemplar for standardized, quantitative methods for usability studies on mHealth systems.

  • 5.
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Using activity theory as a framework for the usability evaluation process and task determination in mhealth self-management systems for diabetes2018In: Studies in Health Technology and Informatics, IOS Press , 2018, Vol. 249, p. 158-163Conference paper (Refereed)
    Abstract [en]

    mHealth systems can be used for patients in their diabetes selfmanagement, but usability evaluations are often needed to determine how to make them more useful for the diabetes patient user in the monitoring and managing of their disease. Activity Theory (AT) was developed within Russian psychology to define the work and activity process in an activity system. AT was here considered to also be a particularly suitable framework for inspiration in usability evaluation both for the whole evaluation process and also for the usability task determination in this process for diabetes patient users. In the following paper, examples are provided from four usability studies using both user-based and expert usability methods in evaluation showing how AT was applied to guide the thoughts in evaluating the usability of two mHealth self-management systems for diabetes. Experiences and insights are provided from this process. © 2018 The authors and IOS Press. All rights reserved.

  • 6.
    Georgsson, Mattias
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Nancy, Staggers
    An evaluation of patients' experienced usability of a diabetes mHealth system using a multi-method approach2016In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 59, p. 115-129Article in journal (Refereed)
  • 7.
    Georgsson, Mattias
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Staggers, Nancy
    Summit Health Informatics, USA.
    Årsand, Eirik
    University Hospital of North Norway, NOR.
    Kushniruk, André
    University of Victoria, CAN.
    Employing a user-centered cognitive walkthrough to evaluate a mHealth diabetes self-management application: A case study and beginning method validation2019In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 91, article id 103110Article in journal (Refereed)
    Abstract [en]

    Introduction: Self-management of chronic diseases using mobile health (mHealth) systems and applications is becoming common. Current evaluation methods such as formal usability testing can be very costly and time-consuming; others may be more efficient but lack a user focus. We propose an enhanced cognitive walkthrough (CW) method, the user-centered CW (UC-CW), to address identified deficiencies in the original technique and perform a beginning validation with think aloud protocol (TA) to assess its effectiveness, efficiency and user acceptance in a case study with diabetes patient users on a mHealth self-management application. Materials and methods: A total of 12 diabetes patients at University of Utah Health, USA, were divided into UC-CW and think aloud (TA) groups. The UC-CW method included: making the user the main evaluator for detecting usability problems, having a dual domain facilitator, and using three other improved processes: validated task development, higher level tasks and a streamlined evaluation process. Users interacted with the same mHealth application for both methods. Post-evaluation assessments included the NASA RTLX instrument and a set of brief interview questions. Results: Participants had similar demographic characteristics. A total of 26 usability problems were identified with the UC-CW and 20 with TA. Both methods produced similar ratings: severity across all views (UC-CW = 2.7 and TA = 2.6), numbers of problems in the same views (Main View [UC-CW = 11, TA = 10], Carbohydrate Entry View [UC-CW = 4, TA = 3] and List View [UC-CW = 3, TA = 3]) with similar heuristic violations (Match Between the System and Real World [UC-CW = 19, TA = 16], Consistency and Standards [UC-CW = 17, TA = 15], and Recognition Rather than Recall [UC-CW = 13, TA = 10]). Both methods converged on eight usability problems, but the UC-CW group detected five critical issues while the TA group identified two. The UC-CW group identified needed personalized features for patients’ disease needs not identified with TA. UC-CW was more efficient on average time per identified usability problem and on the total evaluation process with patients. NASA RTLX scores indicated that participants experienced the UC-CW half as cognitively demanding. Common themes from interviews indicated the UC-CW as enjoyable and easy to perform while TA was considered somewhat awkward and more cognitively challenging. Conclusions: UC-CW was effective for finding severe, recurring usability problems and it highlighted the need for personalized user features. The method was also efficient and had high user acceptance. These results indicate UC-CW's utility and user acceptance in evaluating a mHealth self-management application. It provides an additional usability evaluation technique for researchers. © 2019

  • 8.
    Leigod, Linnéa
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Fransson, Maja
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sjuksköterskors erfarenheter av att stödja barn till egenvård vid diabetes typ-1: En kvalitativ empirisk studie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Barn kan sakna förståelse för hur diabetes typ-1 påverkar deras kroppar och de kan uppleva sin kropp som främmande. Personer som lever med diabetes bör ta ett stort ansvar över sin egenvård, men även hälso- och sjukvården har ett ansvar att ge personerna de rätta verktygen som de behöver. Sjuksköterskans roll är att ge stöd till patienter och undervisa dem med syftet att främja hälsa. Egenvård är en stor utmaning för barnen på grund av smärta och rädsla och barnen behöver därför stöd från vårdpersonalen när det gäller att lära sig att utföra egenvård. 

    Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av att stödja barn till egenvård vid diabetes typ-1.

    Metod: Studien genomfördes som en empirisk intervjustudie i kvalitativt syfte med Graneheim och Lundmans beskrivning av en kvalitativ innehållsanalys. 

    Resultat: Resultatet av sjuksköterskornas erfarenheter av att stödja barn till egenvård mynnade ut i fyra kategorier: att anpassa undervisningen, att främja delaktighet, att underlätta till självständighet och att uppmuntra barnen. Resultatet visade att sjuksköterskorna skulle anpassa undervisningen utefter barnets ålder, mognadsgrad och utveckling. Sjuksköterskorna skulle främja delaktigheten genom att rikta sig till barnen och underlätta självständigheten genom att barnen själva fick göra de moment som sjukdomen kräver. Resultatet visade även att sjuksköterskorna skulle uppmuntra barnen när de hade klarat av ett moment och ge dem belöningar i form av presenter.

    Slutsats: För att stödja barn med diabetes typ-1 till egenvård bör sjuksköterskorna besitta olika förmågor, som att kunna anpassa undervisningen, var pedagogisk och uppmuntra barnen i olika situationer. Studiens resultat kan öka kunskapen om sjuksköterskors erfarenheter av att stödja barn till egenvård vid diabetes typ-1. Resultatet kan även öka medvetenheten och utgöra en grund för sjuksköterskors sätt att stödja barn till egenvård.

     

     

    Nyckelord: Barn, diabetes typ-1, egenvård, sjuksköterska, stöd.

  • 9.
    Lundberg, Jenny
    et al.
    Linnaeus Univ, SWE..
    Claesson, Lena
    Blekinge Institute of Technology, Faculty of Engineering, Department of Applied Signal Processing.
    Early Signs of Diabetes Explored from an Engineering Perspective2019In: SMART INDUSTRY & SMART EDUCATION / [ed] Auer, ME Langmann, R, SPRINGER INTERNATIONAL PUBLISHING AG , 2019, p. 22-31Conference paper (Refereed)
    Abstract [en]

    Undetected diabetes is a global issue, estimated to over 200 million persons affected. Engineering opportunities in capturing early signs of diabetes has a potential due to the complexity to interpret early signs and link it to diabetes. Persons with untreated diabetes are doubled in risk of getting cardiovascular diseases and may also suffer other consequent diseases. In Sweden, approximately 450 thousand have diabetes where 80-90% are of type 2 with 1/4 unaware of it, i.e. approx. 100 thousand. Screening approaches, searching specifically for diabetes in persons not showing symptoms has been initiated with positive results. However, some general drawbacks of screening such as false sense of security are an issue. In this publication, we focus upon in home measurements and empowering of the individual in identifying early signs of diabetes. The methods in this publication are to gather data, evaluate and give suggestion if clinical test to confirm or reject diabetes. In home measurements, education process with companies for innovation possibilities.

  • 10.
    Sandberg, Hanna
    et al.
    Blekinge Hospital, SWE.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Forssell, Henrik
    Blekinge Centre of Competence, SWE.
    Ovhed, Ingvar
    Blekinge Centre of Competence, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Increased Usage of Insulin Pump Functions Not Associated with Improved HbA1c in Children and Adolescents with Type 1 Diabetes Mellitus2016In: Journal of Diabetes Science and Technology, ISSN 1932-2968, Vol. 10, no 4, p. 997-998Article in journal (Refereed)
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