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Improving Diabetes Care for Young People With Type 1 Diabetes Through Visual Learning on Mobile Phones: Mixed-Methods Study

机译:通过手机视觉学习改善1型糖尿病青少年的糖尿病护理:混合方法研究

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摘要

Background: Only 17% of Norwegian children and adolescents with diabetes achieve international treatment goals measured by glycated hemoglobin (HbA1c). Classic patient–physician consultations seem to be poorly adapted to young children. New strategies that are better attuned to young people to improve support of adolescents’ self-management of diabetes need to be tested and evaluated. Objective: (1) To explore how applications for mobile phones can be used in follow-up of adolescents with type 1 diabetes, and (2) to use the findings to guide further development of the applications and as a basis for future studies. Method: We pilot tested two mobile phone applications: (1) an application that contained a picture-based diabetes diary to record physical activity and photos taken with the phone camera of food eaten, where the phone also communicated with the glucometer by Bluetooth technology to capture blood glucose values, and (2) a Web-based, password-secured and encrypted short message service (SMS), based on access using login passwords received via SMS to be used by participants to send messages to their providers when they faced obstacles in everyday life, and to send educational messages to the participants. At the end of the 3-month pilot study, 12 participants (7 girls and 5 boys ) aged 13–19 years completed semistructured interviews. The participants had a mean HbA1c value of 8.3 (SD 0.3), mean age of 16.2 (SD 1.7) years, mean body mass index of 23.3 (SD 3.2) kg/m2, and mean diabetes duration of 7.5 (SD 4.6) years. We applied three additional measurements: change in metabolic control as measured by HbA1c, the System Usability Scale, and diabetes knowledge. Results: From the interviews, three main categories emerged: visualization, access, and software changes. Participants appreciated the picture-based diary more than the SMS solution. Visualization of cornerstones in diabetes self-care (ie, diet, insulin dosage, physical activity, and pre- and postprandial glucose measurements all transformed into one picture) in the mobile diary was found to be an important educational tool through reflections in action. This led to a change in participants’ applied knowledge about the management of their disease. Additional measurements supplemented and supported the qualitative findings. However, changes in HbA1c and participants’ theoretical knowledge as tested by a 27-item questionnaire, based on a national health informatics’ diabetes quiz, before and after the intervention were not statistically significant (P = .38 and P = .82, respectively, paired-samples t test). Participants suggested additional functionality, and we will implement this in the design of the next software generation. Conclusion: Participants reported an increased understanding of applied knowledge, which seem to positively affect diabetes self-care. Visual impressions seem well adapted to the maturation of the adolescent brain, facilitating the link between theoretical knowledge and executive functions. SMS gave the adolescents a feeling of increased access and security. Participants gave valuable input for further development of these applications.
机译:背景:只有17%的挪威糖尿病儿童和青少年达到了通过糖化血红蛋白(HbA1c)衡量的国际治疗目标。经典的患者-医师咨询似乎不适用于幼儿。需要测试和评估更适合年轻人的新策略,以改善对青少年糖尿病自我管理的支持。目的:(1)探讨如何将手机应用程序用于1型糖尿病青少年的随访,以及(2)利用研究结果指导应用程序的进一步开发,并为将来的研究奠定基础。方法:我们对两个手机应用程序进行了试验测试:(1)包含一个基于图片的糖尿病日记来记录体育活动和用手机相机拍摄的食物照片拍摄的应用程序,其中手机还通过蓝牙技术与血糖仪进行通讯,以捕获血糖值,以及(2)基于Web的,密码保护和加密的短消息服务(SMS),该访问基于使用通过SMS接收的登录密码进行的访问,参与者在遇到障碍时可以使用该登录密码向其提供者发送消息在日常生活中,并向参与者发送教育信息。在为期3个月的试验研究结束时,年龄在13-19岁之间的12名参与者(7名女孩和5名男孩)完成了半结构化访谈。参与者的平均HbA1c值为8.3(SD 0.3),平均年龄为16.2(SD 1.7)岁,平均体重指数为23.3(SD 3.2)kg / m2,平均糖尿病病程为7.5(SD 4.6)年。我们应用了三个附加的测量值:通过HbA1c测得的代谢控制变化,系统可用性量表和糖尿病知识。结果:从访谈中,出现了三个主要类别:可视化,访问和软件更改。与SMS解决方案相比,参与者更喜欢基于图片的日记。通过行动中的反思,发现在流动日记中可视化糖尿病自我护理的基石(即饮食,胰岛素剂量,身体活动以及餐前和餐后血糖测量结果全部转换为一张图片)是一种重要的教育工具。这导致参与者对疾病管理的应用知识发生了变化。其他测量补充并支持定性结果。然而,根据一项全国卫生信息学专家对糖尿病的测验,在干预前后,HbA1c和参与者理论知识的变化(通过一项27项问卷调查)均无统计学意义(分别为P = 0.38和P = .82) ,配对样本t检验)。参与者建议了其他功能,我们将在下一代软件的设计中实现此功能。结论:参与者报告了对应用知识的更多了解,这似乎对糖尿病自我保健产生积极影响。视觉印象似乎很好地适应了青少年大脑的成熟,从而促进了理论知识与执行功能之间的联系。 SMS给青少年带来了访问和安全性增强的感觉。与会者为进一步开发这些应用程序提供了宝贵的意见。

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