@Article{信息:doi 10.2196 / / jmir。8712，作者=“Desveaux, Laura和Shaw, James和Saragosa, Marianne和Soobiah, Charlene和Marani, Husayn和Hensel, Jennifer和Agarwal, Payal和Onabajo, Nike和Bhatia, R Sacha和Jeffs, Lianne”，标题=“一个提高2型糖尿病患者自我管理的移动应用程序:定性现实评估”，期刊=“J医学互联网Res”，年=“2018”，月=“Mar”，日=“16”，卷=“20”，数=“3”，页=“e81”，关键词=“远程医疗;糖尿病;自我管理;背景:越来越多地使用基于web的解决方案来预防和促进健康，这为改善2型糖尿病(T2DM)患者的自我管理和坚持基于指南的治疗提供了机会。尽管初步证据很有希望，但由于数据输入的负担、隐藏的成本、兴趣的丧失以及缺乏全面的功能，许多用户停止使用基于web的解决方案。评估往往侧重于有效性或影响，而未能评估可能相互作用以促成结果成功(或失败)的细微变量。目的:本研究旨在评估一个基于web的解决方案，以改善T2DM患者的自我管理，以确定上下文变量和作用机制的关键组合，解释解决方案在什么情况下对谁最有效。方法:在基线和干预期(3个月)结束时分别进行一对一、半结构化电话访谈，进行定性现实评估。主题包括参与者使用基于web的解决方案的经验，自我管理的障碍和促进因素，以及有效使用的障碍和促进因素。 Transcripts were analyzed using thematic analysis strategies, after which the key themes were used to develop statements of the relationships between the key contextual factors, mechanisms of action, and impact on the primary outcome (glycated hemoglobin, HbA1c). Results: Twenty-six interviews (14 baseline, 12 follow-up) were completed with 16 participants with T2DM, and the following 3 key groups emerged: the easiest fit, the best fit, and those who failed to activate. Self-efficacy and willingness to engage with the solution facilitated improvement in HbA1c, whereas competing priorities and psychosocial issues created barriers to engagement. Individuals with high baseline self-efficacy who were motivated, took ownership for their actions, and prioritized diabetes management were early and eager adopters of the app and recorded improvements in HbA1c over the intervention period. Individuals with moderate baseline self-efficacy and no competing priorities, who identified gaps in understanding of how their actions influence their health, were slow to adopt use but recorded the greatest improvements in HbA1c. The final group had low baseline self-efficacy and identified a range of psychosocial issues and competing priorities. These participants were uncertain of the benefits of using a Web-based solution to support self-management, ultimately resulting in minimal engagement and no improvement in HbA1c. Conclusions: Self-efficacy, competing priorities, previous behavior change, and beliefs about Web-based solutions interact to determine engagement and impact on the clinical outcomes. Considering the balance of these patient characteristics is likely to help health care providers identify individuals who are apt to benefit from a Web-based solution to support self-management of T2DM. Web-based solutions could be modified to incorporate the existing screening measures to identify individuals who are at risk of suboptimal adherence to inform the provision of additional support(s) as needed. ", issn="1438-8871", doi="10.2196/jmir.8712", url="//www.mybigtv.com/2018/3/e81/", url="https://doi.org/10.2196/jmir.8712", url="http://www.ncbi.nlm.nih.gov/pubmed/29549070" }