@文章{info:doi/10.2196/23535，作者=“Idris, Muhammed Y和Alema-Mensah, Ernest和Olorundare, Elizabeth和Mohammad, Mohammad和Brown, Michelle和Ofili, Elizabeth和Pemu, Priscilla”，标题=“探讨参与技术辅助糖尿病自我管理教育的患者和教练的话语强调:Health360x临床实施研究”，期刊=“J Med Internet Res”，年=“2022”，月=“3”，日=“18”，卷=“24”，号=“3”，页=“e23535”，关键词=“自我管理;结构化主题建模;指导;糖尿病;少数民族人口;背景:服务不足的糖尿病患者的一个重要需求是定期获得糖尿病自我管理的充分支持。尽管数字技术的进步为电子卫生应用提供了可扩展的路径，为慢性疾病的自我管理提供了量身定制的干预措施，但卫生和数字素养仍然是利用这些技术进行有效的糖尿病自我管理教育的障碍。研究表明，教练的可用性有助于保持参与基于网络的学习，并提高行为改变的自我效能。然而，人们对参与这些相互作用的物质知之甚少。 Objective: This study aims to compare the content of conversations between patient--coach pairs that achieved their self-management goals and those that did not. The context is a clinical implementation study of diabetes self-management behavior change using Health360x within the practices of the Morehouse Choice Accountable Care Organization in the Atlanta metro area. Health360x is a coach-assisted consumer health information technology designed to support self-management skills acquisition and behavior among underserved, high-risk patients with diabetes. Methods: We provide a novel analysis of the discursive emphasis on patients and coaches. We examined transcripts of visits using a structural topic model to estimate topic content and prevalence as a function of patient and coach characteristics. We compared topics between patient--coach pairs that achieved diabetes-related self-management goals and those who did not. We also estimated a regression in which utterances are the units, the dependent variable is the proportion of an utterance that is about a given topic, and the independent variables are speaker types and explored other themes. Results: Transcripts from 50 patients who were recruited and consented, starting in February 2015, were analyzed. A total of 44 topics were estimated for patient--coach pairs that achieved their intended health goals and 50 topics for those who did not. Analysis of the structural topic model results indicated that coaches in patient--coach pairs that were able to achieve self-management goals provided more contextual feedback and probed into patients' experience with technology and trust in consumer information technologies. We also found that discussions around problem areas and stress, support ($\beta$Coach=.015; P<.001), initial visits ($\beta$Coach=.02; P<.001), problems with technology ($\beta$Coach=.01; P<.001), health eating goals ($\beta$Coach=.01; P=.04), diabetes knowledge ($\beta$Coach=.02; P<.001), managing blood sugar ($\beta$Coach=.03; P<.001), and using Health360x ($\beta$Coach=.003; P=.03) were dominated by coaches. Conclusions: Coach-facilitated, technology-based diabetes self-management education can help underserved patients with diabetes. Our use of topic modeling in this application sheds light on the actual dynamics in conversations between patients and coaches. Knowledge of the key elements for successful coach--patient interactions based on the analysis of transcripts could be applied to understanding everyday patient--provider encounters, given the recent paradigm shift around the use of telehealth. ", issn="1438-8871", doi="10.2196/23535", url="//www.mybigtv.com/2022/3/e23535", url="https://doi.org/10.2196/23535", url="http://www.ncbi.nlm.nih.gov/pubmed/35302506" }