TY - JOUR AU - Desveaux, Laura AU - Shaw, James AU - Saragosa, Marianne AU - Soobiah, Charlene AU - Marani, Husayn AU - Hensel, Jennifer AU - Agarwal, Payal AU - Onabajo, Nike AU - Bhatia, R Sacha AU - Jeffs, Lianne PY - 2018 DA - 2018/03/16 TI -一个改善2型糖尿病患者自我管理的移动应用程序:定性现实主义评估JO - J医学Internet Res SP - e81 VL - 20 IS - 3kw -远程医疗KW -糖尿病KW -自我管理KW -定性研究AB -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，这为改善自我管理和坚持基于指南的2型糖尿病(T2DM)患者的治疗提供了机会。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。使用主题分析策略对转录本进行分析，然后使用关键主题来开发关键上下文因素、作用机制和对主要结果(糖化血红蛋白，HbA1c)影响之间关系的陈述。结果:共对16名T2DM患者进行了26次访谈(14次基线，12次随访)，出现了以下3个关键组:最容易匹配组、最佳匹配组和激活失败组。自我效能感和参与解决方案的意愿促进了HbA1c的改善，而相互竞争的优先事项和心理社会问题则为参与制造了障碍。 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. SN - 1438-8871 UR - //www.mybigtv.com/2018/3/e81/ UR - https://doi.org/10.2196/jmir.8712 UR - http://www.ncbi.nlm.nih.gov/pubmed/29549070 DO - 10.2196/jmir.8712 ID - info:doi/10.2196/jmir.8712 ER -