| Objective:To design and develop a mHealth application(APP)based on the needs and preferences of elderly with type 2 diabetes using design thinking and to evaluate its applicability and effectiveness among elderly empty-nesters with type 2 diabetes.Methods:1.Five steps of design thinking including empathy,definitjion,ideate,prototype and test were adopted in APP development.Literature review and interview were collected to understand factors affecting use behavior,needs and preferences of elderly patients in empathy stage.Persona was used to define patient characteristics in the definition stage.The prototype of APP was developed in combination with the interviews of health care providers and informatics expert.User testing and heuristic evaluation were used to evaluate usability of prototype.The final vers:ion of the mHealth APP for the elderly with type 2 diabetes was established and modified by engineers based on the test results.2.A pilot study was conducted on empty-nest elderly with type 2 diabetes who were admitted to a third-class hospital in Shandong Province from 13th August to 27th September 2018.Thirty-three patients were included.Out-of-hospital management was conducted based on APP for empty-nest diabetic patients,including education,data automatic feedback and integration,reminder,online interaction and health guidance.Data and questionnaires of patients were collected and compared before out of the hospital and three months after intervention to evaluate blood glucose control and self-management behaviors.Individual interviews were used to explore using experience among empty-nest elderly.Statistical software SPSS 22.0 was used for quantity data entry,paired sample t test and Wilcoxon signed rank test were used to evaluate the changes of laboratory indicators,self-management behavior and occurrence of hypoglycemia before and after intervention.Content analysis was used for analysis of qualitative research data to explore using experience.Results:1.A mHealth APP for elderly diabetics involving eight functions including knowledge learning,online interaction,recording,test,blood glucose record.medication assistant.blood glucose report and my information was developed through design thinking and it showed good usability among elderly patients.2.The effect of mHealth APP on laboratory indicators:HbAlc,fasting blood glucose and postprandial blood glucose were improved compared with the baseline after 3 months of intervention(P<0.05).There were no statistical differences in triglycerides,total cholesterol,low-density lipoprotein and high-density lipoprotein compared with the baseline(P>0.05).3.The effect of mHealth APP on self-management behavior:Scores in diet control.blood glucose monitoring,foot care and self-management were improved compared with the baseline with statistically significant differences(P<0.05).There was no statistical difference in reasonable exercise(P>0.05).4.The effect of mHealth APP on occurrence of hypoglycemia:There was no statistical difference in the frequency of hypoglycemia between the intervention and the baseline(P>0.05).5.Using experience of empty-nest elderly patients:The mHealth APP increased the awareness and self-management compliance of empty-nest elderly patients about diabetes and improved motivation and confidence in diabetes management.Conclusion:1.The mHealth APP was designed and developed for older patients with type 2 diabetes based on the method of design thinking,which was with good usability.2.An out-of-hospital management program for empty-nest elderly type 2 diabetes patients was constructed based on the mHealth APP for older patients with type 2 diabetes.The results showed that mHealth APP was a beneficial tool to improve blood glucose control and self-management behavior of empty-nest elderly diabetes patients.In addition,it is necessary to strengthen patient training,improve timely response and solve usability problems in future interventions. |
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