The design and development of MyT1DHero: A mobile app for adolescents with type 1 diabetes and their parents

Abstract

Introduction

Type 1 diabetes impacts approximately 1.25 m Americans, many of them young children. As a child grows, there is a transition towards independence and they must learn to manage their diabetes independently. The objective of this study was to design, develop and conduct a prototype test to assess the satisfaction and feasibility of a mobile app for adolescents with type 1 diabetes and their parents to aid in this transition.

Methods

Ten parent/adolescent groups used MyT1DHero for four weeks. They were given a pre-test/post-test survey regarding family conflict with three tasks of diabetes management and the general tone of family communication. At post-test they were asked questions regarding their satisfaction and perception of ease of use of the app. They also participated in short interviews regarding the app. Additionally, we used server data to examine actual app usage.

Results

The parents’ perceptions of conflict around the results of the blood sugar tests increased (t(9) = 2.71, p = .02) as did perceptions of conflict around logging the blood sugar results (t(9) = 3.67, p = .005). The adolescents perceived increased conflict surrounding the results around logging the blood sugars results (t(9) = 3.09, p = .01).There was no change in the tone of general family communication. During the prototype testing, we discovered that the app crashed repeatedly and several of the functions were not working properly. In the interview data, three main themes emerged, app-crashing issues, problems with notifications and positive feedback.

Discussion

Through this process, all of the reported issues were corrected and new features were planned for subsequent versions. A smartphone application has the potential to be a novel intervention for engaging adolescents and their parents in positive communication to support type 1 diabetes management.

Keywords

Type 1 diabetes mhealth telemedicine

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References

Juvenile Diabetes Research Foundation. Type 1 diabetes facts, http://jdrf.org/about-jdrf/fact-sheets/type-1-diabetes-facts/ (2017, accessed 31 July 2017).

Pierce

et al.

Health care transition for young adults with type 1 diabetes: stakeholder engagement for defining optimal outcomes. J Pediatr Psychol 2017; 42(9): 970–982.

Ersig

et al.

Stressors in teens with type 1 diabetes and their parents: immediate and long-term implications for transition to self-management. J Pediatr Nurs 2016; 31: 390–396.

American Diabetes Association. 11. Children and adolescents. Diabetes Care 2016; 39: S86–S93.

Anderson

et al.

Family conflict, adherence, and glycaemic control in youth with short duration type 1 diabetes. Diabetic Med 2002; 19: 635–642.

Anderson

et al.

An office-based intervention to maintain parent–adolescent teamwork in diabetes management. Impact on parent involvement, family conflict, and subsequent glycemic control. Diabetes Care 1999; 22: 713–721.

La Greca

et al.

I get by with a little help from my family and friends: adolescents’ support for diabetes care. J Pediatr Psychol 1995; 20: 449–476.

Laffel

et al.

Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes. J Pediatr 2003; 142: 409–416.

Hamine

et al.

Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Medical Internet Res 2015; 17: 2–2.

10.

Holtz

Lauckner

. Diabetes management via mobile phones: a systematic review. Telemed J E Health 2012; 18: 175–184.

11.

Anderson M, Singh A and Page D. Parents, teens and digital monitoring. Report, Pew Research Center, US, January 2016.

12.

Lenhart A, et al. Teens, social media & technology overview 2015: Internet & American Life Project. Report, Pew Research Centre, US, April, 2015.

13.

Huang

et al.

Preparing adolescents with chronic disease for transition to adult care: a technology program. Pediatrics 2014; 133: e1639–e1646.

14.

Lubans

et al.

Preventing obesity among adolescent girls: one-year outcomes of the Nutrition and Enjoyable Activity for Teen Girls (NEAT Girls) cluster randomized controlled trial. Arch Pediatr Adolesc Med 2012; 166: 821–827.

15.

Martin

et al.

Using social cognitive theory to predict physical activity and fitness in underserved middle school children. Res Q Exerc Sport 2011; 82: 247–255.

16.

Pendley

et al.

Peer and family support in children and adolescents with type 1 diabetes. J Pediatr Psychol 2002; 27: 429–438.

17.

Greco

et al.

A peer group intervention for adolescents with type 1 diabetes and their best friends. J Pediatr Psychol 2001; 26: 485–490.

18.

Ravert

Hancock

Ingersoll

. Online forum messages posted by adolescents with type 1 diabetes. Diabetes Educ 2004; 30: 827–834.

19.

Skinner

John

Hampson

. Social support and personal models of diabetes as predictors of self-care and well-being: a longitudinal study of adolescents with diabetes. J Pediatr Psychol 2000; 25: 257–267.

20.

Hanna

Guthrie

. Adolescents’ behavioral autonomy related to diabetes management and adolescent activities/rules. Diabetes Educ 2003; 29: 283–291.

21.

Hanna

et al.

Emerging adults with type 1 diabetes during the first year post-high school perceptions of parental behaviors. Emerging Adulthood 2013; 2(2): 128–137.

22.

Skinner

Hampson

. Social support and personal models of diabetes in relation to self-care and well-being in adolescents with type I diabetes mellitus. J Adolesc 1998; 21: 703–715.

23.

Stupiansky

et al.

Impulse control, diabetes-specific self-efficacy, and diabetes management among emerging adults with type 1 diabetes. J Pediatr Psychol 2012; 38: 247–254.

24.

Law

et al.

Adolescent and parent diabetes distress in type 1 diabetes: the role of self-efficacy, perceived consequences, family responsibility and adolescent–parent discrepancies. J Psychosom Res 2013; 74: 334–339.

25.

Iannotti

et al.

Self-efficacy, outcome expectations, and diabetes self-management in adolescents with type 1 diabetes. J Dev Behav Pediatr 2006; 27: 98–105.

26.

Anderson

et al.

Diabetes empowerment scale: a measure of pscyo-social self-efficacy. Diabetes Care 2000; 23: 739–743.

27.

Nouwen

et al.

Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes. Psychol Health 2009; 24: 1071–1084.

28.

Viner

et al.

Motivational/solution-focused intervention improves HbA1c in adolescents with type 1 diabetes: a pilot study. Diabetic Med 2003; 20: 739–742.

29.

Cafazzo

et al.

Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. J Med Internet Res 2012; 14: e70–e70.

30.

Deci

Ryan

. The general causality orientations scale: self-determination in personality. J Res Pers 1985; 19: 109–134.

31.

Holtz B, et al. Three perspectives on the transition to self-management. Presented at the 14th Annual Pediatric Research Conference, Detroit, MI, US.

32.

Holtz

et al.

Developing a patient-centered mhealth app: A for adolescents with type 1 diabetes. JMIR mHealth uHealth 2017; 5(4): e53–e53.

33.

Nielsen J and Landauer TK. A mathematical model of the finding of usability problems. In: Proceedings of INTERCHI ’93 conference on human factors in computer systems (eds. S Ashlund, A Henderson, E Hollnagel, et al.), Amsterdam, the Netherlands, April 24-29 1993, pp. 206–213, Amsterdam: IOS Press.

34.

Hood

et al.

Updated and revised diabetes family conflict scale. Diabetes Care 2007; 30: 1764–1769.

35.

Lewis

. IBM computer usability satisfaction questionnaires: psychometric evaluation and instructions for use. Int J Hum Comput Interact 1995; 7: 57–78.

36.

IBM Corp. IBM Statistics for Mac, Version 23. Released 2016, Armonk, NY: IBM Corp.

37.

Braun

Clarke

. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77–101.

38.

Roethlisberger

Dickson

. Management and the Worker, Vol. 5: Psychology Press, 2003.

39.

Fagan

Design and code inspections to reduce errors in program development. In: Broy

Denert

(eds). Software pioneers, Berlin: Springer, 2002, pp. 575–607.

40.

Sillars

Canary

Tafoya

Communication, conflict, and the quality of family relationships. In: Vangelisti

(ed). LEA’s communication series. Handbook of family communication, Mahwah, NJ: Lawrence Erlbaum Associates, 2004, pp. 413–446.

41.

Fitzpatrick

Ritchie

. Communication schemata within the family. Hum Commun Res 1994; 20: 275–301.

42.

Anderson

. Family conflict and diabetes management in youth: clinical lessons from child development and diabetes research. Diabetes Spectr 2004; 17: 22–26.

43.

Ioannidis

. Why most discovered true associations are inflated. Epidemiology 2008; 19: 640–648.

44.

Nielsen Corp. So many apps, so much more time for entertainment, http://www.nielsen.com/us/en/insights/news/2015/so-many-apps-so-much-more-time-for-entertainment.html?afflt=ntrt15340001&afflt_uid=kHO3g3-FBdk.4_iT8AmqXblFk7h5gTxIGuaU53OB8WY5&afflt_uid_2=AFFLT_ID_2 (2015, accessed 7 July 2017).

45.

Dennison

et al.

Opportunities and challenges for smartphone applications in supporting health behaviour change: qualitative study. J Med Internet Res 2013; 15(4): ).