Patients’ and healthcare professionals’ perspectives towards technology-assisted diabetes self-management education. A qualitative systematic review

PLOS ONE RESEARCH ARTICLE Patients’ and healthcare professionals’ perspectives towards technology-assisted diabetes self-management education. A qualitative systematic review Sneha Rajiv Jain ID1, Yuan Sui1, Cheng Han Ng ID1, Zhi Xiong Chen2,3, Lay Hoon Goh4, Shefaly Shorey ID5* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, 2 Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, 3 Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, 4 Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, 5 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore * Abstract OPEN ACCESS Citation: Jain SR, Sui Y, Ng CH, Chen ZX, Goh LH, Shorey S (2020) Patients’ and healthcare professionals’ perspectives towards technologyassisted diabetes self-management education. A qualitative systematic review. PLoS ONE 15(8): e0237647. https://doi.org/10.1371/journal. pone.0237647 Editor: Emily A. Hurley, Children’s Mercy Hospitals and Clinics Department of Pathology and Laboratory Medicine, UNITED STATES Received: February 3, 2020 Accepted: July 30, 2020 Published: August 17, 2020 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0237647 Copyright: © 2020 Jain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Diabetes self-management education is a key aspect in the long-term management of type 2 diabetes. The patient and healthcare professional (HCP) perspective on the use of technology-assisted DSME has yet to be studied. Hence, the objective of this study was to better understand the factors that facilitate or hinder the adoptions of such education by adults with type 2 diabetes and their HCPs. Methods We systematically searched five databases (Medline, Embase, CINAHL, Web of Science Core Collection, and PsycINFO) until August 2019. The search included qualitative and mixed-method studies that reported the views of patients and HCPs regarding features, uses, and implementations of technology-assisted DSME. Data were synthesized through an inductive thematic analysis. Results A total of 13 articles were included, involving 242 patients, ranging from 18 to 81 years and included web-based, mobile application, digital versatile disc (DVD), virtual reality or telehealth interventions. Patients and HCPs had mixed views towards features of the technology-assisted interventions, with patients’ personal qualities and HCPs’ concerns affecting uses of the interventions. Patients generally preferred technologies that were easy to access, use, and apply and that had reliable information. Patients’ ambitions motivated them, and personal attributes such as poor competence with technology, poor literacy, and language barriers acted as barriers. Patients especially liked the peer support that they PLOS ONE | https://doi.org/10.1371/journal.pone.0237647 August 17, 2020 1 / 20 PLOS ONE Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Technology-assisted diabetes self-management education received but did not like it when there was no regulation of advice on these platforms. HCPs believed that while the interventions were useful to patients, they faced difficulties with integration into their clinical workflows. Funding: This paper is funded independently by one of the authors, Goh Lay Hoon. Competing interests: The authors have declared that no competing interests exist. Abbreviations: HbA1c, Haemoglobin A1c; DSME, Diabetes Self-Management Education; HCP, Healthcare Professional; PRISMA, Preferred Reporting Items for Systematic Reviews and MetaAnalyses; sENTREQ, Enhancing transparency in reporting the synthesis of qualitative research. Conclusion This review explored the features of technology-assisted diabetes self-management education interventions that enhanced positive patient engagements and the negative aspects of both the platforms and the target groups. Technical support and training will be effective in managing these concerns and ensuring meaningful use of these platforms. Introduction Diabetes is a complex disease. Its successful management is as much of an art as it is of a science. While the science behind diabetes is a body of well-understood and stable knowledge, the art of managing diabetes remains a dynamic process that requires constant understanding and updates of the interplay between psychological, social, economic, cultural and behavioural factors affecting patients, healthcare professionals (HCPs), and the society [1, 2]. This is further complicated by the need to blend with emerging science on diabetes and technological breakthroughs in delivering patient education. As a chronic disease, the responsibility for successfully managing diabetes cannot lie on HCPs alone as it requires the co-sharing of responsibility between patients and various HCPs [3, 4]. Inherently, type 1 and type 2 diabetes are very different. While type 1 diabetes is largely of childhood or juvenile-onset with a genetic component and a lower prevalence [5, 6], type 2 diabetes has a larger prevalence in adult and elderly patients as well as a link to insulin resistance [7, 8]. In terms of management, type 1 diabetes is mainly treated pharmacologically with exogenous insulin [6], while type 2 diabetes consists of education, lifestyle modifications, and oral hypoglycemic agents, all of which require strict adherence to ensure their effectiveness [9]. In this regard, diabetes self-management education (DSME) becomes a very important component of diabetes care since it provides a foundation to help people navigate their decisions and activities in view of their chronic conditions [10]. This is especially the case for type 2 diabetics since it requires one to make complex self-care decisions daily [10]. DSME involves the continuous transfer and facilitation of skills and knowledge for empowering patients with the abilities to self-care throughout their lifetimes, starting from their diagnoses [11, 12]. This can include information and facts about the disease, how to self-monitor blood glucose and its importance, how to prevent or identify and manage unstable glucose levels and other complications, and how to access information up (...truncated)