mHealth applications for diabetes – user preference and implications for app development

Background
Increasing diabetes prevalence is driving a demand for more sustainable yet person-centred service. As the worldwide smartphone market continues to grow, the number of diabetes self care mHealth applications also grows exponentially. mHealth can improve clinical outcomes, but current usage patterns, effectiveness and valued features are unclear. This study sought to assess levels of engagement with mHealth technologies within a subset of the Scottish diabetes population; to identify specific demographic sub-groups of interest; and draw comparisons between desirable and currently available features of diabetes mHealth applications.
Methods
A snapshot analysis of the diabetes mHealth app marketplace was undertaken in July 2014. Available features were used to construct a questionnaire. A random sample of 400 patients (stratified by diabetes type and age) was obtained from the Scottish Diabetes Research Network (n=200) and users of patient health record (MyDiabetesMyWay, n=200). Demographic variables (age group, gender and diabetes type) were cross-tabulated with preference for mHealth technologies and loglinear analysis was used to identify significant interactions. Desirable features of a diabetes mHealth app were compared with currently available diabetes apps.
Results
Available app features include: data storage/graphical presentation; integration with other apps; exercise tracking; health/diet tracking; reminders/alarms; and education. 59% (234/400) people responded to the questionnaire; 62% owned a smartphone. Most smartphone users expressed a preference towards mHealth apps (especially younger age groups) although mobile phone app use for diabetes self management was low (12/163 (7%)). Older women with T2D were significantly less likely to favour diabetes mHealth apps. Respondents favoured a wide variety of potential features, contrasting with current availability: patient education – favoured by 45% (98/220) users but available in 14% (10/74) apps; personal health record - favoured by 40% (89/220) users but unavailable on apps reviewed.
Discussion/conclusion
mHealth has the potential to empower patients; improve outcomes; and provide service in a sustainable way. This study demonstrates that mHealth acceptance is high, but current engagement is low and functionality does not match potential user preferences. Engagement and functionality could perhaps be improved by including relevant stakeholders in future development, driven by clinical and user need.