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open access
Embargoed until 2021-07-01
Copyright: Kaplan, Ruth
Embargoed until 2021-07-01
Copyright: Kaplan, Ruth
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Abstract
Background: Public health organisations in Australia lag behind other sectors using client-facing smartphone applications (apps) to enhance service delivery. Patients are increasingly seeking smartphone-enabled health management resources. Mobile health (mHealth) systems incorporating apps may offer effective means of enabling patient-centred care. mHealth interventions can fail to translate into practice due to: design-reality gaps; real-world change outpacing research; or health service sociotechnical complexity. Pragmatic, participatory research methodologies may help meet these challenges. Tools such as the Consolidated Framework for Implementation Research (CFIR) offer structure around which investigators can build fit to context.
Aim: Examine the feasibility and acceptability of a co-produced prototype mHealth intervention and model of care to manage gestational diabetes (GDM) focusing on barriers to translation into practice. Through Proof of Concept offer recommendations for future study.
Methods: An mHealth system (SugaMama) was developed using lean, agile methodologies guided by Social Constructivist theory. It comprised a patient app (iPhone, Android); Bluetooth glucometer; and clinician web portal. Environmental analysis situated the study in a real-world context. The study was planned and evaluated by a Quality Improvement Collaborative (QIC) comprising patients, clinicians, health service managers and researchers. Mixed methods and an observational case study design were employed.
Results: Sixteen GDM patients and seven clinicians trialled SugaMama over 44 days and found it to be technically feasible, acceptable and aligned with patient lifestyle. Technology functioned as intended. A sole critical issue related to planning for system downtime. Patients preferred supported self-management utilising SugaMama over standard care. Clinicians experienced increased control through viewing real-time patient data. For the next iteration more personalisation was requested by patients; clinicians sought improved medication management and integration with other systems.
Conclusion: mHealth-enabled care is likely to support patient-clinician partnerships and extend health service reach. Utilisation of CFIR constructs and a QIC may support implementation. Critical barriers to translation into practice can arise despite an intervention being evidence-based; feasible; acceptable; and supported by sponsors, patients and clinicians in a target context.