Efficacy Study of Interactive Web Application for Problem Solving in Diabetes Management
|ClinicalTrials.gov Identifier: NCT02021591|
Recruitment Status : Completed
First Posted : December 27, 2013
Last Update Posted : March 15, 2018
|Condition or disease||Intervention/treatment|
|Diabetes Mellitus||Behavioral: Mobile Diabetes Detective (MoDD)|
Well-developed problem-solving is essential to successful diabetes management results in better diabetes self-care behaviors, and leads to improvements in clinical outcomes. Problem-solving is central to many self-management and behavior change programs; the American Diabetes Association (ADA) includes problem-solving as a critical self-care behavior. Given the importance of problem solving skills, innovative diabetes education programs, such as Discovering Diabetes, have been developed and shown to be effective in fostering independent problem-solving.
At the same time, many care management programs and diabetes education centers struggle with staffing shortages, limited funding, and competitive time demands. As a result, 50 to 80% of individuals with diabetes experience significant knowledge and skill deficits. Health Information Technology (HIT) can make successful interventions available to more diverse populations. At present, however, many HIT interventions target improved patient-clinician communication and logging and monitoring, rather than focusing more specifically on fostering problem-solving skills. Moreover, few HIT interventions have been rigorously evaluated in controlled trials. The main contribution of this research is a theoretically-grounded HIT intervention, Mobile Diabetes Detective (MoDD), that incorporates best practices and current guidelines for supporting and fostering individuals' problem-solving skills in context of diabetes self-management. In our prior work we developed and evaluated a mobile application for reflection and discovery in diabetes management, MAHI (Mobile Access to Health Information). MAHI helped individuals with diabetes capture diabetes-related experiences and reflect on them under a supervision of a diabetes educator. The proposed intervention, MoDD will further extend this prior work, specifically focusing on guided problem-solving through experimentation. The intervention will utilize an open source platform for disease self-management developed by the research team.
If the results are achieved, the project will have significant impact both locally and globally. Locally, diabetes continues to be a major problem in NYC, particularly among disadvantaged populations, many of whom are served by the Health Resources and Services Administration (HRSA) funded Community Health Centers (CHCs) participating in this study. In the past 10 years, the number of people with diabetes in NYC has more than doubled. An estimated 530,000 adult New Yorkers have been diagnosed with diabetes, with another 265,000 having diabetes but are unaware. In the HRSA funded CHCs in New York State, 8% of the adult patients have a diagnosis of diabetes. At the same time, our prior studies showed that despite such barriers as low health literacy or lower socio-economic status, disadvantaged populations in NYC can greatly benefit from informatics interventions that target health and wellness. The proposed research will use HIT to partially assuage the ongoing challenge of control and management of diabetes. The expected improvement in problem-solving skills has been shown to lead to improved self-care behaviors, such as a more careful diet and appropriate level of exercise, and significant reduction in HbA1c7, which in turn has been linked to reduction in diabetes-related complications. Thinking more broadly, this research can provide new insights into facilitating problem-solving in diabetes management with HIT, as an alternative to more traditional staff-intensive interventions.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||248 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Primary Purpose:||Supportive Care|
|Official Title:||Randomized Clinical Trial of Health Information Technology for Problem Solving in Diabetes Management|
|Actual Study Start Date :||December 2013|
|Primary Completion Date :||August 2017|
|Study Completion Date :||August 2017|
No Intervention: Control
Control Arm: Study participants attending one of the 4 control arm centers will receive usual diabetes education provided by staff at the site; be provided with free test strips for their blood glucose meters during the 4-week intervention period; given access to the MODD application at the end of the study. Instructions on how to use the MODD will be provided by site staff.
Intervention: Mobile Diabetes Detective (MoDD) Study participants attending one of the 4 Intervention sites will receive usual diabetes education provided by staff at the site and be given access to the MODD application and instructions for use for 4 weeks at the beginning of the study. After the initial 4 weeks of access to the MODD application, participants will be offered an option to continue using MODD for the duration of the study.
Behavioral: Mobile Diabetes Detective (MoDD)
MoDD is a web-based application that is designed to help individuals with diabetes identify specific problems related to glycemic control, and engage in problem-solving process. MoDD includes a number of messages that explain its users the nature of various problems related to glycemic control, aspects of individuals' behaviors that might have contributed to these problems, and alternative behaviors that could help to improve glycemic control. In addition to these messages displayed on the MoDD website, study participants may receive SMS messages with reminders to test blood glucose, or to follow the selected new behavior.
- Change in HgA1c [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]Glycated hemoglobin is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time.
- Change in Score on the Diabetes Problem-Solving Inventory (DPSI) [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]Diabetes Problem-Solving Inventory (DPSI) is a 9-item questionnaire that assesses individuals' problem-solving skills as applied specifically to overcoming barriers to diabetes self-management.
- Change in Score on the Summary of Diabetes Self-Care Activities Questionnaire (SDSCA) [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]Summary of Diabetes Self-Care Activities Questionnaire (SDSCA) contains 12 items with 5 subscales (diet, exercise, blood glucose testing, foot care, smoking status). The respondent is asked how many days in the past week he/she performed the behavior; higher scores indicate higher performance.
- Change in Score on Problem Areas in Diabetes Scale (PAID) [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]Problem Areas in Diabetes Scale (PAID) is a 20 item 5 point Likert scale that measures the emotional aspect of living with diabetes .
- Change in Score on the Diabetes Self-Efficacy Scale (DSES) [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]Diabetes Self-Efficacy Scale (DSES) is 15-item 10-point Likert scale (1-cannot do at all; 10-Certain can do) that measures the belief that one can self-manage one's own health, specifically adapted to diabetes.
- Change in Score on the Patient Health Questionnaire-2 (PHQ-2) [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]Patient Health Questionnaire-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day").
- Change in Fasting Blood Glucose Level [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]Fasting blood glucose will be collected from patients' charts.
- Change in Total Cholesterol [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]
- Change in Blood Pressure [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]Blood pressure will be collected using patients' charts.
- Change in High-Density Lipoprotein [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]
- Change in Low-Density Lipoprotein [ Time Frame: Baseline, post-intervention 4 weeks, 3 months, 12 months ]
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02021591
|United States, New York|
|Clinical Directors Network|
|New York, New York, United States, 10018|
|Principal Investigator:||Olena Mamykina, PhD||Columbia University|
|Study Chair:||Jonathan Tobin, PhD||Clinical Directors Network|