Evaluation of the Implementation of a Mobile Health App to Support Dutch Primary Care for Diabetes: Qualitative Study
Bibliographic record
Abstract
BACKGROUND: Over 1 million Dutch people have diabetes, of whom 90% have type 2 diabetes. Studies show that lifestyle plays an important role in the course of type 2 diabetes. MiGuide (MiGuide Ltd) is an online platform that helps people adopt and sustain lifestyle changes. The platform is integrated into existing diabetes care within primary care. Previous research has shown that implementing new (eHealth) interventions is challenging and may reduce effectiveness. Mapping out the barriers and success factors in the implementation process is essential so that eHealth interventions such as MiGuide can be used effectively in regular health care. OBJECTIVE: This study aimed to evaluate the implementation of MiGuide within Dutch primary care. METHODS: A qualitative study design was used, supplemented by quantitative data from patients. Five general practices participated. Three focus groups (FGs; at baseline, after 6 months, and after 12 months) were conducted with 3 general practitioners, 3 FGs with 8 specialized practice nurses (divided into 2 separate groups with 4 participants per group), 2 FGs (at 6 months and after 12 months) with 5 patients, and 2 FGs (at baseline and after 12 months) with 4 stakeholders from the management of the care group. The implementation process was discussed with health care professionals and management, and usage and user-friendliness were discussed with patients. The framework method was used to analyze the data. The following quantitative data were collected: patient characteristics, user data, and questionnaires at baseline and 6 months, assessing quality of life, usability, and diabetes self-care. The quantitative data were examined using exploratory analyses. RESULTS: Four themes were found in the qualitative data: "innovation," "capability, motivation, and opportunity," "processes," and "setting." Different factors within these themes played an essential role throughout the implementation process, such as facilities, technical difficulties, motivation, COVID-19, and the work processes. Areas for improvement were also identified. The supplemented quantitative data showed that usability scored below average at 6 months (mean 53.8; SD 9.3; n=8). Participants had a mean score of 0.84 (SD 0.13) on the EuroQoL-5 dimension and 81.9 (SD 13.4) on the EuroQoL visual analogue scale at baseline. Moreover, the average number of days someone exercised was 4.2 (SD 1.7), and the number of days someone ate a generally healthy diet was 5.1 (SD 1.3). Insufficient data on quality of life and diabetes self-care were collected at 6 months and therefore not presented in this study. CONCLUSIONS: Implementation is a complex process with multiple barriers and facilitators. It is essential to explore the use of context-specific strategies that are aligned with the implementation process phase. Further research is needed to evaluate the next version of the MiGuide platform, which is being implemented in another setting with lifestyle coaches.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.026 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".