An evaluation of the short-term impacts of a patient-centered computerized self-monitoring system among patients with type 2 diabetes and hypertension

Abstract

Consumer health information technologies (CHITs) are emerging as promising tools for delivering healthcare services and facilitating patient self-management of chronic diseases; however, the use of the CHITs is largely constrained by usability problems and unclear evidence on the effectiveness of the technologies. The ergonomics research team of The University of Hong Kong developed a patient-centered computerized self-monitoring system that appeared to be useful and easy to use; with the system, this thesis focuses on the examination of the short-term impacts of the technology on patient outcomes for diabetic and hypertensive patients. The self-monitoring technology was designed using user-centered approaches and relevant human factors principles. Iterative usability evaluations were conducted to assess and improve the usability of the technology with 97 chronically ill patients. Also, using data from a larger randomized controlled trial (RCT) of technology-based disease self-management to improve patients’ outcomes, this thesis compared the short-term effects of the use of a computerized self-monitoring system to usual care using 63 patients with type 2 diabetes and hypertension for four weeks. Thirty-three patients were randomized into intervention group, whose disease care was supported by the self-monitoring system, while 30 patients into control group, who continued with their usual care. A pretest-posttest repeated measures design was employed to determine the effects of the technology on clinical, psychosocial, behavioral, usage, and technology perception outcomes over time. Measurements were obtained at baseline, and after 2 and 4 weeks.

The iterative usability studies improved and verified the usability of the self-monitoring system for chronically ill patients. Results from the RCT showed that after four weeks, there were significant decreases in systolic blood pressure (p < 0.001) and diastolic blood pressure (p < 0.001), self-efficacy for managing chronic disease (p = 0.001), and adherence to treatment (p = 0.001) in the intervention group compared with the control group. Significant differences in favor of intervention group after four weeks were also documented for changes of several quality of life subscales (i.e., general health (p = 0.010), role physical (p = 0.001), role emotional (p = 0.002), bodily pain (p = 0.050), and physical component summary score (p = 0.005)), and perceived ease of use (p = 0.007). No significant difference was found between groups for fasting blood glucose (p = 0.687), perceived usefulness (p = 0.661), frequency of self-monitoring of blood pressure (p = 0.230) and self-monitoring of blood glucose (p = 0.993), and several other quality of life subscales over time. The usability evaluation presented in this thesis report demonstrated that the method was effective and efficient in identifying potential usability problems at the early stage of system development for CHITs. The findings from the RCT indicated that the use of the human factored-engineered self-monitoring technology had short-term effectiveness in improving blood pressure control, self-efficacy for managing chronic disease, adherence to treatment, and quality of life for patients with type 2 diabetes and hypertension. A human factored-engineered self-management technology appears to be an effective tool in patient self-management of chronic diseases.