Table 3.
Framework domain |
|
Design elements |
Value drivers |
|
Clinical behavioral engagement |
Outcomes and metrics |
|
|
|
Clinicalc |
Outcome: At target or improved Metrics: A1c<7% or 8% (risk) or 1% improvement if above; BP<140/90 or decrease 10/5 mm/Hg if above; LDL<100 mg/dL or <70 (cardiac risk) or a decrease of 26% if above; HDL>50 mg/dL for females or an increase of 8% if above; HDL>40 mg/dL for males or an increase of 8% if above; Triglycerides<150 mg/dL or a decrease of 26% if above |
|
Behaviorald |
Outcome: Improve or maintain medication adherence Metric: Medication adherence: ≥80% adherence to metabolic meds (correct meds and as prescribed) |
|
Patient Engagemente |
Outcome: Initial mHealth application use. Sustained mHealth application use Metrics: One interaction with the application each week for 1st 3 months |
Program objectives for stakeholders |
|
Effective diabetes self-management; Effective clinical decision-making; Effective patient-provider communication |
Essential behavioral domains/supporting actions |
|
AADE7f; medication-taking; monitoring (BGg); problem-solving (high & low BGs); eating; reducing risk (complications); being active; healthy coping; engagement |
Multidimensional profile |
|
|
|
Clinical | Medication regimen; BG value ranges |
|
Contextual | BG reading type |
|
Behavioral | Medication-taking behaviors: consistent, inconsistent, nonadherent |
EBG-driven clinical and behavioral interventions (evidence-based) |
|
Educational and skills-building support; self-monitoring of blood glucose support; coaching support; behavioral adherence support (medication-taking, carb counting); patient-provider communication support; problem-solving support (eg, addressing high and low BGs); social support |
App features/content |
|
|
|
|
Logbook; medication list & schedule; carb estimation tool; SMBGh tool; reminders; alerts; patient data summary report for health care team; clinical decision support feature |
Information/educational content | Learning library; ADAi standards of care; DSME/Sj educational topics; content to support AADE7 self-management behaviors; tips | |
Message types |
Reminders Time-based “touch point messages”: daily messages for engagement, motivation Longitudinal feedback messages: based on multiple BG data points entered into journal to improve skills for SMBG Real-time feedback: Based on data entered into journal to improve skills for SMBG |
a Implementing organization = health care technology company
b Program implementation model = Rx only by health care providers for patients
c Clinical outcomes for chronic conditions (at the patient level)
d Behavioral outcomes related to patient self-management
e Initial and sustained mHealth application use
f AADE7: American Association of Diabetes Educators behavioral domains
g BG: blood glucose
h SMBG: self-monitoring of blood glucose
i ADA: American Diabetes Association
j DSME/S: Diabetes self-management education and support