Table 3.

Application of the framework to the mHealth prescription product (stakeholder input on the Diabetes mHealth App)^a,b.

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