Implementation of Technology-Delivered Diabetes Self-care Interventions in Clinical Care: a Narrative Review
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PSYCHOSOCIAL ASPECTS (SS JASER, SECTION EDITOR)
Implementation of Technology-Delivered Diabetes Self-care Interventions in Clinical Care: a Narrative Review Lyndsay A. Nelson 1,2
&
Sarah E. Williamson 1,2 & Audriana Nigg 1 & William Martinez 1
Accepted: 26 October 2020 / Published online: 18 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Evidence is growing for the positive effects of technology-delivered diabetes self-care interventions on behavioral and clinical outcomes. However, our understanding of how to effectively implement these interventions into routine clinical practice is limited. This article provides an overview of the methods and results of studies examining the implementation of technology-delivered diabetes self-care interventions into clinical care. We focus specifically on patient-facing behavioral interventions delivered with technology (e.g., text messaging, apps, websites). Recent Findings Eleven articles were included in the review. Most studies (n = 9) examined barriers and facilitators to implementation, while about half (n = 5) integrated the intervention into clinical care and evaluated implementation and/or effectiveness. Only six studies applied a theory or framework. The most common determinants of implementation were time constraints for clinic staff, familiarity with technology, knowledge of the intervention, and perceived value. We found substantial variation in implementation outcomes, including which were reported, how they were assessed, and the results. In the four studies that evaluated effectiveness, hemoglobin A1c improved. Summary Successful implementation of technology-delivered interventions has the potential to transform healthcare delivery and improve diabetes health on a population level. Promising strategies to address common determinants of implementation include appointing a clinic champion, developing staff training and educational materials, and adapting intervention processes to the clinic context. Future research should evaluate these implementation strategies to understand when and how they impact outcomes. Frameworks such as Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) can help ensure outcomes are systematically reported and allow for comparison across studies. Keywords Technology . Interventions . Diabetes . Self-management . Implementation . Mobile health
Introduction Among patients with diabetes mellitus, self-care is essential to achieve adequate glycemic control and prevent complications; This article is part of the Topical Collection on Psychosocial Aspects Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s11892-02001356-2. * Lyndsay A. Nelson [email protected] 1
Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN 37203, USA
2
Center for Health Behavior and Health Education, Vanderbilt University Medical Center, 2525 West End Ave. Suite 45
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