Evaluating the Effectiveness of Computer-Based Interventions in Diabetes Treatment

Research Summary

Self-management is an essential tool that contributes to the efficient treatment of diabetes because it reduces the risks of diabetes-related complications. However, productive self-management is inseparable from extensive and structured education programs. In some cases, they are connected to particular challenges because it is not always possible to attend lectures or other educational initiatives. For instance, some patients cannot feel comfortable to ask questions during face-to-face sessions. Therefore, there is a new educational intervention that aims at improving self-management skills, thus avoiding diabetes-related complications and making treatment more effective. One of the examples of educational alternatives is a computer-based intervention.

A computer-based intervention aimed at improving self-management skills among adult patients with diabetes is the focus of research conducted by Pal et al. (2014). It is essential to note that the authors recognize that there is a great variety of computer-based interventions. That is why the researchers label them as digital interventions, and this group involves different applications that require patient input and communication effort, as well as the involvement of processing technologies, for obtaining knowledge regarding diabetes management and treatment and providing patients’ responses to the shared information. Here, it is important to mention that these applications can be installed on different devices: personal computers, tablets, laptops, and mobile phones (Pal et al., 2014). No difference is made between them, as all of the interventions involving digital devices are perceived as computer-based.

The research was based on a comprehensive search of scholarly articles and conference proceedings, describing computer-based interventions and diabetes treatment plans. As a result, they selected 16 studies with a sample of over 3,500 participants – adults with both type 1 and type 2 diabetes. No adolescents or young children were covered by the interventions under investigation. All of these researches focused on changing behaviors – improving self-management skills – through computer-based interventions.

Based on the findings of the chosen articles, the authors developed a detailed overview of the influence of digital interventions on the effectiveness of diabetes treatment plans. Regardless of a differing focus of the analyzed articles, all of them used common types of models aimed at changing behaviors: providing feedback on patients’ performance, setting goals, sharing information on consequences of particular (healthy and unhealthy) behaviors, identifying barriers to solving diabetes-related problems, and self-monitoring of behavioral outcomes (Pal et al., 2014). The authors broke down the research findings into several groups, such as cognitive, behavioral, and emotional outcomes. All of them will be reviewed in detail below.

According to the authors of the research under consideration, cognitive outcomes stand for the changes in knowledge of the most efficient patterns for treating diabetes and making treatment plans more productive. In most cases, patients obtained new knowledge. Such a positive change is associated with improved self-efficacy. However, there is no evidence that would point to the positive impact of increased knowledge on self-management skills and, as a result, better health outcomes or more effective diabetes treatment. So, cognitive outcomes of digital interventions are not significant.

As for behavioral outcomes, they incorporate any changes in physical activities and dieting. It is a generally recognized fact that the combination of nutrition and activity patterns is one of the most effective ways of preventing and managing the issue of diabetes (Asif, 2014; Carter, Khunti, & Devies, 2012). That is why these two habits are mentioned as behavioral outcomes. Therefore, it was concluded that there were significant improvements in nutrition habits. It can be connected to the commonality of lacking knowledge about the postulates of healthy lifestyle and nutrition patterns beneficial for managing the problem of diabetes. However, there were no improvements in physical activities. That being said, behavioral outcomes of computer-based interventions are mixed.

Finally, emotional effects are associated with the risks of depressions and their consequences. The authors state that there is no connection between computer-based interventions and decreased risks of depressions (Pal et al., 2014). Still, it is essential to point to the link between emotional and cognitive outcomes. Because the influence of digital interventions on self-efficacy was positive, it can be said that the overall emotional outcomes are mixed, not insignificant.

Keeping in mind all facts mentioned above, it is evident that the effectiveness of computer-based interventions for improving self-management skills is low. It can be explained by several causes. To begin with, the implementation of the newest technologies into diabetes treatment is a relatively new field of patient care. Therefore, the further development of this area of care is needed and much attention should be paid to details of digital devices operation. More than that, they are poorly monitored that means that people do not share feedback and reports on their performance.

Still, if supplemented with face-to-face meetings with health care professionals, computer-based interventions may become a valuable contribution to coping with the challenge of the diabetes epidemic in the modern world. The same is true in the case of intensifying digital interventions and making them more comprehensively designed and incorporated into diabetes treatment. Still, there are two effective behavior-changing strategies: feedback on performance and self-monitoring of behavioral outcomes (Pal et al., 2014).

Intervention Presentation

Slide 1: Main Specificities of Computer-Based Interventions

• The latest development in diabetes treatment plans;
• Are generally referred to as digital interventions;
• Diabetes treatment based on the newest technologies;
• Applications for smartphones, tablets, and personal computers;
• No difference between the type of device;
• Focus is made on the broad concept.

Slide 2: The Scope of Computer-Based Interventions

Sharing knowledge about managing diabetes with patients:

• The best practices for addressing the problem;
• The most effective patterns of physical exercises;
• The most productive dieting practices – healthy dieting;
• Consequences of healthy and unhealthy behaviors.
• Collecting reports on performance to estimate progress;

Slide 3: The Scope of Computer-Based Interventions

• Setting personal goals for overcoming diabetes-related problems;
• Improving patients’ overall self-management and self-monitoring skills;
• Creating opportunities for self-monitoring progress in treatment;
• Solving diabetes-related issues based on identifying barriers;
• Assessing individual behavioral outcomes and lifestyle changes;
• Interventions may be both home- and hospital-based.

Slide 4: Outcomes of Computer-Based Interventions

• The main focus on changing patients’ behaviors;
• Driven by a desire to improve self-management skills;

Three blocks of the most significant outcomes:

• Cognitive (any changes in patients’ knowledge);
• Behavioral (alteration of patients’ common behaviors);
• Emotional (changes in patients’ emotional wellbeing).

Slide 5: Cognitive Outcomes of Computer-Based Interventions

• Any changes in knowledge about diabetes treatment;
• No positive knowledge-related changes in health outcomes;
• No connection between knowledge and self-management skills;
• Generally improved self-efficacy based on increased knowledge;
• No link with increased effectiveness of treatment;
• The overall influence of interventions in insignificant.

Slide 6: Behavioral Outcomes of Computer-Based Interventions

• Changes in physical activities and dieting patterns;
• Significant improvements in patients’ common nutrition patterns;
• Enhancement associated with knowledge about healthy lifestyle;
• No significant improvements in physical activities patterns;
• The overall outcomes of interventions are mixed;
• No evidence pointing to universal positive outcomes.

Slide 7: Emotional Outcomes of Computer-Based Interventions

• Based on estimating depression and its consequences;
• Extremely low influence on decreasing depression risks;
• A connection with cognitive outcomes – improved self-efficacy;
• The positive impact of self-efficacy issues;
• The overall influence of interventions is mixed.

Slide 8: Conclusion: Key Lessons Learned

• The overall outcomes either mixed or insignificant;
• Increased effectiveness when more intensified and monitored;
• May be effectively combined with face-to-face initiatives;
• Efficiency measured among adult patients only;
• Poor reporting and performance assessments entail challenges;
• Critical role of increased patient involvement.

Slide 9: Conclusion: Main Challenges Associated with Digital Interventions

The existence of effectiveness issues explained by:

• The novelty of digital technologies;
• Lacking detailed guidelines for using them;
• Need for developing guidelines for digital-based care
• Incomplete incorporation of the newest technologies.

Slide 10: Integrating Computer-Based Interventions into Practice

• Launching an intervention in an out-of-hospital environment;
• Addressing both adolescents and adult patients;
• Making it supplementation to face-to-face meetings;
• Involving patients from the most distant areas;
• Focusing on effective diabetes treatment plans;
• Designing a detailed framework for conducting the intervention.

Slide 11: Integrating Computer-Based Interventions into Practice:

Strategies for increasing the effectiveness of interventions:

• Developing an efficient feedback option;
• Motivating patients to report on their performance;
• Focusing on the emotions and behaviors of patients
• Avoiding significantly detailed theoretical and practical materials;
• Including information in a short and concise manner.

References

Asif, M. (2014). The prevention and control of type-2 diabetes by changing lifestyle and dietary pattern. Journal of Education and Health Promotion, 3, 1-8. doi:10.4103/2277-9531.127541

Carter, P., Khunti, K., & Devies, M. J. (2012). Dietary recommendations for the prevention of type 2 diabetes: What are they based on? Journal of Nutrition and Metabolism, 2012(4), 106. doi:10.1155/2012/847202

Pal, K., Eastwood, S. V., Michie, A., Farmer, A., Barnard, M. L., Peacock, R., … Murray, E. (2014). Computer-based interventions to improve self-management in adults with type 2 diabetes: A systematic review and meta-analysis. Diabetes Care, 37(6), 1759-1766. doi:10.2337/dc13-1386