1. Usage and Perceptions of a Mobile Self-Management Application for People with Type 2 Diabetes: Qualitative Study of a Five-Month Trial Naoe Tatara a, b, c Eirik Årsand a, b Tone Bratteteig c Gunnar Hartvigsen b, a a Norwegian Centre for Integrated Care and Telemedicine b University of Tromsø, Dept. of computer science c University of Oslo, Dept. of informatics

2. Reasons for focusing on engagement Results showing three types of usage patterns and user experience 5-month trial of the Few Touch application ©Owl and Mouse Educational Software This presentation discusses patients’ actual engagement with mobile self-management application

3. Limited number of research works report patients’ engagement with mHealth in detail ©Gee Whiz Labs, Inc Clinical outcomes Health Behavior Theories Usability issues Individual difference Change over time It is important to investigate patients’ individual engagement with mHealth over time to understand how mHealth works or doesn’t

4. The Few Touch application (FTA) was designed involving patients in iterative design process Blood glucose sensor systemNutrition habit recording system Physical activity recording system

5. Improved FTA was tested for 5 months by 11 people with T2DM who were novice to FTA (Trial II) Norway Sweden Finland Harstad: Oct. 2010 – Feb. 2011 ©Diabetesforbundet ©Universitetssykehuset Nord-Norge HF ©Owl and Mouse Educational Software Participants in Motivation Group

6. Mixed methods were used to analyze participants’ engagement and user experience Questionnaires: 74 major questions based on results of a previous trial (Trial I) Recorded data with FTA: Focus on daily use per week Mann-Kendall test to analyze change in use over time http://insightrix.com/about/focus-group-facility Focus group: User experience and usability issues

7. Patterns of engagement with FTA and user experience could be roughly divided into 3 types Group AGroup B Group C

8. Group A: Frequent use with positive experience Very frequent use of BG sensor system throughout the trial (Mean: 94%) Increasing trends in usage rate of 2 / 3 functions are seen by 3 / 4 participants Most answers to questions were positive

9. Group B: Moderate use with relatively neutral experience 2 / 3 participants were originally enough motivated for self- management and did not find FTA motivating or having effect to change their self-management activities 1 / 3 participant at high risk of T2DM became more conscious

10. Group C: Little use of Nutrition Habit and Physical Activity recording with mixed experience Decreasing trends in usage rate is seen by 2 / 4 participants 3 / 4 participants experienced data transmission errors of BG sensor system Almost no change was made in self-management activities except 2 / 4 participants increased frequency of BG measurements

11. Usability problems of the mobile phone Trial I Usability of FTA was improved from the version used in the previous trial, but not perfectly Trial II

12. In summary, perceived usefulness implies a great impact on the degree of usage Patient-users with diverse background should be involved from an early phase to long-term testing for design iteration Usability problems should be removed as much as possible before an intervention starts