Evaluating Mobile Health Applications for Diabetes Management

This report assesses the effectiveness of mobile health applications in improving health outcomes for individuals with diabetes. It uses the PICO(T) framework to formulate a research question focusing on the impact of mobile health apps compared to usual care over two years. The report evaluates a study on the 'DialBetics' smartphone-based self-management system, highlighting its experimental design and positive outcomes. It connects the research to the National Strategic Framework for Chronic Conditions, emphasizing the role of mobile health in enhancing patient engagement and self-management. The literature review discusses several studies supporting the use of mobile apps and messaging services in diabetes management. It also emphasizes the potential for nursing professionals to integrate these technologies into their practice. The report concludes with recommendations for future research, including exploring the influence of social determinants of health and the impact on nurse-patient relationships. It also suggests conducting systematic reviews and cohort studies to further validate the benefits and cost-effectiveness of mobile health interventions in diabetes care.

Running head: ASSESSMENT 1
Evidence based practice research
Name of the Student
Name of the University
Author Note

1ASSESSMENT 1
Research question- The Research question in this context was created with the use of the
PICO(T) mnemonic that contains 5 elements of a good clinical question (Hastings & Fisher,
2014). The research question was as follows:
Do mobile health applications improve health among the diabetic population, over a time
period of 2 years, when compared to usual care?
Key search terms such as, ‘diabetes’, ‘management’, ‘prevention’, ‘mobile’, ‘health’,
‘smart-phone, ‘mHealth’ were fed into two electronic databases namely, CINAHL and PubMed.
The phrases were combined with Boolean operators ‘AND’ and ‘OR’ that helped in either
narrowing or broadening the search results. Using filters helped in extraction of articles that were
published on or after 2013, in English language (McGowan et al., 2016). 5 relevant articles were
retrieved from the databases.
P Diabetes patients
I Mobile applications
C Usual care
O Enhanced health, reduced blood glucose
T 2 years
Table 1- PICOT format
Evaluation of research- Waki, K., Fujita, H., Uchimura, Y., Omae, K., Aramaki, E.,
Kato, S., ... & Ohe, K. (2014). DialBetics: a novel smartphone-based self-management support
system for type 2 diabetes patients. Journal of diabetes science and technology, 8(2), 209-215.
https://doi.org/10.1177%2F1932296814526495

2ASSESSMENT 1
The article selected for evaluation elaborated on the effectiveness of ‘DialBetics’, a
smart-phone based diabetes self-management system, implemented across patients in Japan. The
research design was an experimental one that was grounded on randomisation of participants in
two different groups, for 3 months. Moreover, conduction of an RCT also helped in concluding
whether one form of treatment was superior to the other. The research paradigm was based on
positivism where the researchers derived conclusions regarding effectiveness of the intervention
through their logic and reason (Antwi & Hamza, 2015). Allocation of the participants after
obtaining their informed consent was followed by exposure of those in the intervention group to
the four models of the ‘DialBetics’ program. Effectiveness of the study findings can be
elaborated by the significant decline and fasting blood sugar (5.5 mg/dl) and HbA1c (0.4%), in
the intervention group, when compared to the non-DialBetics group. The researchers had
followed the ethical norms, since they had obtained in approval from the Institutional Review
Board and also allowed the participants to give their voluntary consent, before they were
subjected to the intervention (Kim & Miller, 2015). Furthermore, allowing the participants to try
the smart-phone based program for 2 weeks before the final study also clarified all ethical
grounds (Waki et al., 2014).
Research topic- Chronic diseases refer to conditions of human health that are long lasting
or persistent and the effects commonly exist in a person for more than 3 months (Kennedy et al.,
2014). Some of the major chronic diseases that have been identified by the Australian Institute of
Health and Welfare include cardiovascular disease, cancer, asthma, chronic respiratory disease,
diabetes, musculoskeletal conditions, eye health, mental disease, and endometriosis, among
others (Australian Government, 2017). The research topic of the assignment is in accordance to
the National Strategic Framework for chronic conditions, since the framework takes into

3ASSESSMENT 1
consideration the ever increasing rates of chronic conditions in the Australian population, due to
alterations in the lifestyle. The research question that focuses on determining the effectiveness of
mobile health applications on improving diabetes among people is essential for the management
of chronic disease since it focuses on the use of mobile devices that have created new ways of
communication between patients and healthcare service providers (Weinstein et al., 2014). The
research topic is focused on improving health outcomes among people suffering from the
identified chronic conditions, with the usage of mobile communication tools has been found to
facilitate greater engagement of patients. This in turn elaborates on better focusing on
improvement of Health and Wellness (Silva, Rodrigues, de la Torre Díez, López-Coronado &
Saleem, 2015).
Use of the smart-phone based diabetes management and prevention applications will help
the patients to stick to a regimen that comprises of diet recommended by physician, exercise,
routine and other lifestyle modifications, besides adherence to medication program (Steinhubl,
Muse & Topol, 2015). Furthermore, the National Strategic Framework has also identified certain
priority areas such as, the Aboriginal and Torres Strait islander, people residing in rural and
remote regions, those belonging to poor socio-economic sections of the society and diverse
linguistic and cultural backgrounds (Australian Government, 2017). This population usually
faces disparities in their health outcome, due to lack of exercise to proper healthcare resources
and facilities. However, determination of effectiveness of mobile based applications will largely
help a major section of this priority population to participate in self-management of their chronic
health condition, thereby improving their wellbeing and overall health related quality of life.
Literature review- Results presented in the article by (Waki et al., 2014) suggested that
monitoring health data of people who are remotely located helps in the engagement of nursing

4ASSESSMENT 1
professional with their patients in a real-time setting and also facilitates providing necessary
guidance for self-managing different chronic diseases. The results found in the study supported
that the mobile health application was able to bring about an improvement in the HbA1c levels
over a period of 3 months. This intervention time period was quite less however enhancement in
the health and wellbeing suggested the efficacy of mobile health Technologies that nursing
professional scan used for managing their patients. Therefore, the results indicated that all
healthcare professionals, specifically the nursing staff can make comfortable use of this
equipment while providing care to their service users and those smart-phone based applications
can be easily incorporated into nursing practice.
Efficacy of mobile phone messaging for prevention of type 2 diabetes was also elucidated
in another primary research. Working men having been diagnosed with impaired tolerance of
glucose were randomly assigned to an intervention and control group, with the former receiving
mobile phone messaging services. Upon assessing the health outcomes of the patients it was
found that only 18% of the participants present in the intervention group had developed diabetes,
in comparison to 27% in the control group (Ramachandran et al., 2013). Thus, mobile messaging
applications that constantly remind people about dietary adherence, healthy lifestyle principles,
physical activity and maintenance of body weight could be adopted in nursing practice to reduce
security of diabetes among patients whom the nurse is considered to be at a high risk.
Another primary research was conducted with the aim of evaluating effectiveness of
easily accessible smart-phone applications in combination with text messaging feedback from
diabetes educators on the improvement of glycemic index in adult patients with Type 1 Diabetes.
The patients were randomised to the intervention and control group for six monts, followed by a
3 month follow-up period. Findings from the study suggested that patients recruited to the

5ASSESSMENT 1
intervention group demonstrated significant improvement send their glycemic control, when
compared to the baseline values. Presence of significantly high baseline HbA1c in the
intervention group, in comparison to the control group was also accompanied by reports of a
healthier diet in the former group (Kirwan, Vandelanotte, Fenning & Duncan, 2013).
Similar findings were also reported in another study where “Diabetes Interactive Diary”
(DID) Telemedicine application was found to reduce the HbA1c levels in the intervention group,
followed by a subsequent 86% lesson risks of great to hypoglycemia (Rossi et al., 2013). The
Diabeo software based smart-phone application also reported parallel results where it brought
about substantial improvement in metabolic control of diabetes in patients, who had used the
software (Charpentier et al., 2011). Hence, such smart-phone applications and messaging
services can be easily used by nursing professionals in order to increase their engagement with
their patients.
Nurses will be able to provide regular feedback on the blood glucose levels, dietary
patterns, and insulin administration to the patients. Such mobile health applications would also
improve communication between the service user and the carer, thereby creating the provision of
asking and clarifying all diabetes related questions (Torous, Nicholas, Larsen, Firth &
Christensen, 2018). Nursing professionals can also provide educational tips and positively
reinforce the patients for self-management of the chronic condition, which in turn would
empower them and help them in living a healthy life. Additional benefits of such intervention in
nursing practice can be associated with their low cost. The applications and messaging services
have negligible costs, which can be easily installed in the mobile phones of all nursing
professionals and patients, who are being provided the necessary care (Singh et al., 2016).
Therefore, in addition to usual diabetes treatment, the application of such smart-phone based

6ASSESSMENT 1
technologies, combined with regular feedback from nursing professionals will effectively help in
bringing about noteworthy decrease in blood glucose levels, among the high priority population.
Effective dissemination of research findings refers to the process of distributing the results of
research to individuals, who can make use of them with the aim of maximizing the research
benefits, without further delay. Hence, the primary findings of this research that mobile based
health applications, when implemented by nursing professionals can help in controlling the blood
glucose levels among their patients should be disseminated among different individuals. The
core principle of this dissemination would focus on stakeholder engagement and utilising
appropriate opportunities. The primary audience that comprises of nursing staff should be
engaged early throughout the project, involving them from the first steps of planning to the
implementation (El Demellawy, Zaman & Hannes, 2017). Obtaining inputs from the nursing
professionals and other secondary audience will also help in formulating a better plan for
increasing their awareness on the use of this intervention. Building efficient partnerships with
already established networks, making use of infographics, and press releases will also help in the
same. Podcasts, blogs, and social media might also prove beneficial in increasing the reach of the
research findings among the nurses, clinicians, charities, and patients, who might gain direct
benefit from the research (Melnyk, Gallagher‐Ford, Long & Fineout‐Overholt, 2014).
Recommendations- Future research should leverage on the progress and advancement of
the ubiquitous nature of the software based applications, in order to make them accessible to all
nursing professionals and patients who form the core of the study. Future studies should also
evaluate the extent to which the social determinants of health might play a role in increasing or
decreasing compliance of the patients to the diabetes self-management applications that are
recommended or prescribed by the nurses. There is a need to conduct supplementary research in

7ASSESSMENT 1
order to gain an understanding on the effect of such applications on the therapeutic nurse-patient
relationship. Conducting a systematic review of evidence related to this area is crucial for
reviewing and identifying the direct benefits that nursing professionals gain with the
implementation of such applications, in relation to their stress, burnout or work pressure, while
managing diabetic patients. There is also a need to conduct a cohort study in order to determine
the prevalence and incidence of the chronic disease (diabetes) in Australia, before and after the
implementation of the novel health-based mobile applications. This will directly prove beneficial
in terms of health and welfare of the entire nation, and the subsequent cost-effectiveness can also
be measured.

8ASSESSMENT 1
References
Antwi, S. K., & Hamza, K. (2015). Qualitative and quantitative research paradigms in business
research: A philosophical reflection. European Journal of Business and
Management, 7(3), 217-225. Retrieved from
https://www.researchgate.net/publication/295087782
Australian Government. (2017). National Strategic Framework for Chronic
Conditions. Retrieved from
http://www.health.gov.au/internet/main/publishing.nsf/content/A0F1B6D61796CF3DCA
257E4D001AD4C4/$File/National%20Strategic%20Framework%20for%20Chronic
%20Conditions.pdf.
Charpentier, G., Benhamou, P. Y., Dardari, D., Clergeot, A., Franc, S., Schaepelynck-Belicar, P.,
... & Bosson, J. L. (2011). The Diabeo software enabling individualized insulin dose
adjustments combined with telemedicine support improves HbA1c in poorly controlled
type 1 diabetic patients: a 6-month, randomized, open-label, parallel-group, multicenter
trial (TeleDiab 1 Study). Diabetes care, 34(3), 533-539. https://doi.org/10.2337/dc10-
1259
El Demellawy, H., Zaman, B., & Hannes, K. (2017). An exploration of the potential of
progressive dissemination formats of research findings. ECQI 2017
PROCEEDINGS, 2017, 208. Retrieved from
https://www.researchgate.net/profile/Giorgos_Kesisoglou/publication/
313871365_THE_GENDERED_EXPERIENCES_OF_AFFECT_AND_FLOW_OF_AC
CLAIMED_GREEK_CONTEMPORARY_PERFORMERSSONGWRITERS_DURING

9ASSESSMENT 1
_STAGE_PERFORMANCE_AND_SONGWRITING/links/
58ac4ca3aca27206d9bf996b/THE-GENDERED-EXPERIENCES-OF-AFFECT-AND-
FLOW-OF-ACCLAIMED-GREEK-CONTEMPORARY-PERFORMERS-
SONGWRITERS-DURING-STAGE-PERFORMANCE-AND-
SONGWRITING.pdf#page=214
Hastings, C., & Fisher, C. A. (2014). Searching for proof: Creating and using an actionable PICO
question. Nursing management, 45(8), 9-12. doi:
10.1097/01.NUMA.0000452006.79838.67
Kennedy, B. K., Berger, S. L., Brunet, A., Campisi, J., Cuervo, A. M., Epel, E. S., ... & Rando,
T. A. (2014). Geroscience: linking aging to chronic disease. Cell, 159(4), 709-713.
https://doi.org/10.1016/j.cell.2014.10.039
Kim, S. Y., & Miller, F. G. (2015). Informed consent for pragmatic trials: the integrated consent
Model, NEJM, 370(8), 769-772. DOI: 10.1056/NEJMhle1312508
Kirwan, M., Vandelanotte, C., Fenning, A., & Duncan, M. J. (2013). Diabetes self-management
smartphone application for adults with type 1 diabetes: randomized controlled
trial. Journal of medical Internet research, 15(11), e235. doi: 10.2196/jmir.2588
McGowan, J., Sampson, M., Salzwedel, D. M., Cogo, E., Foerster, V., & Lefebvre, C. (2016).
PRESS peer review of electronic search strategies: 2015 guideline statement. Journal of
clinical epidemiology, 75, 40-46. https://doi.org/10.1016/j.jclinepi.2016.01.021
Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., & Fineout‐Overholt, E. (2014). The
establishment of evidence‐based practice competencies for practicing registered nurses

10ASSESSMENT 1
and advanced practice nurses in real‐world clinical settings: Proficiencies to improve
healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence
‐
Based Nursing, 11(1), 5-15. https://doi.org/10.1111/wvn.12021
Ramachandran, A., Snehalatha, C., Ram, J., Selvam, S., Simon, M., Nanditha, A., ... & Oliver,
N. (2013). Effectiveness of mobile phone messaging in prevention of type 2 diabetes by
lifestyle modification in men in India: a prospective, parallel-group, randomised
controlled trial. The Lancet Diabetes & Endocrinology, 1(3), 191-198.
https://doi.org/10.1016/S2213-8587(13)70067-6
Rossi, M. C., Nicolucci, A., Lucisano, G., Pellegrini, F., Di Bartolo, P., Miselli, V., ... &
Vespasiani, on behalf of the DID Study Group, G. (2013). Impact of the “Diabetes
Interactive Diary” telemedicine system on metabolic control, risk of hypoglycemia, and
quality of life: a randomized clinical trial in type 1 diabetes. Diabetes technology &
therapeutics, 15(8), 670-679. https://doi.org/10.1089/dia.2013.0021
Silva, B. M., Rodrigues, J. J., de la Torre Díez, I., López-Coronado, M., & Saleem, K. (2015).
Mobile-health: A review of current state in 2015. Journal of biomedical informatics, 56,
265-272. https://doi.org/10.1016/j.jbi.2015.06.003
Singh, K., Drouin, K., Newmark, L. P., Rozenblum, R., Lee, J., Landman, A., ... & Bates, D. W.
(2016). Developing a framework for evaluating the patient engagement, quality, and
safety of mobile health applications. Issue Brief (Commonw Fund), 5(1), 11. Retrieved
from
https://pdfs.semanticscholar.org/ade3/0f2769248c3a649d69ac8a415882ba6e93f5.pdf

11ASSESSMENT 1
Steinhubl, S. R., Muse, E. D., & Topol, E. J. (2015). The emerging field of mobile
health. Science translational medicine, 7(283), 283rv3-283rv3. DOI:
10.1126/scitranslmed.aaa3487
Torous, J., Nicholas, J., Larsen, M. E., Firth, J., & Christensen, H. (2018). Clinical review of user
engagement with mental health smartphone apps: evidence, theory and
improvements. Evidence-based mental health, 21(3), 116-119.
http://dx.doi.org/10.1136/eb-2018-102891
Waki, K., Fujita, H., Uchimura, Y., Omae, K., Aramaki, E., Kato, S., ... & Ohe, K. (2014).
DialBetics: a novel smartphone-based self-management support system for type 2
diabetes patients. Journal of diabetes science and technology, 8(2), 209-215.
https://doi.org/10.1177%2F1932296814526495
Weinstein, R. S., Lopez, A. M., Joseph, B. A., Erps, K. A., Holcomb, M., Barker, G. P., &
Krupinski, E. A. (2014). Telemedicine, telehealth, and mobile health applications that
work: opportunities and barriers. The American journal of medicine, 127(3), 183-187.
https://doi.org/10.1016/j.amjmed.2013.09.032

12ASSESSMENT 1
Appendix- Annotated bibliography
Waki, K., Fujita, H., Uchimura, Y., Omae, K., Aramaki, E., Kato, S., ... & Ohe, K. (2014).
DialBetics: a novel smartphone-based self-management support system for type 2
diabetes patients. Journal of diabetes science and technology, 8(2), 209-215.
https://doi.org/10.1177%2F1932296814526495
The article was based on a randomised controlled trial the aimed to determine the effectiveness
of a novel mobile based application for management of type 2 diabetes. 54 patients were
allocated to an intervention and a control group. The intervention group comprised of 4 modules
that focused on data transmission, evaluation, communication, and dietary evaluation. The
findings suggested that the application was able to reduce HbA1c by 0.4% in the intervention
group, compared to 0.1% in control group. The results indicate that significant decline can be
obtained in blood glucose levels upon use of smart-phone applications.
Ramachandran, A., Snehalatha, C., Ram, J., Selvam, S., Simon, M., Nanditha, A., ... & Oliver,
N. (2013). Effectiveness of mobile phone messaging in prevention of type 2 diabetes by
lifestyle modification in men in India: a prospective, parallel-group, randomised
controlled trial. The Lancet Diabetes & Endocrinology, 1(3), 191-198.
https://doi.org/10.1016/S2213-8587(13)70067-6
The article elaborates on a prospective, parallel group RCT that recruited 537 working Indian
men and randomly allocated them to a standard care group and an mobile based intervention
group. Frequent mobile phone messages regarding health management and lifestyle
modifications were sent to those in the intervention group. While 27% participants in standard
care developed type 2 diabetes, only 18% in intervention group reported diabetes onset. This

13ASSESSMENT 1
indicated that mobile phone messaging services were able to increase adherence to lifestyle
modifications and prevent type 2 diabetes onset among at risk men.
Kirwan, M., Vandelanotte, C., Fenning, A., & Duncan, M. J. (2013). Diabetes self-management
smartphone application for adults with type 1 diabetes: randomized controlled
trial. Journal of medical Internet research, 15(11), e235. doi: 10.2196/jmir.2588
This article illustrated the findings of a randomised controlled trial that focused on determining
the efficiency of a Diabetes Self-Management Smartphone Application, in combination with text
messages. Recruitment of type 1 diabetes patients to the intervention and usual care group was
followed by use of the Glucose Buddy application and text messaging in the former. Study
results showed that improvement in HbA1c from baseline occurred in the intervention group,
compared to usual care. This indicated that usage of diabetes-related smartphone and text
messaging reminders have the potential of bringing about glycemic control.