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Cited by 175Mobile Health and mHealth ApplicationsTelemedicine and Telehealth ImplementationTechnology Use by Older Adults

The DOI matches its Crossref record; 73 of the 74 references it cites were found in a registry or an index.

Factors Influencing the Use of a Web-Based Application for Supporting the Self-Care of Patients with Type 2 Diabetes: A Longitudinal Study

Open access
Nijland, Nicol, van Gemert-Pijnen, Julia EWC, Kelders, Saskia M, Brandenburg, Bart J, Seydel, Erwin R·2011·Journal of Medical Internet Research
DOI 10.2196/jmir.1603PMC PMC3222177
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Abstract

BACKGROUND: The take-up of eHealth applications in general is still rather low and user attrition is often high. Only limited information is available about the use of eHealth technologies among specific patient groups. OBJECTIVE: The aim of this study was to explore the factors that influence the initial and long-term use of a Web-based application (DiabetesCoach) for supporting the self-care of patients with type 2 diabetes. METHODS: A mixed-methods research design was used for a process analysis of the actual usage of the Web application over a 2-year period and to identify user profiles. Research instruments included log files, interviews, usability tests, and a survey. RESULTS: The DiabetesCoach was predominantly used for interactive features like online monitoring, personal data, and patient-nurse email contact. It was the continuous, personal feedback that particularly appealed to the patients; they felt more closely monitored by their nurse and encouraged to play a more active role in self-managing their disease. Despite the positive outcomes, usage of the Web application was hindered by low enrollment and nonusage attrition. The main barrier to enrollment had to do with a lack of access to the Internet (146/226, 65%). Although 68% (34/50) of the enrollees were continuous users, of whom 32% (16/50) could be defined as hardcore users (highly active), the remaining 32% (16/50) did not continue using the Web application for the full duration of the study period. Barriers to long-term use were primarily due to poor user-friendliness of the Web application (the absence of "push" factors or reminders) and selection of the "wrong" users; the well-regulated patients were not the ones who could benefit the most from system use because of a ceiling effect. Patients with a greater need for care seemed to be more engaged in long-term use; highly active users were significantly more often medication users than low/inactive users (P = .005) and had a longer diabetes duration (P = .03). CONCLUSION: Innovations in health care will diffuse more rapidly when technology is employed that is simple to use and has applicable components for interactivity. This would foresee the patients' need for continuous and personalized feedback, in particular for patients with a greater need for care. From this study several factors appear to influence increased use of eHealth technologies: (1) avoiding selective enrollment, (2) making use of participatory design methods, and (3) developing push factors for persistence. Further research should focus on the causal relationship between using the system's features and actual usage, as such a view would provide important evidence on how specific technology features can engage and captivate users.

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Figure 1 Chronology of the data collection process.
Figure 1 Chronology of the data collection process.CC BY · PubMed Central
Figure 2 Long-term use of the web application by patients per practice.
Figure 2 Long-term use of the web application by patients per practice.CC BY · PubMed Central
Figure 3 Long-term use of the core features of the web application by patients.
Figure 3 Long-term use of the core features of the web application by patients.CC BY · PubMed Central
Figure 4 User activity of DiabetesCoach enrollees.
Figure 4 User activity of DiabetesCoach enrollees.CC BY · PubMed Central

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Research works printed but not linked: 2

  1. 2002, Am J Prev Med, 22, 10
  2. Wangberg, SC, 2008, Patient Prefer Adherence, 2, 57

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Metadata

Authors
Nijland, N., van Gemert-Pijnen, J. E., Kelders, S. M., Brandenburg, B. J., & Seydel, E. R.
Affiliations
University of Twente (NL)
Corresponding author
Nijland, Nicol
ORCID
Kelders, Saskia M
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2011-09-30
Volume
13
Issue
3
Pages
e71
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.1603
PMC
PMC3222177
OpenAlex
W2101939845
Cited by
175
References
74
Citations by year
2026: 1 · 2025: 3 · 2024: 5 · 2023: 12 · 2022: 8 · 2021: 5 · 2020: 10 · 2019: 15 · 2018: 12 · 2017: 21 · 2016: 12 · 2015: 17 · 2014: 18 · 2013: 22 · 2012: 12
FWCI
32.05
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Journal of Medical Internet Research (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • University of Twente Research Information (submittedVersion, cc-by)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Geriatrics and Gerontology › Technology Use by Older Adults
Keywords
type 2 diabetes, web application, digital health adoption, self-care, user attrition, user profiles, continuous feedback, nurse-patient communication, internet access barriers, ease of use, participatory design, diabetes duration, medication use, technology acceptance, patient engagement, personalized feedback, ceiling effect, health behavior change, diabetes self-management education
MeSH terms
Adult, Aged, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Patient Education as Topic, Patient Participation, Self Care, Social Support, User-Computer Interface, Disease Management, Internet, Access to Information, Electronic Mail, Consumer Health Information

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