Background
The relevance of social support for diabetes self-management
Social support and technology-supported diabetes self-management
Research gap: the influence of (non-) professional social support on technology use
Methods
Study 1: semi-structured face-to-face interviews
Study 2: standardized online survey
Study samples
Study 1 – Interviews | Study 2 – Survey | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Variable | n | % of N | M | SD | Min | Max | n | % of N | M | SD | Min | Max |
Age (in years) | – | – | 48.35 | 17.46 | 19.00 | 68.00 | – | – | 49.74 | 14.67 | 20.00 | 70.00 |
Education | ||||||||||||
MA graduate or higher | – | – | 15 | 23.1 | ||||||||
BA graduate/college graduate | 6 | 28.6 | 22 | 33.8 | ||||||||
Some college | 7 | 33.3 | 12 | 18.5 | ||||||||
High school graduate | 1 | 4.8 | 12 | 18.5 | ||||||||
Some high school | 4 | 19.0 | 3 | 4.6 | ||||||||
Other education level | 1 | 4.8 | 1 | 1.5 | ||||||||
Employment | ||||||||||||
Full- time working | 8 | 38.1 | 34 | 52.3 | ||||||||
Part-time working | 3 | 14.3 | 12 | 18.5 | ||||||||
Homemaker | 3 | 14.3 | 1 | 1.5 | ||||||||
Retired | 3 | 14.3 | 7 | 10.8 | ||||||||
Student | 3 | 14.3 | 5 | 7.7 | ||||||||
Unemployed | – | – | 6 | 9.3 | ||||||||
Family status | ||||||||||||
Married | 9 | 42.9 | 32 | 49.2 | ||||||||
Never married | 8 | 38.1 | 18 | 27.7 | ||||||||
Never married but relationship | – | – | 4 | 6.2 | ||||||||
Separated/divorced | 1 | 4.8 | 7 | 10.8 | ||||||||
Widowed | 1 | 4.8 | 4 | 6.2 | ||||||||
Gender | ||||||||||||
Men | 11 | 52.4 | 32 | 49.2 | ||||||||
Women | 10 | 47.6 | 33 | 50.8 | ||||||||
Nationality | ||||||||||||
Singaporean | 19 | 90.5 | 57 | 87.7 | ||||||||
Malaysian | 1 | 4.8 | 4 | 6.2 | ||||||||
Other | 1 | 4.8 | 4 | 6.2 | ||||||||
Diabetes Background | ||||||||||||
Diabetes family history | 12 | 57.1 | 50 | 76.9 | ||||||||
Diabetes type | ||||||||||||
T2DM (incl. gestational) | 11 | 52.4 | 50 | 76.9 | ||||||||
T1DM | 9 | 42.9 | 13 | 20.0 | ||||||||
Pre-diabetes | 1 | 4.8 | 2 | 3.1 | ||||||||
Diseases (other) | 8 | 38.1 | – | – | ||||||||
Education on diabetes (received) | 17 | 81.0 | 50 | 76.9 | ||||||||
Length of diabetes (in years) | – | – | 19.89 | 12.07 | 4.00 | 38.00 | – | – | 13.73 | 9.81 | .00 | 36.00 |
Medication | ||||||||||||
Insulin injection (syringe or pump) | 14 | 66.7 | 25 | 38.5 | ||||||||
Oral diabetes medication | 10 | 47.6 | 51 | 78.5 | ||||||||
(Self-) Management | ||||||||||||
Check-up frequency (in months) | – | – | 3.83 | 1.36 | 2.00 | 6.00 | – | – | – | – | – | – |
Diabetes app use | 11 | 52.4 | – | – | ||||||||
Never used | – | – | 34 | 52.3 | ||||||||
Previous use | – | – | 17 | 26.2 | ||||||||
Current use | – | – | 14 | 21.5 | ||||||||
Online health information seeking (Study 2: days per week) | 19 | 90.5 | – | – | – | – | – | – | 2.70 | 2.27 | .00 | 7.00 |
Part of support group | 15 | 71.4 | – | – | ||||||||
Offline | – | – | 42 | 64.6 | ||||||||
Online | – | – | 19 | 29.2 | ||||||||
Part of diabetes program | 2 | 9.5 | 7 | 10.8 |
Results
Interview results on social support and diabetes app use (Study 1)
Non-User of Diabetes Apps | Diabetes App User | ||||
---|---|---|---|---|---|
App user type | The diabetes app non-user without interest in diabetes apps | The interested non-user of diabetes apps | The dissatisfied adopter of diabetes apps | The experienced diabetes app switcher | The consistent long-term diabetes app user |
Self-management | No risk group, experienced with good perceived diabetes knowledge, mainly good self-management | Diabetes risk group, lacking diabetes knowledge or misperceptions, avoidance strategies, insufficient self-management, dangerous health behaviors | No risk group, good diabetes knowledge (educated at young age), good self-management | No risk group, very good diabetes knowledge, very good self-management, experienced, strict regimen | No risk group, specialized diabetes knowledge, intense diabetes education, good self-management, strict carb counting, active |
Medical specialty of healthcare professionals (HCPs) | Mainly general practitioners | Mainly general practitioners | Diabetes specialists | General practitioners or diabetes specialists | Diabetes specialists, partly other HCPs as part of a diabetes program |
Perceived physician quality | Partly incontent, or content after choosing selected physicians | Incontent, physicians not supportive (with exceptions) | Content but also seeing downsides | Content or incontent, depending on medical specialty of physician | Content, physicians as “friends” |
Decision-making | Independent patient decision-making | Dependent or independent patient decision-making with dangerous health behaviors | Independent patient decision-making but listening to HCP advice, shared decision-making | Independent patient decision-making | Shared decision-making with close relationships between HCP and patient |
Physician communi-cation | Partly short consultations, no engagement, patients need to ask questions to receive information | Short consultations, physicians not helpful, answer questions only (no further engagement) | Consultations also through Email/online/ calls, close relationships with intense communication, partly busy doctors | Short consultations (general practitioners), longer consultations but more expensive (specialists), partly contact through Email | Discussions similar to friends’ relationships, honesty in consultations, partly long consultations |
Support group participation | Support group leader or follower | No support group participation or support group follower only | Support group follower or leader, volunteering for other patients, part of diabetes program | Support group leader or follower | Support group leader, part of a diabetes or app pilot program |
Family/friend support | Managing without support or negative influences by family/friends (but perceived relevance of support) | Managing without support, rarely support by family | Involvement/ support by family only right after diagnose (beginning of the disease) | Support especially by friends, family support | Partly family support, sometimes negative family/friend influences |
Interviewees (IP no., age group, diabetes type) | IP2, 56–60, T2DM IP7, 66–70, T2DM IP8, 61–65, T1DM IP9, 66–70, pre-diab (IP17, 61–65, T2DM) | IP4, 46–50, T2DM IP10, 56–60, T2DM (IP12, 61–65, T2DM) IP15, 46–50, T2DM IP20, unknown, T2DM | IP1, 16–20, T1DM IP11, 21–25, T1DM IP16, 21–25, T1DM IP18, 16–20, T1DM | IP3, 66–70, T2DM IP13, 56–60, T1DM IP21, 56–60, T1DM | IP5, 26–30, T2DM IP6, 56–60, T2DM IP14, 41–45, T1DM IP19, 31–35, T1DM |
Diabetes app (non-) use in the sample – description of the dependent variable
Professional support – physician-patient relationship
Non-professional support – family & friends’ support
(H1a) Supportive behaviors by the supervising physician (shared decision-making styles and supportive communication) positively predict diabetes app use for self-management.
(H1b) The medical specialty of the supervising physician (specialist versus GP) is a predictor of diabetes app use for self-management, with specialist care promoting app use to a greater extent than care by GPs.
(H2a) (Positive) support by the patient’s personal social network (family and friends) positively predicts diabetes app use for self-management.