On designing educational portals for self-management of type 2 diabetes : lessons learnt from an Iranian context

Introduction: The prevalence of type 2 diabetes (T2D) has been rising steadily and more rapidly in middle- and low-income countries. It is estimated that, by 2040, about 640 million people will have diabetes. Web-based technology and mobile phones have provided different services for patients with diabetes (e.g., patient portals and mobile health apps) to improve their self-management. There is a growing number of web-based services; however, it appears that they have often been designed without involving the end users — patients with diabetes. To engage end users and achieve sustained adoption of a new technology, health technologies have to be designed following targeted user groups’ needs, using usability principles and evidence-based guidelines.

Aim: The overall aim of this research is to contribute to understanding how a portal can be designed to support and improve the self-management of diabetes patients.

Methods: A mixed-method approach was used for the different phases of the research. Quantitative and qualitative techniques, such as surveys and interviews, were used for data collection and analysis. A design-based research (DBR) framework with an iterative process of data collection and design was adopted. Two models of self-care were used to design mockups illustrating the layout and look of the portal components. Then a portal prototype was developed and evaluated by participants, i.e., patients with T2D and healthcare providers. A think-aloud method was adopted to investigate the portal’s usability with patients, and design principles were formulated to direct the evaluation.

Results: The analysis of data showed that patients lacked enough knowledge about diabetes and wanted to know more, for example, about diet, stress, blood sugar control, and drug complications. They would have liked to receive educational material through new technology once the source of information was reliable and culturally contextualised. Traditional means of patient education were also appreciated. The patients recognised several facilitators and barriers to using the internet for patient education. First, a series of mock-ups and an educational portal was developed to support the self-management of diabetes. The participants were not able to discern between the two care models, while the need for adapting information and portal functionalities addressing health-related behaviours would have benefitted by development within a cultural context. Design principles were drawn from the literature and tested. Numerous issues related to the proposed design principles were observed, and some of the issues confirmed the intentions of the principles, while others worked against them, leading to further refinement of the principles. The participants spent much time entering personal and laboratory data and suggested many improvements.

Conclusions: For a patient portal to be adopted and used by a patient group, it needs to be designed to address health-related behaviours specific to a certain group of patients and their cultural context, engaging healthcare providers and peers. Usability tests are necessary to assess the potential of a portal as functional for patients and its long-term use for self-management.

List of scientific papers

I. Readiness of Diabetics to Use the Internet and Mobile Services: The Case of a Large City in a Middle-Income Country (2015). Jafari J, Karimi Moonaghi H., Ahmady S., Zary, N. & Masiello, I. Journal of Community Medicine & Health Education. 5:380.
https://doi.org/10.4172/2161-0711.1000380

II. Exploring educational needs and design aspects of internet-enabled patient education for persons with diabetes: a qualitative interview study. Jafari J, Karimi Moonaghi H, Zary N, & Masiello I (2016). BMJ Open. 6(10), e013282.
https://doi.org/10.1136/bmjopen-2016-013282

III. Designing internet-enabled patient education for self-management of T2D diabetes—The case of the Razavi-Khorasan province in Iran (2021). Jafari J, Karlgren K, Karimi Moonaghi H, Layegh P, Bonacina S, Masiello I. Plos one. 16(4), e0250781.
https://doi.org/10.1371/journal.pone.0250781

IV. Usability aspects supporting and hindering self-management of type 2 diabetes. Jafari J, Karlgren K, Karimi Moonaghi H, Mazaheri Habibi MR, Eslami S, Bonacina S, Masiello I. [Manuscript]