Purpose of Review

Evidence is growing for the positive effects of technology-delivered diabetes self-care interventions on behavioral and clinical outcomes. However, our understanding of how to effectively implement these interventions into routine clinical practice is limited. This article provides an overview of the methods and results of studies examining the implementation of technology-delivered diabetes self-care interventions into clinical care. We focus specifically on patient-facing behavioral interventions delivered with technology (e.g., text messaging, apps, websites).

Recent Findings

Eleven articles were included in the review. Most studies (n = 9) examined barriers and facilitators to implementation, while about half (n = 5) integrated the intervention into clinical care and evaluated implementation and/or effectiveness. Only six studies applied a theory or framework. The most common determinants of implementation were time constraints for clinic staff, familiarity with technology, knowledge of the intervention, and perceived value. We found substantial variation in implementation outcomes, including which were reported, how they were assessed, and the results. In the four studies that evaluated effectiveness, hemoglobin A1c improved.

Summary

Successful implementation of technology-delivered interventions has the potential to transform healthcare delivery and improve diabetes health on a population level. Promising strategies to address common determinants of implementation include appointing a clinic champion, developing staff training and educational materials, and adapting intervention processes to the clinic context. Future research should evaluate these implementation strategies to understand when and how they impact outcomes. Frameworks such as Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) can help ensure outcomes are systematically reported and allow for comparison across studies.

中文翻译：

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技术交付的糖尿病自我护理干预在临床护理中的实施：叙事回顾

审查目的

技术提供的糖尿病自我护理干预对行为和临床结果产生积极影响的证据越来越多。但是，我们对如何有效地将这些干预措施应用于常规临床实践的了解有限。本文概述了研究技术提供的糖尿病自我护理干预措施在临床护理中的实施情况的研究方法和结果。我们特别关注技术（例如，短信，应用程序，网站）提供的面向患者的行为干预。

最近的发现

该评价包括11篇文章。大多数研究（n  = 9）检查了实施的障碍和促进因素，而大约一半（n  = 5）将干预措施整合到临床护理中并评估了实施和/或效果。只有六项研究应用了理论或框架。实施的最常见决定因素是诊所工作人员的时间限制，对技术的熟悉程度，干预知识和感知价值。我们发现实施成果有很大差异，包括报告的内容，评估方式和结果。在评估有效性的四项研究中，血红蛋白A1c有所改善。

概要

成功实施技术提供的干预措施有可能改变医疗保健的提供方式，并改善整个人群的糖尿病健康状况。解决实施的常见决定因素的有前途的策略包括任命诊所负责人，开发人员培训和教育材料以及根据诊所情况调整干预流程。未来的研究应该评估这些实施策略，以了解它们何时以及如何影响结果。达到有效性采用实施维持（RE-AIM）之类的框架可以帮助确保系统地报告结果，并允许跨研究进行比较。