Abstract
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.
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Acknowledgments
Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K12HL137943 and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Numbers K23DK106511 and R18DK123373. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The authors thank Drs. Sunil Kripalani and Kenneth Wallston for their valuable feedback on the manuscript and Camille Ivey with the Vanderbilt Eskind Biomedical Library for assisting with the literature search.
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Nelson, L.A., Williamson, S.E., Nigg, A. et al. Implementation of Technology-Delivered Diabetes Self-care Interventions in Clinical Care: a Narrative Review. Curr Diab Rep 20, 71 (2020). https://doi.org/10.1007/s11892-020-01356-2
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DOI: https://doi.org/10.1007/s11892-020-01356-2