Background: People with T1DM are confronted with self-management tasks and strategies to reduce risks of long-term complications against the risk of hypoglycemic events. The potential of advanced and evolving technology to address these issues involves consideration of psychological and behavioral constructs alongside the usability of devices. Access and uptake of advanced technology is further influenced by economic factors and health care provider capacity to support such interventions. Previous reviews have focused upon either clinical outcomes or descriptively scoped the literature or have synthesized studies on adults with children and young people where human factors are different.
Objective: The objective of this review was to describe the relationship between human factors and adherence with technology for data logging processes in adults (> 18 years) with T1DM and to explore the factors which influence this association.
Methods: A systematic literature review.
Results: 18 studies were included in the review following a literature search using the PRISMA guidelines and a quality appraisal process. This included 3320 participants with a mean age of 42 years.
Overall, adults felt more satisfied with their treatment on transition to advanced technology (insulin pump and CGM), the most significant contributing factor was when BG levels were consistently < 7.00mmol/l (P =.009). However, participants spent considerable time on their diabetes self-care. There was evidence that logging of data was positively correlated with increasing age with the use of an app that provided meaningful feedback (regression coefficient = 55.8 recordings/ year; P = 0.009). Furthermore, there were benefits of CGM use for older adults in mediating complexities and their fears of hypoglycemia with reported significant differences in well-being (P= .009).
Qualitative studies within the review aimed to explore the use and uptake of technology within the context of everyday lives. Participants experienced ‘frustrations’ with CGM, CSII, calibration of devices and alarms. In addition, there were implications for ‘body image’ when carrying and using a device. This takes into account wide variations in individual use and interaction with technology across a continuum of sociocultural contexts. This has implications for the way in which future technologies are designed.
Many of the quantitative studies in the review were limited by small sample sizes. This may make it difficult to generalize findings to other contexts. This is further limited by a sample that was predominantly Caucasian, well-controlled and engaged with their self-care. However, the use of critical appraisal frameworks has highlighted areas where research into human factors and data logging processes of individuals could be improved. This includes engaging people in the design of the technology, and further exploration of the way in which significant others impact on the behavior and attitude of the individual towards technology use.
Waite, Marion AMartin, Clare EFranklin, RDuce, DavidHarrison, Rachel
Faculty of Health and Life SciencesFaculty of Technology, Design and Environment\Department of Computing and Communication Technologies
Year of publication: 2018Date of RADAR deposit: 2017-12-08