RESUMO
Objective: Delay discounting denotes the tendency for humans to favor short-term immediate benefits over long-term future benefits. Episodic future thinking (EFT) is an intervention that addresses this tendency by having a person mentally "pre-experience" a future event to increase the perceived value of future benefits. This study explores the feasibility of using mobile health (mHealth) technology to deliver EFT micro-interventions. Micro-interventions are small, focused interventions aiming to achieve goals while matching users' often limited willingness or capacity to engage with interventions. We aim to explore whether EFT delivered as digital micro-interventions can reduce delay discounting, the users' perceptions, and if there are differences between regular EFT and goal-oriented EFT (gEFT), a variant where goals are embedded into future events. Method: A randomized study was conducted with 208 participants allocated to either gEFT, EFT, or a control group for a 21-day study. Results: Results indicate intervention groups when combined achieved a significant reduction of Δlogk=-.80 in delay discounting (p=.017) compared to the control. When split into gEFT and EFT separately only the reduction of Δlogk=.96 in EFT delay discounting was significant (p=.045). We further explore and discuss thematic user perceptions. Conclusions: Overall, user perceptions indicate gEFT may be slightly better for use in micro-interventions. However, perceptions also indicate that audio-based EFT micro-interventions were not always preferable to users, with findings suggesting that future EFT micro-interventions should be delivered using different forms of multimedia based on user preference and context and supported by other micro-interventions to maintain interest.
RESUMO
BACKGROUND: Self-management of the progressive disease type 2 diabetes mellitus (T2DM) becomes part of the daily life of patients starting from the time of diagnosis. However, despite the availability of technical innovations, the uptake of digital solutions remains low. One reason that has been reported is that digital solutions often focus purely on clinical factors that may not align with the patient's perspective. OBJECTIVE: The aim of this study was to develop digital solutions that address the needs of patients with T2DM, designed from the user's perspective. The goal was to address the patients' expressed real-world needs by having the users themselves choose the scope and format of the solutions. METHODS: Using participatory methods, we conducted 3 cocreation workshops in collaboration with the Danish Diabetes Association, with 20 persons with T2DM and 11 stakeholders across workshops: user experience designers, researchers, and diabetes experts including a diabetes nurse. The overall structure of the 3 workshops was aligned with the 4 phases of the double diamond: initially discovering and mapping out key experienced issues, followed by a workshop on thematic mapping and definition of key concepts, and succeeded by an exploration and development of 2 prototypes. Subsequently, high-fidelity interactive prototypes were refined as part of the delivery phase, in which 7 formative usability tests were conducted. RESULTS: The workshops mapped experiential topics over time from prediagnosis to the current state, resulting in a detailed exploration and understanding of 6 themes related to and based on the experiences of patients with T2DM: diabetes care, diabetes knowledge, glucose monitoring, diet, physical activity, and social aspects of diabetes. Two prototypes were developed by the participants to address some of their expressed needs over time related to the 6 themes: an activity-based continuous glucose monitoring app and a web-based guide to diabetes. Both prototypes emphasize periods of structured self-measurements of blood glucose to support evolving needs for self-exploration through distinct phases of learning, active use, and supporting use. Periods of low or intermittent use may thus not reflect a failure of design in a traditional sense but rather be a sign of evolving needs over time. CONCLUSIONS: Our results indicate that the needs of patients with T2DM differ between individuals and change over time. As a result, the suggested digitally supported empowering health prototypes can be personalized to support self-exploration, individual preference in long-term management, and changing needs over time. Despite individuals experiencing different journeys with diabetes, users perceive the self-measurement of blood glucose as a universally useful tool to empower everyday decision-making.
