This thesis describes the evaluation of a mobile telehealth intervention for people with diabetes. In line with the gaps in the literature identified in a systematic review of mobile telehealth interventions in diabetes, the aims of this thesis were to test the effectiveness of a mobile telehealth intervention, to examine the mechanisms of action of the intervention, to identify predictors of benefit and of telehealth usage, to explore patients’ perspectives on telehealth and to assess intervention fidelity. A randomized controlled trial comparing standard care to standard care supplemented with mobile telehealth was conducted and included 81 participants with insulin-requiring and poorly controlled diabetes. Participants completed assessments at baseline, 3 months and 9 months. Outcomes included glycaemic control (HbA1c), self-management behaviours, quality of life and health care utilization. Efficacy beliefs and personal models of diabetes were assessed as process variables. In addition, mobile telehealth participants completed assessments of acceptability of telehealth, perceived adequacy of training and self-efficacy to use telehealth. Semi-structured interviews conducted with intervention group participants having completed the study explored patients’ perceptions and experiences using mobile telehealth. Results indicated the intervention had no effect on study outcomes. Efficacy beliefs in the intervention group were found to improve significantly compared to the control group and there was some evidence in mediation analyses to suggest these changes mediated improvements in study outcomes. Some evidence also suggested that improvements in efficacy beliefs were predicted by clinical variables. In terms of patients’ usage of telehealth, weekly frequency of self-monitoring of blood glucose and dietary behaviours at baseline were the strongest predictors, but results also suggested that acceptability, self-efficacy to use telehealth, perceived adequacy of training, and the number of contacts with telehealth providers were related to telehealth usage. The qualitative interviews highlighted features of the mobile telehealth equipment that were particularly popular. They also provided valuable information on the perceived effects of mobile telehealth and on key areas of improvement for the successful implementation of telehealth in routine practice. Data collected on the delivery of the intervention suggested it was unlikely to have been delivered faithfully.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:626704 |
| Date | January 2014 |
| Creators | Baron, J. S. |
| Publisher | University College London (University of London) |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://discovery.ucl.ac.uk/1420536/ |
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