mHealth pilot in Norway finds no significant differences between individuals using self-management app and those receiving only the usual care. Interesting usage findings may inform further innovations in mHealth.

Diabetes Prevalence Growing Along with Waistlines in Europe

Like many other developed countries, Norway has seen rapid growth in the number of citizens with diabetes, prediabetes, or obesity. With a national diabetes prevalence of 5.9%, Norway comes in slightly below the European regional prevalence of 8.5%. However, it is important to note that even this lower prevalence has a significant impact on healthcare expenditure, quality of life, and life expectancy among Norwegians.

Approximately three Norwegians die from diabetes every day.

To address the growing threat of diabetes and other non-communicable diseases in Europe, the European Union has developed a collaborative project called RENEWING HEALTH (REgioNs of Europe WorkING together for HEALTH). Focused on piloting large-scale, academic studies of patient-centered telemedicine and mHealth interventions, RENEWING HEALTH seeks scalable, long-term technologically supported solutions to health issues in Europe.

As part of the RENEWING HEALTH collaboration, Norwegian researchers from Oslo and Akershus University College of Applied Sciences, the University of Oslo, and University Hospital of North Norway conducted a study to determine whether an mHealth app could improve a diabetic patient’s rate of successful, long-term behavior change. The group recently published two articles on their pilot in the Journal of Medical Internet Research.

Researchers Pilot mHealth Intervention for Self-Management of Type 2 Diabetes

The pilot involved the use of the Few Touch Application (FTA), an mHealth tool for self-management, with or without telephone counseling. All study participants had Type 2 diabetes and received the usual care by their general practitioner. Researchers were interested in monitoring the glycated hemoglobin levels, self-management, and health-related quality of life among all intervention groups.

 Researchers randomly divided the 151 participants into three groups:

  1. Those receiving the FTA (referred to as the FTA group).
  2. Those receiving FTA in addition to telephone-based health counseling administered by a nurse (FTA-HC).
  3. Those in the control group.

 FTA is a diabetes diary that combines blood-glucose measurement with automatic wireless data transfer, a diet manual, a record of physical activity, and personal goal management. Based on behavior change theory, the app increases awareness both of diabetes and lifestyle choices, in addition to offering motivational feedback.

FTA users entered information about their food intake, physical activity, and goals manually. Blood glucose was measured daily with LifeScan One Touch Ultra Easy, a glucometer that uses Bluetooth technology to transfer information automatically to the FTA app.

No Significant Differences Found, but Interesting Usage Patterns

Glycated hemoglobin levels were reduced in participants in the control group and those in the FTA and FTA-HC groups. However, no significant differences were noted between the control group and the intervention groups.

After one year, 39% of the FTA and FTA-HC participants were still using the app. Given the number of self-monitoring apps most of us download, use briefly, and abandon, this 39% seems significant.

One survey by research firm Ruder Finn found that, in the US, only 16% of smartphone and tablet users access health apps regularly. Survey respondents with chronic conditions were more than half as likely to use mHealth technology compared to health consumers.

Additionally, during the trial, new iterations of mobile phones were introduced to the market, which may account for the lower rate of use by some participants.

When looking at the study findings by participant age, those participants aged 63 and over were more likely to use the app. Although this may seem contradictory to previously held assumptions about lower adoption rates in this age group, this result is in line with increasing technology use by aging Baby Boomers.

Combining Telephone Health Counseling with mHealth Apps May Lead to Success

After adjusting for variances in age, gender, and education level, the FTA-HC group showed improved self-management techniques compared to both the FTA-only group and the control group. This is a promising finding: a combination of regular care, inexpensive yet effective telehealth counseling services, and mHealth apps should increase a patient’s self-management skills and ability to use technical aids.

At a time when more and more resources are being spent caring for individuals with noncommunicable diseases, many of them caused in part by lifestyle choices, the RENEWING HEALTH project seems promising.

Jenn Lonzer has a B.A. in English from Cleveland State University and an M.A. in Health Communication from Johns Hopkins University. Passionate about access to care and social justice issues, Jenn writes on global digital health developments, research, and trends. Follow Jenn on Twitter @jnnprater3.