Waite Marion, Martin Clare, Franklin Rachel, Duce David, Harrison Rachel
Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom.
Faculty of Technology, Design & Engineering, Oxford Brookes University, Oxford, United Kingdom.
JMIR Hum Factors. 2018 Mar 15;5(1):e11. doi: 10.2196/humanfactors.9049.
People with type 1 diabetes (T1D) undertake self-management to prevent short and long-term complications. Advanced technology potentially supports such activities but requires consideration of psychological and behavioral constructs and usability issues. Economic factors and health care provider capacity influence access and uptake of advanced technology. Previous reviews have focused upon clinical outcomes or were descriptive or have synthesized studies on adults with those on children and young people where human factors are different.
This review described and examined the relationship between human factors and adherence with technology for data logging processes in adults with T1D.
A systematic literature search was undertaken by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality appraisal was undertaken and data were abstracted and categorized into the themes that underpinned the human factor constructs that were examined.
A total of 18 studies were included. A total of 6 constructs emerged from the data analysis: the relationship between adherence to data logging and measurable outcomes; satisfaction with the transition to advanced technology for self-management; use of advanced technology and time spent on diabetes-related activities; strategies to mediate the complexities of diabetes and the use of advanced technology; cognition in the wild; and meanings, views, and perspectives from the users of technology.
Increased treatment satisfaction was found on transition from traditional to advanced technology use-insulin pump and continuous glucose monitoring (CGM); the most significant factor was when blood glucose levels were consistently <7.00 mmol/L (P ≤.01). Participants spent considerable time on their diabetes self-care. Logging of data was positively correlated with increasing age when using an app that provided meaningful feedback (regression coefficient=55.8 recordings/year; P ≤.01). There were benefits of CGM for older people in mediating complexities and fears of hypoglycemia with significant differences in well-being (P ≤.001). Qualitative studies explored the contextual use and uptake of technology. The results suggested frustrations with CGM, continuous subcutaneous insulin infusion, calibration of devices, and alarms. Furthermore implications for "body image" and the way in which "significant others" impacted on the behavior and attitude of the individual toward technology use. There were wide variations in the normal use of and interaction with technology across a continuum of sociocultural contexts, which has implications for the way in which future technologies should be designed. Quantitative studies were limited by small sample sizes, making it difficult to generalize findings to other contexts. This was further limited by a sample that was predominantly white, well-controlled, and engaged with self-care. The use of critical appraisal frameworks demonstrated where research into human factors and data logging processes of individuals could be improved. This included engaging people in the design of the technology, especially hard-to-reach or marginalized groups.
1型糖尿病（T1D）患者需进行自我管理以预防短期和长期并发症。先进技术可能有助于此类活动，但需要考虑心理和行为因素以及可用性问题。经济因素和医疗服务提供者的能力会影响先进技术的获取和采用。以往的综述主要关注临床结果，或具有描述性，或综合了针对成年人与儿童及青少年的研究，而成年人与儿童及青少年的人为因素有所不同。
本综述描述并研究了T1D成年患者在数据记录过程中人为因素与技术依从性之间的关系。
采用系统评价与Meta分析的首选报告项目（PRISMA）指南进行系统文献检索。进行质量评估，并提取数据并归类为支撑所研究人为因素构建的主题。
共纳入18项研究。数据分析得出6个构建因素：数据记录依从性与可测量结果之间的关系；对向先进自我管理技术过渡的满意度；先进技术的使用与糖尿病相关活动所花费时间；调节糖尿病复杂性与先进技术使用的策略；实际情境中的认知；以及技术使用者的意义、观点和视角。
从使用传统技术过渡到使用先进技术（胰岛素泵和持续葡萄糖监测[CGM]）时，治疗满意度有所提高；最显著的因素是血糖水平持续<7.00 mmol/L（P≤0.01）。参与者在糖尿病自我护理上花费了大量时间。当使用提供有意义反馈的应用程序时，数据记录与年龄增长呈正相关（回归系数=55.8条记录/年；P≤0.01）。CGM对老年人在调节低血糖的复杂性和恐惧方面有益，幸福感有显著差异（P≤0.001）。定性研究探讨了技术的实际使用和采用情况。结果表明对CGM、持续皮下胰岛素输注、设备校准和警报存在不满。此外，还涉及“身体形象”以及“重要他人”对个体使用技术的行为和态度的影响。在不同社会文化背景下，技术的正常使用和交互存在很大差异，这对未来技术的设计方式具有启示意义。定量研究受样本量小的限制，难以将研究结果推广到其他情境。这一局限性因样本主要为白人、病情控制良好且积极进行自我护理而进一步加剧。批判性评价框架的使用表明了在个体人为因素和数据记录过程研究方面可改进之处。这包括让人们参与技术设计，尤其是难以接触到或边缘化的群体。
