Sahin Cigdem, Naylor Patti-Jean
Social Dimensions of Health Program, University of Victoria, Victoria, BC, Canada.
School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada.
JMIR Diabetes. 2017 Feb 6;2(1):e3. doi: 10.2196/diabetes.6667.
Considering the increasing incidence and prevalence of diabetes worldwide and the high level of patient involvement it requires, diabetes self-management is a serious issue. The use of mobile health (mHealth) in diabetes self-management has increased, but so far research has not provided sufficient information about the uses and effectiveness of mHealth-based interventions. Alternative study designs and more rigorous methodologies are needed. Mixed-methods designs may be particularly useful because both diabetes self-management and mHealth studies require integrating theoretical and methodological approaches.
This scoping review aimed to examine the extent of the use of mixed-methods research in mHealth-based diabetes management studies. The methodological approaches used to conduct mixed-methods studies were analyzed, and implications for future research are provided.
Guided by Arksey and O'Malley's framework, this scoping review implemented a comprehensive search strategy including reviewing electronic databases, key journal searches, Web-based research and knowledge centers, websites, and handsearching reference lists of the studies. The studies focusing on mHealth technologies and diabetes management were included in the review if they were primary research papers published in academic journals and reported using a combination of qualitative and quantitative methods. The key data extracted from the reviewed studies include purpose of mixing, design type, stage of integration, methods of legitimation, and data collection techniques.
The final sample (N=14) included studies focused on the feasibility and usability of mHealth diabetes apps (n=7), behavioral measures related to the mHealth apps (n=6), and challenges of intervention delivery in the mHealth context (n=1). Reviewed studies used advanced forms of mixed-methods designs where integration occurred at multiple points and data were collected using multiple techniques. However, the majority of studies did not identify a specific mixed-methods design or use accepted terminology; nor did they justify using this approach.
This review provided important insights into the use of mixed methods in studies focused on diabetes management via mHealth technologies. The prominent role of qualitative methods and tailored measures in diabetes self-management studies was confirmed, and the importance of using multiple techniques and approaches in this field was emphasized. This review suggests defining specific mixed-methods questions, using specific legitimation methods, and developing research designs that overcome sampling and other methodological problems in future studies.
鉴于全球糖尿病发病率和患病率不断上升，且糖尿病自我管理需要患者高度参与，糖尿病自我管理是一个严峻的问题。移动健康（mHealth）在糖尿病自我管理中的应用有所增加，但迄今为止，研究尚未提供足够的关于基于mHealth的干预措施的使用情况和有效性的信息。需要采用替代研究设计和更严格的方法。混合方法设计可能特别有用，因为糖尿病自我管理研究和mHealth研究都需要整合理论和方法。
本范围综述旨在研究在基于mHealth的糖尿病管理研究中使用混合方法研究的程度。分析了用于进行混合方法研究的方法，并为未来研究提供了启示。
在阿克西和奥马利框架的指导下，本范围综述实施了全面的搜索策略，包括检索电子数据库、重点期刊搜索、基于网络的研究和知识中心、网站，并人工搜索研究的参考文献列表。如果研究是发表在学术期刊上的原创研究论文，并报告使用了定性和定量方法的组合，则纳入本综述中关注mHealth技术和糖尿病管理的研究。从纳入综述的研究中提取的关键数据包括混合的目的、设计类型、整合阶段、合法化方法和数据收集技术。
最终样本（N = 14）包括关注mHealth糖尿病应用程序的可行性和可用性的研究（n = 7）、与mHealth应用程序相关的行为测量的研究（n = 6）以及mHealth背景下干预实施挑战的研究（n = 1）。纳入综述的研究使用了混合方法设计的高级形式，即在多个点进行整合，并使用多种技术收集数据。然而，大多数研究没有确定具体的混合方法设计或使用公认的术语；也没有说明使用这种方法的理由。
本综述为在基于mHealth技术的糖尿病管理研究中使用混合方法提供了重要见解。定性方法和量身定制的测量在糖尿病自我管理研究中的突出作用得到了证实，并强调了在该领域使用多种技术和方法的重要性。本综述建议在未来研究中定义具体的混合方法问题，使用特定的合法化方法，并开发克服抽样和其他方法问题的研究设计。
