# Evaluation of the Implementation of a Mobile Health App to Support Dutch Primary Care for Diabetes: Qualitative Study

## TL;DR

This study evaluated how a mobile health app called MiGuide was implemented in Dutch primary care for diabetes, identifying barriers and success factors through qualitative and quantitative methods.

## Contribution

The study provides insights into the implementation process of MiGuide in primary care, highlighting context-specific strategies for eHealth interventions.

## Key findings

- Four key themes—innovation, capability, motivation, and opportunity—were identified as influencing the implementation process.
- Usability of MiGuide scored below average at 6 months, indicating room for improvement in user experience.
- Technical difficulties, motivation, and work processes were among the factors affecting implementation success.

## Abstract

Over 1 million Dutch people have diabetes, of whom 90% have type 2 diabetes. Studies show that lifestyle plays an important role in the course of type 2 diabetes. MiGuide (MiGuide Ltd) is an online platform that helps people adopt and sustain lifestyle changes. The platform is integrated into existing diabetes care within primary care. Previous research has shown that implementing new (eHealth) interventions is challenging and may reduce effectiveness. Mapping out the barriers and success factors in the implementation process is essential so that eHealth interventions such as MiGuide can be used effectively in regular health care.

This study aimed to evaluate the implementation of MiGuide within Dutch primary care.

A qualitative study design was used, supplemented by quantitative data from patients. Five general practices participated. Three focus groups (FGs; at baseline, after 6 months, and after 12 months) were conducted with 3 general practitioners, 3 FGs with 8 specialized practice nurses (divided into 2 separate groups with 4 participants per group), 2 FGs (at 6 months and after 12 months) with 5 patients, and 2 FGs (at baseline and after 12 months) with 4 stakeholders from the management of the care group. The implementation process was discussed with health care professionals and management, and usage and user-friendliness were discussed with patients. The framework method was used to analyze the data. The following quantitative data were collected: patient characteristics, user data, and questionnaires at baseline and 6 months, assessing quality of life, usability, and diabetes self-care. The quantitative data were examined using exploratory analyses.

Four themes were found in the qualitative data: “innovation,” “capability, motivation, and opportunity,” “processes,” and “setting.” Different factors within these themes played an essential role throughout the implementation process, such as facilities, technical difficulties, motivation, COVID-19, and the work processes. Areas for improvement were also identified. The supplemented quantitative data showed that usability scored below average at 6 months (mean 53.8; SD 9.3; n=8). Participants had a mean score of 0.84 (SD 0.13) on the EuroQoL-5 dimension and 81.9 (SD 13.4) on the EuroQoL visual analogue scale at baseline. Moreover, the average number of days someone exercised was 4.2 (SD 1.7), and the number of days someone ate a generally healthy diet was 5.1 (SD 1.3). Insufficient data on quality of life and diabetes self-care were collected at 6 months and therefore not presented in this study.

Implementation is a complex process with multiple barriers and facilitators. It is essential to explore the use of context-specific strategies that are aligned with the implementation process phase. Further research is needed to evaluate the next version of the MiGuide platform, which is being implemented in another setting with lifestyle coaches.