Design, feasibility, and acceptability of an intervention using personal digital assistant-based self-monitoring in managing type 2 diabetes.

BACKGROUND The information processing demands associated with behavioral self management of diabetes are extensive Pairing personal digital assistant PDA based self monitoring with a behavioral self management intervention may improve adherence and patient outcomes METHODS ENHANCE is a randomized controlled trial to test an intervention designed to improve regimen adherence in adults with type 2 diabetes The intervention based on Social Cognitive Theory SCT is paired with PDA based self monitoring In this paper we describe the a manner in which PDA based self monitoring is integrated within the SCT based intervention b feasibility and acceptability of PDA based dietary self monitoring and c issues encountered in teaching participants to self monitor using a PDA RESULTS During the first 30 months of this 5 year study 232 participants were screened and 151 were randomized To date 6 cohorts have completed the study The retention rate is 85 n 129 Of those randomized to the intervention n 74 and completing the study n 61 88 reported understanding the usefulness of PDA monitoring 85 reported ease in entering foods into the device 70 reported ease in interpreting feedback graphs and 82 indicated that they would continue to use the PDA for self monitoring after the study concluded Assuming 3 meals per day participants entered an average of 58 of their meals in their PDA and 43 were entered assuming 4 meals per day If we eliminate from the analysis those individuals who entered less than 10 of their expected meals n 12 the average rate of self monitoring was 69 assuming 3 meals per day and 52 assuming 4 meals per day CONCLUSIONS PDA based dietary monitoring is perceived by participants to be useful and acceptable The approach used to instruct participants in use of the PDA and lessons learned are discussed PDA technology shows promise as a tool for assisting those with type 2 diabetes in their efforts to manage their disease