C H Yu1, R Bahniwal, A Laupacis. Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers. J Am Med Inform Assoc doi:10.1136/amiajnl-2011-000307
The objective of this research is to identify and evaluate the effectiveness, clinical usefulness, sustainability, and usability of web-compatible diabetes-related tools. Studies were included if they described an electronic audiovisual tool used as a means to educate patients, care givers, or clinicians about diabetes management and assessed a psychological, behavioral, or clinical outcome. Study abstraction and evaluation for clinical usefulness, sustainability, and usability were performed by two independent reviewers.
Of 12616 citations and 1541 full-text articles reviewed, 57 studies met inclusion criteria. Forty studies used experimental designs, and 17 used observational designs. Methodological quality and ratings for clinical usefulness and sustainability were variable, and there was a high prevalence of usability errors. Tools showed moderate but inconsistent effects on a variety of psychological and clinical outcomes including HbA1c and weight. Meta-regression of adequately reported studies demonstrated that, although the interventions studied resulted in positive outcomes, this was not moderated by clinical usefulness nor usability.
The researchers determined that:
- 60% of the tools had at least three usability errors;
- 25% of the tools provided easily accessible and clinically useful answers most of the time; and
- 6% had no usability errors.
The researchers also noted high rates of inconsistent use of the tools, which could limit the tools’ value.
The researchers concluded that few tools were identified that met the criteria for effectiveness, usefulness, sustainability, and usability. Priority areas include identifying strategies to minimize website attrition and enabling patients and clinicians to make informed decisions about website choice by encouraging reporting of website quality indicators.