title: An Innovative Approach to Informing Research: Gathering Perspectives on Diabetes Care Challenges From an Online Patient Community.
abstract: BACKGROUND
  Funding agencies and researchers increasingly recognize the importance of patient stakeholder engagement in research. Despite calls for greater patient engagement, few studies have engaged a broad-based online community of patient stakeholders in the early stages of the research development process.
  
  
  OBJECTIVE
  The objective of our study was to inform a research priority-setting agenda by using a Web-based survey to gather perceptions of important and difficult aspects of diabetes care from patient members of a social networking site-based community.
  
  
  METHODS
  Invitations to participate in a Web-based survey were sent by email to members of the PatientsLikeMe online diabetes community. The survey asked both quantitative and qualitative questions addressing individuals' level of difficulty with diabetes care, provider communication, medication management, diet and exercise, and relationships with others. Qualitative responses were analyzed using content analysis.
  
  
  RESULTS
  Of 6219 PatientsLikeMe members with diabetes who were sent survey invitations, 1044 (16.79%) opened the invitation and 320 (5.15% of 6219; 30.65% of 1044) completed the survey within 23 days. Of the 320 respondents, 33 (10.3%) reported having Type 1 diabetes; 107 (33.4%), Type 2 diabetes and taking insulin; and 180 (56.3%), Type 2 diabetes and taking oral agents or controlling their diabetes with lifestyle modifications. Compared to 2005-2010 National Health and Nutrition Examination Survey data for individuals with diabetes, our respondents were younger (mean age 55.8 years, SD 9.9 vs 59.4 years, SE 0.5); less likely to be male (111/320, 34.6% vs 48.4%); and less likely to be a racial or ethnic minority (40/312, 12.8% vs 37.5%). Of 29 potential challenges in diabetes care, 19 were categorized as difficult by 20% or more of respondents. Both quantitative and qualitative results indicated that top patient challenges were lifestyle concerns (diet, physical activity, weight, and stress) and interpersonal concerns (trying not to be a burden to others, getting support from family/friends). In our quantitative analysis, similar concerns were expressed across patient subgroups.
  
  
  CONCLUSIONS
  Lifestyle and interpersonal factors were particularly challenging for our online sample of adults with Type 1 or Type 2 diabetes. Our study demonstrates the innovative use of social networking sites and online communities to gather rapid, meaningful, and relevant patient perspectives that can be used to inform the development of research agendas.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States. emily.x.schroeder@kp.org.
authors.forename: Emily B
authors.identifier: http://orcid.org/0000-0002-6323-4790
authors.initials: EB
authors.lastname: Schroeder
authors.forename: Jay
authors.identifier: http://orcid.org/0000-0002-3010-8501
authors.initials: J
authors.lastname: Desai
authors.forename: Julie A
authors.identifier: http://orcid.org/0000-0001-8995-5345
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Andrea R
authors.identifier: http://orcid.org/0000-0002-9574-2642
authors.initials: AR
authors.lastname: Paolino
authors.forename: Jennifer L
authors.identifier: http://orcid.org/0000-0002-8525-8873
authors.initials: JL
authors.lastname: Schneider
authors.forename: Glenn K
authors.identifier: http://orcid.org/0000-0002-0487-0682
authors.initials: GK
authors.lastname: Goodrich
authors.forename: Jean M
authors.identifier: http://orcid.org/0000-0002-2480-8480
authors.initials: JM
authors.lastname: Lawrence
authors.forename: Katherine M
authors.identifier: http://orcid.org/0000-0003-0904-0722
authors.initials: KM
authors.lastname: Newton
authors.forename: Gregory A
authors.identifier: http://orcid.org/0000-0002-7563-6236
authors.initials: GA
authors.lastname: Nichols
authors.forename: Patrick J
authors.identifier: http://orcid.org/0000-0002-2324-6228
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: Marcy
authors.identifier: http://orcid.org/0000-0001-5705-3902
authors.initials: M
authors.lastname: Fitz-Randolph
authors.forename: John F
authors.identifier: http://orcid.org/0000-0002-6514-6057
authors.initials: JF
authors.lastname: Steiner
keywords: diabetes mellitus; patient centered outcome research; quality of health care; social networking