title: Structured scaffolding for reflection and problem solving in diabetes self-management: qualitative study of mobile diabetes detective.
abstract: OBJECTIVE
  To investigate subjective experiences and patterns of engagement with a novel electronic tool for facilitating reflection and problem solving for individuals with type 2 diabetes, Mobile Diabetes Detective (MoDD).
  
  
  METHODS
  In this qualitative study, researchers conducted semi-structured interviews with individuals from economically disadvantaged communities and ethnic minorities who are participating in a randomized controlled trial of MoDD. The transcripts of the interviews were analyzed using inductive thematic analysis; usage logs were analyzed to determine how actively the study participants used MoDD.
  
  
  RESULTS
  Fifteen participants in the MoDD randomized controlled trial were recruited for the qualitative interviews. Usage log analysis showed that, on average, during the 4 weeks of the study, the study participants logged into MoDD twice per week, reported 120 blood glucose readings, and set two behavioral goals. The qualitative interviews suggested that individuals used MoDD to follow the steps of the problem-solving process, from identifying problematic blood glucose patterns, to exploring behavioral triggers contributing to these patterns, to selecting alternative behaviors, to implementing these behaviors while monitoring for improvements in glycemic control.
  
  
  CONCLUSIONS
  This qualitative study suggested that informatics interventions for reflection and problem solving can provide structured scaffolding for facilitating these processes by guiding users through the different steps of the problem-solving process and by providing them with context-sensitive evidence and practice-based knowledge related to diabetes self-management on each of those steps.
  
  
  CONCLUSIONS
  This qualitative study suggested that MoDD was perceived as a useful tool in engaging individuals in self-monitoring, reflection, and problem solving.
authors.affiliation: Department of Biomedical Informatics, Columbia University, New York, NY, USA lena.mamykina@dbmi.columbia.edu.
authors.forename: Lena
authors.initials: L
authors.lastname: Mamykina
authors.affiliation: School of Nursing, Columbia University, New York, NY, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Heitkemper
authors.affiliation: School of Nursing, Columbia University, New York, NY, USA.
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Smaldone
authors.affiliation: Department of Biomedical Informatics, Columbia University, New York, NY, USA.
authors.forename: Rita
authors.initials: R
authors.lastname: Kukafka
authors.affiliation: Department of Biomedical Informatics, Columbia University, New York, NY, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Cole-Lewis
authors.affiliation: West Chester University, West Chester, PA, USA.
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Davidson
authors.affiliation: Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Mynatt
authors.affiliation: The Rockefeller University Center for Clinical and Translational Science, New York, NY USA Department of Epidemiology and Public Health, Albert Einstein College of Medicine of Yeshiva University/Montefiore Medical Center, New York, NY USA.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Tobin
authors.affiliation: Clinical Directors Network, Inc., New York, NY, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cassells
authors.affiliation: Clinical Directors Network, Inc., New York, NY, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Goodman
authors.affiliation: Department of Biomedical Informatics, Columbia University, New York, NY, USA.
authors.forename: George
authors.initials: G
authors.lastname: Hripcsak
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003151:Community Health Centers; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006040:Goals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D063731:Mobile Applications; D011340:Problem Solving; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D017216:Telemedicine
chemical_list: D001786:Blood Glucose
keywords: chronic disease; diabetes; intervention; qualitative study; self-care