Structured scaffolding for reflection and problem solving in diabetes self-management: qualitative study of mobile diabetes detective

J Am Med Inform Assoc. 2016 Jan;23(1):129-36. doi: 10.1093/jamia/ocv169. Epub 2016 Jan 14.


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.

Discussion: 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.

Conclusion: This qualitative study suggested that MoDD was perceived as a useful tool in engaging individuals in self-monitoring, reflection, and problem solving.

Keywords: chronic disease; diabetes; intervention; qualitative study; self-care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Community Health Centers
  • Diabetes Mellitus, Type 2 / ethnology
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Goals
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Minority Groups
  • Mobile Applications*
  • Problem Solving
  • Qualitative Research
  • Randomized Controlled Trials as Topic
  • Self Care*
  • Telemedicine


  • Blood Glucose