Measures of Patient-Reported Expectations, Acceptance, and Satisfaction Using Automated Insulin Delivery Systems: A Review
Abstract
:1. Introduction
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- For continuous subcutaneous insulin infusion (CSII): painful catheter insertion, set obstructions, altered body shape and problems with social acceptance, dissatisfaction with the size and appearance of the pump, and physical discomfort and limitations during physical activity or while bathing;
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- For continuous glucose monitoring (CGM): skin irritation, inaccurate readings, excessive exposure to device alarms (in particular, false or unnecessary ones) that cause daily activity interruptions and poor or interrupted sleep, limitations in remote monitoring access for parents, and frustrations with technical glitches;
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- For the algorithm: system-mandated exits, which are a system-initiated reversion to open-loop insulin, have been reported as leading to user frustration and device discontinuation [2].
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- Intention to use it, which is the subjective probability that one will use the AP;
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- The perceived usefulness of AID, which is the degree to which the patient thinks that the AP would facilitate glucose control. Its determinants are the quality of care (the degree of glucose control), the consequences of the AP (healthcare cost and required time investment, quality of life), the importance of the AP towards glucose control, the influence of relatives (subjective norm), and the perceived image in a peer group if using the AP;
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- The perceived ease of use is the degree to which the patient believes that using the AP would be free of effort. The determinants are the self-efficacy to operate the AP, the need for training (external control), the use of the features of the currently used insulin pump (proxy for intrinsic motivation), and the anxiety at the time of starting the new treatment.
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- Trust in the AP manufacturer and features of the AP system are additional factors.
2. Search Strategy
3. Summary of the Literature Analysis
3.1. Measures Exploring Expectations and Acceptance
3.1.1. “Artificial Pancreas Acceptance” Measure
3.1.2. “INSPIRE” Measure
3.1.3. “DSAT” Measure
3.1.4. “Experience with Bionic Pancreas” Measure
3.1.5. Measures Not Validated
3.1.6. Semi-Structured Interviews for Expectations and Acceptance
Reference | Population and Study Design | Questionnaire Used | Outcome Measured | Results |
---|---|---|---|---|
Van Bon et al., 2011 [10] | 132 adults on CSII (mean age 43 y) Cross-sectional | Artificial Pancreas Acceptance, validated in this study | Future Expectancies/Acceptance | High scores on IU, PU, PE, and T |
Ziegler et al., 2015 [21] | 40 adolescents (10–18 y) on CSII RCT crossover: CSII + rtCGM (4 d) vs. CSII + overnight closed loop (4 d) | Artificial Pancreas Acceptance AP satisfaction questionnaire, validated in this study | Before and after Experience | After: higher IU, PU, PE, and T Higher satisfaction |
Troncone et al., 2016 [13] | 30 children (5–9 y) on CSII 34 parents; 7-day camp RCT crossover: CSII + rtCGM (3 d) vs. CSII + overnight closed loop (3 d) | Artificial Pancreas Acceptance, for parents Semi-structured interview based on TAM DTSQ (parent) | Before and after Experience | Parents, after: high IU, PU, and PE |
Von dem Berge et al., 2022 [25] | 38 children (2–14 y) on CSII with or without CGM RCT: 670 G with Guardian 3 sensor (8 w) vs. SAP and PLGM (8 w) | Artificial Pancreas Acceptance DISABKIDS questionnaire (diabetes satisfaction and burden) | After Experience | High scores for acceptance and satisfaction |
Renard et al., 2019 [24] | 24 prepubertal children (7–12 y) on CSII and their parents RCT closed loop (48 h) vs. SAP with LGS (48 h) | Artificial Pancreas Acceptance, only child | Before and after Experience | After: significantly improved AP acceptance |
Bevier et al., 2014 [14] | 36 adults, 89% on CSII (46.6 ± 12.5 y), who had already participated in an AP trialCross-sectional | AP participants’ technology acceptance, validation study | Future Expectancies/Acceptance | High scores on IU, PU, and PE |
Oukes et al., 2019 [15] | 602 T1D adults (39.1 ± 16.0; 45.8 ± 13.5 y) MDI, CSII, and CSII + CGM Cross-sectional | AP acceptance questionnaire (40 items), validation study | Future Expectancies/Acceptance | High IU, related to AID characteristics and not to readiness or social influence |
Weissberg-Benchell et al., 2016 [16] | 19 children (6–11 y) on CSII RCT crossover: CSII + rtCGM (5 d) vs. CSII + overnight closed loop (5 d) | Experience with the Bionic Pancreas questionnaire | Before and after Experience | Positive and negative key areas were reported |
Bisio et al., 2020 [32] | 13 children (7–10 y, mean 9.1 ± 0.9 y) on CSII and caregivers Prospective: Tandem CIQ (4 w) vs. SAP (4 w) | Experience with the Bionic Pancreas questionnaire, parents | Before and after Experience | After, parents reported greater perceived benefits and fewer perceived burdens |
Pinsker et al., 2021 [31] | 1435 adults on Tandem CIQ (45.5 ± 16.6 y) Prospective evaluations at +3 and +7 w after starting CIQ | Two open ended questions Technology acceptance survey (adapted from “Experience with BP”) | After Experience | High user satisfaction, trust, and ease of use |
Weissberg-Benchell et al., 2019 [26] | 291 youths (8–17 y) 150 parents of youths ages 3–17 y 159 adults From the T1D Exchange Registry, 70% on CSII Cross-sectional | Insulin delivery Systems: Perceptions, Ideas, Reflections and Expectations (INSPIRE), validation study | Future Expectancies/Acceptance | The questionnaire measured positive expectancies |
Kudva et al., 2021 [27] | 48 adolescents (14–18 y), 80% on CSII, 70% on CGM, and caregivers RCT 2:1: closed loop n = 28 (6 m) vs. SAP n = 30 (6 m) | Technology EXPECTATIONS surveyTechnology ACCEPTANCE survey adaptated from “Experience with the Bionic Pancreas questionnaire” INSPIRE | Before and after Experience | Positive expectations for the device before and after the trial After: higher scores on the INSPIRE meant positive user experience of participants |
Cobry et al., 2021 [28] | 101 children (6–13 y, 11.2 ± 2.1 y) on CSII (80%) and CGM (92%) and parents RCT 3:1: Tandem CIQ n = 78 (28 w) vs. SAP n = 23 (28 w) | INSPIRE child/parents | Before and after Experience | No change comparing the two groups |
Naranjo et al., 2016 [18] | 1503 adults (35.3 ± 14.77 y) 38% on CSII + BGM 32% on CSII + CGM 25% on MDI + BGM 5% on MDI + CGM Cross-sectional | DSAT questionnaire, validation study | Expectations | Patients using any type of more advanced diabetes technology, such as pump therapy, CGM, or SAP, demonstrated more positive attitudes about diabetes technology |
Hood et al., 2021 [29] | 113 adolescents and young adults (19 ± 4 y) on CSII or MDI RCT: AHCL (55) vs. HCL (57) (28 w) | Technology attitude (DSAT) At baseline and during followup | Before and after Experience | Technology attitude about diabetes technology was not different After: satisfaction improved with AHCL |
Hood et al., 2022 [30] | 98 children and adolescents (6–18 y, 12.7 ± 2.8 y) on CSII and parents RCT: AHCL n = 48 (6 m) vs. CSII n = 50 with or without CGM (6 m) | Technology attitude (DSAT) Focus group | Before and after Experience | No psychosocial benefit |
Musolino et al., 2019 [17] | 20 children (1–7 y) on CSII and caregiver Day and night HCL (Cambridge FlorenceM) Prospective for 3 w | Closed-loop Experience Questionnaire, to caregivers | After Experience | HCL users were satisfied Positive: reduced hypoglycemia, more stable glycemic control, felt reassured, improved sleep quality, and alarms Negative: size, battery performance, connectivity issues, and alarms |
Petruzelkova et al., 2021 [33] | 8 preschool (3–7 y) and 18 school-aged children (8–14 y) in SAP and their caregivers (6 m) Switch to AndroidAPS HCL Retrospective analysis | Closed-loop Experience Questionnaire | After Experience | High scores in ease of use, trust, and positive key areas |
Taushmann et al., 2016 [34] | 12 adolescents (15 ± 3) in CSII with suboptimal control and parents RCT crossover: Closed-loop Dana + Free Style Navigator II (3 w) vs. SAP without LGS (3 w) | Questionnaire not validated | After Experience | Positive: PU, T, and improved sleep Negative: number and size of the devices, alarms, and connectivity issues |
Forlenza et al., 2019 [7] | 24 children (6–12 y) on CSII RCT: Tandem CIQ (3 d) vs. SAP (3 d) | Technology acceptance questionnaire (TAQ), not validated | After Experience | After: Positive responses for acceptance |
Barnard et al., 2014 [19] | 15 adolescents (12–18 y) on CSII and 13 parents RCT crossover: CSII + rtCGM (21 d) vs. CSII + overnight closed-loop (21 d) | Semi-structured interviews DTQ | Before and after Experience | High IU Reported benefits and concern/barriers Increased satisfaction |
Barnard et al., 2017 [20] | 26 children and adolescents (6–18 y) on CSII RCT crossover: CSII + rtCGM (12 w) vs. CSII + overnight closed-loop (12 w) | Semi-structured qualitative interviews DTQ | Before and after Experience | Reported benefits and concern/barriers Increased satisfaction |
Iturralde et al., 2017 [36] | 17 adults, 15 adolescents on 670 G pump in a diabetes camp (4–5 d) Prospective | Focus groups | After Experience | Perceived benefits: improved glycemic control, anticipated reduction in long-term complications, better quality of life, and reduced mental burden of diabetes Hassles and limitations: unexpected tasks for the user, difficulties wearing the system, concerns about controlling highs, and reminders of diabetes |
Tanenbaum et al., 2020 [37] | 17 adults, 15 adolescents on 670 G pump in a diabetes camp (4–5 d) Prospective | Focus groups | After Experience | Trust in HCL was context-dependent; overall, users trusted the system more to manage diabetes overnight than to handle meals and exercise |
Naranjo et al., 2017 [8] | 35 adolescents 16 children 65 parents (113 adults) With and without AID knowledge 75% on CSII Cross-sectional | Semi-structured interviews | Expectations | Three themes were identified as critical for uptake of automated insulin delivery: considerations of trust and control, system features, and concerns and barriers to adoption |
Garza et al., 2018 [35] | 113 adults, 35 adolescents/young adults, 16 children Most on CSII (72%) Cross-sectional | Semi-structured interviews Focus group | Expectations | There is an expectation that AID will alleviate diabetes-specific worry and burden There is also hope that this system may reduce day-to-day stress AID will improve family relationships |
3.2. Measures to Assess Satisfaction with AP
3.2.1. “DTQ” and “DTSQ” Measures
3.2.2. “Satisfaction with Use of an Artificial Pancreas” Measure
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Share and Cite
Marigliano, M.; Mozzillo, E.; Mancioppi, V.; Di Candia, F.; Rosanio, F.M.; Antonelli, A.; Nichelatti, I.; Maffeis, C.; Tumini, S.; Franceschi, R. Measures of Patient-Reported Expectations, Acceptance, and Satisfaction Using Automated Insulin Delivery Systems: A Review. J. Pers. Med. 2023, 13, 1031. https://doi.org/10.3390/jpm13071031
Marigliano M, Mozzillo E, Mancioppi V, Di Candia F, Rosanio FM, Antonelli A, Nichelatti I, Maffeis C, Tumini S, Franceschi R. Measures of Patient-Reported Expectations, Acceptance, and Satisfaction Using Automated Insulin Delivery Systems: A Review. Journal of Personalized Medicine. 2023; 13(7):1031. https://doi.org/10.3390/jpm13071031
Chicago/Turabian StyleMarigliano, Marco, Enza Mozzillo, Valentina Mancioppi, Francesca Di Candia, Francesco Maria Rosanio, Annalisa Antonelli, Ilaria Nichelatti, Claudio Maffeis, Stefano Tumini, and Roberto Franceschi. 2023. "Measures of Patient-Reported Expectations, Acceptance, and Satisfaction Using Automated Insulin Delivery Systems: A Review" Journal of Personalized Medicine 13, no. 7: 1031. https://doi.org/10.3390/jpm13071031