Aim: The overall aim of this thesis was to examine currently available evidence on selected digital health technology (DHT) for diabetes self-care support, explore people's experiences with their use for diabetes self-care, and identify relationships between DHT use and psychosocial self-efficacy, eHealth literacy, and other selected variables among adults with type 1 diabetes (T1D).

Methods: In this thesis, an integrative review methodology, along with cross-sectional and qualitative designs, was used to explore perspectives on DHT support for diabetes self-care. The population in focus in all four studies was adults (≥ 18years) with T1D. Outcome measures examined features of mobile health applications (mHealth apps) that promote diabetes self-care, factors affecting mHealth app use in diabetes self-care, reported changes in PROMs in literature, psychosocial self-efficacy, eHealth literacy, and experiences with using DHT for diabetes self-care. 

Main results: The integrative review was inconclusive due to the limited number and heterogeneity of studies reporting on perceptions of mHealth apps. Higher psychosocial self-efficacy was associated with higher well-being and lower HbA1c. Higher eHealth literacy was associated with younger age, higher psychosocial self-efficacy, and lower HbA1c. Using DHTs in diabetes self-care was experienced as empowering yet exasperating.

Conclusion: This thesis showed the importance of measuring psychosocial self-efficacy and eHealth literacy among adults with T1D using DHTs. People described feeling empowered by DHTs. However, there is a need for measures to support people facing exasperating experiences while using DHTs. This is important in improving DHT use and glucose control in this population. This thesis indicates a need for further research in this area.

Type 1 diabetes is a chronic illness, and diabetes self-care measures play a crucial role in disease management. Well-designed digital health technologies (DHTs) can support diabetes self-care, however, their use can be challenging. This thesis explores perspectives on DHT support for diabetes self-care among adults with type 1 diabetes. 

In this thesis, higher psychosocial self-efficacy has been associated with higher well-being scores and better glucose control. In addition, younger age, higher psychosocial self-efficacy, and better glucose control have been associated with higher eHealth literacy. Participants experienced DHTs in diabetes self-care as empowering yet exasperating. The exasperating experiences may contribute to digital health inequities and are therefore important to address. This thesis showed the importance of measuring psychosocial self-efficacy and eHealth literacy among adults with type 1 diabetes using DHTs. More studies in this area among adults with type 1 diabetes is required.

Background: The use of digital health technology in diabetes self-care is increasing, making eHealth literacy an importantfactor to consider among people with type 1 diabetes. There are very few studies investigating eHealth literacy among adultswith type 1 diabetes, highlighting the need to explore this area further.Objective: The aim of this study was to explore associations between eHealth literacy and demographic factors, disease-specific factors, and well-being among adults with type 1 diabetes.Methods: The study used data from a larger cross-sectional survey conducted among adults with type 1 diabetes in Sweden(N=301). Participants were recruited using a convenience sampling method primarily through advertisements on social media.Data were collected between September and November 2022 primarily through a web-based survey, although participantscould opt to answer a paper-based survey. Screening questions at the beginning of the survey determined eligibility toparticipate. In this study, eHealth literacy was assessed using the Swedish version of the eHealth Literacy Scale (Sw-eHEALS).The predictor variables, well-being was assessed using the World Health Organization-5 Well-Being Index and psychosocialself-efficacy using the Swedish version of the Diabetes Empowerment Scale. The survey also included research group–developed questions on demographic and disease-specific variables as well as digital health technology use. Data wereanalyzed using multiple linear regression presented as nested models. A sample size of 270 participants was required in orderto detect an association between the dependent and predictor variables using a regression model based on an F test. The finalsample size included in the nested regression model was 285.Results: The mean Sw-eHEALS score was 33.42 (SD 5.32; range 8‐40). The model involving both demographic anddisease-specific variables explained 31.5% of the total variation in eHealth literacy and was deemed the best-fitting model.Younger age (P=.01; B=–0.07, SE=0.03;95% CI –0.12 to –0.02), lower self-reported glycated hemoglobin levels (P=.04; B=–0.06, SE=0.03; 95% CI –0.12 to 0.00), and higher psychosocial self-efficacy (P<.001; B=3.72, SE=0.53; 95% CI 2.68-4.75)were found associated with higher Sw-eHEALS scores when adjusted for demographic and disease-specific variables in thismodel. Well-being was not associated with eHealth literacy in this study.Conclusions: The demographic and disease-specific factors explained the variation in eHealth literacy in this sample. Furtherstudies in this area using newer eHealth literacy tools are important to validate our findings. The study highlights theimportance of development and testing of interventions to improve eHealth literacy in this population for better glucosecontrol. These eHealth literacy interventions should be tailored to meet the needs of people in varying age groups and withdiffering levels of psychosocial self-efficacy.

Introduction The management of type 1 diabetes, a non-preventable chronic disease, leads to a high physical and psychological burden on the individual. Digital health technology can improve a person's psychosocial self-efficacy and thereby contribute to improved diabetes self-care. The aim of this study was to explore associations between psychosocial self-efficacy and demographic-, disease specific-, well-being as well as digital health technology (DHT) related factors among adults with type 1 diabetes.Methods A primarily web-based cross sectional survey was conducted among adults with type 1 diabetes in Sweden (n = 301). Psychosocial self-efficacy was assessed using the Swedish version of the Diabetes Empowerment Scale, Swe-DES-23. The survey also contained questions related to demographic-, disease specific-, well-being as well as digital health technology related variables.Results Higher well-being scores and lower HbA1c levels were associated with higher psychosocial self-efficacy in multiple linear regression analysis. In multivariate analysis, gender, body mass index, well-being scores, and HbA1c levels showed association with psychosocial self-efficacy. None of the DHT factors were found associated with psychosocial self-efficacy.Conclusions In this study, higher well-being score and lower self-reported HbA1c levels were associated with higher psychosocial self-efficacy in both univariate- and multivariate analysis and accounted for 30% of the variation in psychosocial self-efficacy in the regression model. Thus, measures to improve psychosocial self-efficacy in adults with type 1 diabetes may help maintain their psychological well-being and blood glucose control.

Background: Individually designed interventions delivered through mobile health applications (mHealth apps)may be able to effectively support diabetes self-care. Our aim was to review and synthesize available evidence in theliterature regarding perception of adults with type 1 diabetes on the features of mHealth apps that help promote dia-betes self-care, as well as facilitators and barriers to their use. An additional aim was to review literature on changes inpatient reported outcome measures (PROMs) in the same population while using mHealth apps for diabetes self-care.Methods: Quantitative and qualitative studies focusing on adults aged 18 years and over with type 1 diabetes in anycontext were included. A systematic literature search using selected databases was conducted. Data was synthesisedusing narrative synthesis.Results: We found that features of mHealth apps designed to help promote and maintain diabetes self-care could becategorized into self-care data monitoring, app display, feedback & reminders, data entry, data sharing, and additionalfeatures. Factors affecting the use of mHealth apps reported in the literature were personal factors, app design orusability factors, privacy and safety factors, or socioeconomic factors. Quality of life and diabetes distress were themost commonly reported PROMs in the included studies.Conclusion: We are unable to reach a conclusive result due to the heterogeneity of the included studies as well asthe limited number of studies reporting on these areas among adults with type 1 diabetes. We therefore recommendfurther large-scale studies looking into these areas that can ultimately improve mHealth app use in type 1 diabetesself-care.

Background: Due to regional variations in diabetic care quality indicators, diabetes care in Sweden, still needs to undergo reforms. This research project aims to identify areas of improvement and to evaluate innovative health care technology in diabetes self-management using a multi-modal perspective.

Methods: A randomized controlled trial (RCT) to test person-centered diabetes mobile application is being planned. Persons with type1 and type 2 diabetes between 18-80 years of age will be enrolled. The persons will receive feedback on the application based on the monitoring parameters like blood glucose, insulin intake, diet, activity etc. There will be a backend web application at the health center, which can help monitor patient parameters remotely and will alert health care personnel when immediate response is required. The outcome measures would be HbA1C level and complications requiring hospital admission, and HRQoL. A qualitative study focusing on patients use and perception of the mobile application will be undertaken post RCT. The study is still in its early feasibility assessment phase.

Conclusion: Through individually tailored, diabetes self-management digital applications we intend to reduce complications related to uncontrolled blood glucose level.

BACKGROUND: Information on the comparative efficacy of single deep breathing versus tidal breathing for inhaled asthma medications is limited, although such information can be of much use for the treatment of patients suffering from asthma. The objective of the present study was to compare the relative difference in improvement in peak expiratory flow (PEF) with single maximal inhalation with breath-holding versus 5 tidal breaths during inhalation of salbutamol from a pressurized metered dose inhaler (pMDI) with valved holding chamber (VHC) in children 5-15 y of age with asthma.

METHODS: The randomized controlled trial was carried out on children with asthma between 5 and 15 y of age using a pMDI with a VHC either by a single deep breath with breath-hold or 5 tidal breaths. The experimental group received 200 μg of salbutamol from the pMDI with VHC with a single maximal inhalation and breath-hold technique, whereas the control group received 200 μg of salbutamol from pMDI with VHC using the 5 tidal breaths technique. The outcome variable, PEF, was reassessed 30 min after salbutamol use.

RESULTS: Eighty-two subjects (mean age 8.79 ± 2.5 y, 65 boys and 17 girls) were analyzed. There was significant improvement in the PEF, from baseline (pre-intervention) to post-intervention within the single maximal inhalation with breath-hold group and tidal breathing group independently (P < .001). The mean difference in improvement in PEF between the single maximal inhalation with a breath-hold and 5 tidal breaths group was 30.0 ± 18.16 and 28.29 ± 13.94 L/min, respectively, and was not statistically significant (P = .88).

CONCLUSIONS: Single maximal inhalation with a breath-hold technique is not superior to tidal breathing for improvement in PEF following salbutamol inhalation. Either method may be used in children between 5 and 15 y of age. (India's Clinical Trials Registry CTRI/2013/04/003559.).