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Background: As pregnant mothers increasingly engage in shared decision making regarding prenatal decisions, such as induction of labor, the patient's level of activation may influence pregnancy outcomes. One potential tool to increase patient activation in the clinical setting is mobile applications. However, research is limited in comparing mobile apps with other modalities of patient education and engagement tools. Aim: This study was designed to test the effectiveness of a mobile app as a replacement for a spiral notebook guide as a patient education and engagement tool in the prenatal clinical setting. Method: This randomized controlled trial was conducted in the Women's Health Clinic and Family Health Clinic of three hospitals. Repeated-measures analysis of covariance was used to test intervention effects in the study sample of 205 patients. Results: Mothers used a mobile app interface to more frequently record information about their pregnancy; however, across time, mothers using a mobile app reported a significant decrease in patient activation. Discussion: The unexpected negative effects in the group of patients randomized to the mobile app prompt these authors to recommend that health systems pause before distributing their own version of mobile apps that may decrease patient activation. Conclusion: Mobile apps can be inherently empowering and engaging, but how a system encourages their use may ultimately determine their adoption and success.

Background: Remission of diabetes can be rewarding for patients and physicians, but there is limited study of how patients perceive the timeline of a disease along the continuum of glycaemic control. Objective: To explore how patients perceive the timeline of diabetes along the continuum of glycaemic control and their goals of care and to identify whether family physicians communicate the principles of regression and remission of diabetes. Design: Mixed methods approach of qualitative semi‐structured interviews with purposive sampling followed by cross‐sectional survey of physicians. Participants: Thirty‐three patients living with prediabetes (preDM) or type 2 diabetes mellitus (T2DM) at medical centres in Georgia and Nevada; and 387 family physicians providing primary care within the same health system. Results: Patients described two timelines of diabetes: as a lifelong condition or as a condition that can be cured. Patients who perceived a lifelong condition described five treatment goals: reducing glucose‐related laboratory values, losing weight, reducing medication, preventing treatment intensification and avoiding complications. For patients who perceived diabetes as a disease with an end, the goal of care was to achieve normoglycaemia. In response to patient vignettes that described potential cases of remission and regression, 38.2% of physician respondents would still communicate that a patient has preDM and 94.6% would tell the patient that he still had diabetes. Conclusions: Most physicians here exhibited reluctance to communicate remission or regression in patient care. Yet, patients describe two different potential timelines, including a subset who expect their diabetes can be 'cured'. Physicians should incorporate shared decision making to create a shared mental model of diabetes and its potential outcomes with patients. Patient or Public Contribution: In this mixed methods study, as patients participated in the qualitative phase of this study, we asked patients to tell us what additional questions we should ask in subsequent interviews. Data from this qualitative phase informed the design and interpretation of the quantitative phase with physician participants. [ABSTRACT FROM AUTHOR]

Objectives: The present study takes a culture-centered approach to better understand how the experiences of culture affect patient's perception of type 2 diabetes mellitus (T2DM). This study explores personal models of T2DM and compares personal models across regional and race/ethnicity differences., Methods: In a practice-based research network, a cross-sectional survey was distributed to patients diagnosed with T2DM at medical centers in Nevada and Georgia. In analyses of covariance, controlling for age, health literacy, and patient activation, geographic location, and race/ethnicity were tested onto 5 dimensions of illness representation., Results: Among 685 patients, race/ethnicity was significantly associated with lower reported understanding diabetes ( P < .01) and less perceived longevity of diabetes ( P < .001). Geographic location was significantly associated with seriousness of the disease ( P < .005) and impact of diabetes ( P < .001)., Conclusion: Non-Hispanic White Americans report greater understanding and perceive a longer disease course than non-Hispanic Black Americans and Asian Americans. Regionally, patients in Nevada perceive T2DM as more serious and having more impact on their lives than patients living in Georgia. Primary care physicians should elicit patient perceptions of diabetes within the context of the patient's ethnic and geographic culture group to improve discussions about diabetes self-management. Specifically, primary care physicians should address the seriousness of a diabetes diagnosis and the chronic nature of the disease with patients who belong to communities with a higher prevalence of the disease.