Objectives. Smart device apps for diabetes have the potential to support patients in their daily disease management. However, uncertainty exists regarding their suitability for empowering patients to improve self-management behaviors....
moreObjectives. Smart device apps for diabetes have the potential to support patients in their daily disease management. However, uncertainty exists regarding their suitability for empowering patients to improve self-management behaviors. This paper addresses a general research gap regarding theoretically based examinations of empowerment in diabetes research, by examining how diabetes app features correspond with conceptual indicators of empowerment. Methods. We examined features of 121 apps for diabetes self-management available in Singapore, with the second highest proportion of diabetes among developed nations, for psychological empowerment (feeling of empowerment) and for behavioral empowerment (social support). Results. Diabetes apps studied offered a narrow range of features, with limited feature-sets corresponding to indicators of empowerment. Customization as a strategy to improve perceived relevance of diabetes self-management as an indicator of psychological empowerment was especially limited. Moreover, there was a lack of features supporting patients' communication with healthcare professionals and within their private social networks. Conclusions. Mobile apps for diabetes self-management failed to provide relevant features for empowering patients. Specific practical recommendations target improved adoption, sustained usage, and effectiveness of diabetes self-management apps. Diabetes care programs increasingly include advanced mobile-based technological devices. These technologies entered the market aiming to supplement traditional diabetes healthcare and to support self-management by patients (1). Consequently, smart applications on mobile devices for diabetes self-management proliferated, increasing exponentially in app stores (2). Diabetes apps are designed to support self-management activities like blood glucose (BG) and complication monitoring, medication adherence, healthy eating, exercise, and problem-solving (1). With the increased availability of apps targeted at consumers, research began examining their potential for diabetes self-management. Current trends in mHealth, "the use of mobile communications for health information and services" (3, p. 1), focus on effects research (4), contrasting overly optimistic study results on diabetes app use effects (5) with a more critical view toward mHealth effectiveness (6;7). A meta-analysis showed that such interventions "that have statistically significant effects are small and of borderline clinical importance" (4, p. 25). The potential of mHealth for diabetes self-management, including diabetes apps, requires further investigation, especially in theoretical terms. We focus on the concept of empowerment as a fundamental predictor of self-management behaviors (8), particularly in relation to diabetes (9;10), to evaluate the potential of diabetes apps for empowered self-management. Specifically, this study examines how technological features of apps for diabetes self-management correspond with theoretical indicators of (RQ1) psychological and (RQ2) behavioral empowerment. The study first defines two sub-concepts of empowerment for diabetes self-management, then addresses extant gaps regarding empowerment in mHealth research, particularly in relation to diabetes apps. To address research gaps, we examined features of 121 diabetes apps corresponding to indicators of empowerment.