Annette Ovink*, University Hospital Maastricht, The Netherlands, Maastricht, Netherlands Lisette Van Gemert-pijnen*, IBR-Center for eHealth Research and Disease management, University of Twente, Enschede, Netherlands Nicol Nijland*, department Psychology Health Communication & Risk, University of Twente, Enschede, Netherlands Evelien Heinrich, department of Health Education and Promotion, Maastricht University, Maastricht, Netherlands Hans Ossebaard*, IBR-Center for eHealth Research and Disease management, University of Twente; National Institute for Public Health and the Environment (RIVM), Enschede, Netherlands Nicolaas Schaper, department of Internal Medicine, division of Endocrinology, University Hospital Maastricht, Maastricht, Netherlands Track: Practice Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues Presentation Type: Oral presentation Submission Type: Single Presentation Building: MECC Room: 0.8 Rome Date: 2010-11-29 04:45 PM – 06:15 PM Last modified: 2010-11-23

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Encouragement and support of selfmanagement with the use of web based technology is a promising area in diabetes care. The Diabetes Interactive Education Programme DIEP is an online application for persons with type 2 diabetes mellitus (DM2) and their health care providers in the Netherlands. The programme aims to increase understanding of DM2 and its sequelae; to stimulate active patient participation and patient-health care provider interaction; and to provide tools to support adequate selfmanagement.
DIEP is developed following the principles of Intervention Mapping, in close collaboration with the stakeholders involved.
The information is presented in spoken language supported by headlines, images, video-fragments and patient experiences. The website (www.diep.info) in its original form was released in 2005, and counted 67.000 unique visitors until April 2010.
DIEP has been updated and upgraded several times in line with national guidelines and in response to feedback from users. An audio-visually more advanced bilingual version based on DIEP’s content was recently developed in Belgium.

DIEP was evaluated in a series of recent studies. An effect evaluation (a randomised controlled trial with a pre-test and post-test design, n = 99 DM2 patients) showed a significant intervention effect (p < .01) on knowledge. An user evaluation (online questionnaire in n=564 DM2 patients and one-on-one interview in n=11) showed high satisfaction with the content, credibility and user-friendliness of the programme. DIEP was incorporated in a Diabetes Coach, which is a free service offered by a health insurance company for its members and this Diabetes Coach was evaluated over a period of 2 years in 50 DM2 patients. This study revealed that finding specific information on the DIEP website could be difficult and many patients were not motivated to visit the website repeatedly. During the two-year study period a decline in use of the Diabetes Coach took place and at the end 66% had used the diabetes coach once while 36% had used it frequently during the two years. Patients reported that the main reason for low-usage was that they did not use their computer daily and several patients did not want to be reminded daily to control their disease. Patients were also less inclined to use DIEP and the Diabetes Coach as its use was not integrated in daily care.

In conclusion, DIEP is a promising innovation in diabetes care, but further improvements are necessary before it can become integrated in daily practice and selfcare.
Based on our evaluations we aim to redesign DIEP in close collaboration with all stakeholders involved, using a business modelling approach. The challenge will be to evolve DIEP from primarily an informational site to a persuasive, interactive e-tool which enables, encourages and supports selfmanagement. A website with a two-way communication between the website and its user, with an added value for the health care providers of the DM2 patient and in accordance with the national Standard of Diabetes Care.