Diabetes Multimorbidity Typology, Trajectory, and Feasibility of an Audio Diary Mobile Application to Support Self-management

Feasibility of the Audio Diary Mobile App

Feasibility will be assessed through feedback from clinicians or researcher experts, and participants with interviews and feasibility question replies in the audio diary mobile application. Semi-structured interviews (30-45 minutes) will probe experiences with filling in the RedCap survey and using the mobile app (e.g., design, navigation, structure, and language). Interviews and field notes will capture participants' interactions with the survey and mobile app and document problems using them. With a final version that will be used in the clinical trial, participants will be asked to use the app and respond to questions such as "Please talk more about the acceptability, appropriateness and feasibility of this audio diary mobile app" or "Please discuss the acceptability, appropriateness, feasibility, and usability of this audio diary mobile app based on the question above. For example, the likes and dislikes about the app." More positive feedback indicates greater feasibility.

Expressiveness

A 5-item manipulation check questionnaire adapted from Pennebaker and Beall (1986) was used to assess participants' perceptions of expressiveness levels with the audio diary task condition to which they were assigned. On a Likert scale, ranging from 1=not at all to 7=a great deal, participants were asked to respond to items such as "How personal was your essay today?" and "To what degree did you reveal your emotions in your essay?" (total score from 5 to 35). Higher expressiveness scores indicate more expressiveness and greater feasibility.

Acceptability, Appropriateness, and Feasibility Measures

A 12-iteminstrument that consists of three distinct four-item scales used to evaluate implementation acceptability, appropriateness, and feasibility. On a Likert scale, ranging from 1=completely disagree to 5=completely agree, participants were asked to respond to items such as "This audio diary mobile app is appealing to me" for acceptability, "This audio diary mobile app seems fitting" for appropriateness or "This audio diary mobile app seems possible for feasibility. Higher measure scores indicate greater acceptability, appropriateness, and feasibility.

System Usability Scale

The System Usability Scale (SUS) is a standardized, 10-item questionnaire used to measure the perceived usability of a product, system, or service. Each item is rated on a 5-point Likert scale ranging from Strongly disagree to Strongly agree. Participants were asked to respond to items such as "I think that I would like to use this app frequently." Higher scale scores indicate greater usability

PROMIS Self-Efficacy Scores

Measures confidence in managing health and daily life across multiple domains, including general self-efficacy, managing medications and treatment, managing symptoms, managing daily activities, managing social interactions, and managing emotions. Items use a 1-5 scale ("I am not at all confident" to "I am very confident"), such as "I can manage to solve difficult problems if I try hard enough" and "I can handle whatever comes my way." Higher scores indicate greater self-efficacy.

Healthcare Utilization: Number of services

Measures the number of healthcare service uses, including clinician visits, home health visits, hospitalizations, emergency room visits, prescriptions filled, acupuncture, massage, mind-body therapies (e.g., relaxation therapy), and movement therapies (e.g., Yoga, Tai Chi) with responses including "Yes" or "No", times, and a 4-litem Likert scale from "Never/Rarely" to "Always."

Healthcare Utilization: Cost

Costs that are paid out-of-pocket for participant (or family) healthcare (including deductibles, co-pays, and uncovered services).

Quality of life: Visual Analog Scale

Self-reported quality of life using a Visual Analog Scale (0-100 scale). Higher scores indicate better quality of life.