Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review

Megan Racey^{1

2}, Carly Whitmore^{2

3}, Paige Alliston¹, Joseph A Cafazzo^{4

5}, Allison Crawford^{3

6}, David Castle³, Rosa Dragonetti³, Donna Fitzpatrick-Lewis¹, Milos Jovkovic¹, Osnat C Melamed^{3

7}, Farooq Naeem^{3

6}, Peter Senior^{8

9}, Gillian Strudwick^{3

6}, Seeta Ramdass^{10

11}, Victor Vien^{3

6}, Peter Selby^{3

7}, Diana Sherifali^{1

2}

Affiliations

¹ McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada.
² School of Nursing, McMaster University, Hamilton, ON, Canada.
³ Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁴ Healthcare Human Factors, University Health Network, Toronto, ON, Canada.
⁵ eHealth Innovation, University Health Network, Toronto, ON, Canada.
⁶ University of Toronto, Toronto, ON, Canada.
⁷ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada.
⁹ Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada.
¹⁰ Diabetes Action Canada, Toronto, ON, Canada.
¹¹ McGill University, Montreal, QC, Canada.

PMID: 37159256
PMCID: PMC10206630
DOI: 10.2196/44652

Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review

Megan Racey et al. JMIR Diabetes. 2023.

. 2023 May 9:8:e44652.

doi: 10.2196/44652.

Authors

Affiliations

¹ McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada.
² School of Nursing, McMaster University, Hamilton, ON, Canada.
³ Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁴ Healthcare Human Factors, University Health Network, Toronto, ON, Canada.
⁵ eHealth Innovation, University Health Network, Toronto, ON, Canada.
⁶ University of Toronto, Toronto, ON, Canada.
⁷ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada.
⁹ Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada.
¹⁰ Diabetes Action Canada, Toronto, ON, Canada.
¹¹ McGill University, Montreal, QC, Canada.

PMID: 37159256
PMCID: PMC10206630
DOI: 10.2196/44652

Abstract

Background: For individuals living with diabetes and its psychosocial comorbidities (eg, depression, anxiety, and distress), there remains limited access to interprofessional, integrated care that includes mental health support, education, and follow-up. Health technology, broadly defined as the application of organized knowledge or skill as software, devices, and systems to solve health problems and improve quality of life, is emerging as a means of addressing these gaps. There is thus a need to understand how such technologies are being used to support, educate, and help individuals living with co-occurring diabetes and mental health distress or disorder.

Objective: The purpose of this scoping review was to (1) describe the literature on technology-enabled integrated interventions for diabetes and mental health; (2) apply frameworks from the Mental Health Commission of Canada and World Health Organization to elucidate the components, type, processes, and users of technology-enabled integrated interventions for diabetes and mental health; and (3) map the level of integration of interventions for diabetes and mental health.

Methods: We searched 6 databases from inception to February 2022 for English-language, peer-reviewed studies of any design or type that used technology to actively support both diabetes and any mental health distress or disorder in succession or concurrently among people with diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes). Reviewers screened citations and extracted data including study characteristics and details about the technology and integration used.

Results: We included 24 studies described in 38 publications. These studies were conducted in a range of settings and sites of care including both web-based and in-person settings. Studies were mostly website-based (n=13) and used technology for wellness and prevention (n=16) and intervention and treatment (n=15). The primary users of these technologies were clients and health care providers. All the included intervention studies (n=20) used technology for clinical integration, but only 7 studies also used the technology for professional integration.

Conclusions: The findings of this scoping review suggest that there is a growing body of literature on integrated care for diabetes and mental health enabled by technology. However, gaps still exist with how to best equip health care professionals with the knowledge and skills to offer integrated care. Future research is needed to continue to explore the purpose, level, and breadth of technology-enabled integration to facilitate an approach to overcome or address care fragmentation for diabetes and mental health and to understand how health technology can further drive the scale-up of innovative integrated interventions.

Keywords: application; clinical integration; digital health; distress; education; health information technology; integrated care; intervention; mental health; psychosocial; scoping review; support; technology; type 1 diabetes; type 2 diabetes; virtual care.

©Megan Racey, Carly Whitmore, Paige Alliston, Joseph A Cafazzo, Allison Crawford, David Castle, Rosa Dragonetti, Donna Fitzpatrick-Lewis, Milos Jovkovic, Osnat C Melamed, Farooq Naeem, Peter Senior, Gillian Strudwick, Seeta Ramdass, Victor Vien, Peter Selby, Diana Sherifali. Originally published in JMIR Diabetes (https://diabetes.jmir.org), 09.05.2023.

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Conflict of interest statement

Conflicts of Interest: P Selby reports receiving grants and/or research support from CIHR, New Frontiers in Research Fund, Canadian Cancer Society, National Research Council of Canada, and the Ontario Ministry of Health. Through an open tender process Johnson & Johnson, Novartis, and Pfizer Inc. are vendors of record for providing smoking cessation pharmacotherapy, free or discounted, for research studies in which P Selby is the principal investigator or co-investigator. He is also supported by the Giblon Professorship held at the University of Toronto and research stipends from CAMH as well as the Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto. The authors have no further interests to declare.

Figures

**Figure 1**
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.

**Figure 2**
Number of included papers by year and country. Note: 3 reviews are not included in this figure.

**Figure 3**
Tree map of the purpose of technology used in included studies as reported in 20 studies. Note: as per the definitions from the Mental Health Commission of Canada “Mental Health, Technology, and You,” 3 systematic reviews and 1 focus group study are not part of the data extraction to construct this figure.

**Figure 4**
Tree map of the digital health intervention classifications as reported in 20 studies. Note: as per the World Health Organization’s “Classification of Digital Health Interventions v1.0,” 3 systematic reviews and 1 focus group study are not part of the data extraction to construct this figure.

See this image and copyright information in PMC

References

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Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review

Affiliations

Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources