The effect of mHealth program on behavior modification and health outcomes among patients with diabetes: A randomized controlled trial study
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Keywords

technology-based intervention
mobile health application
diabetes mellitus
health promotion
behavior modification
mHealth
Malaysia

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Firdaus, M. K. Z. H., Jittanoon, P., Boonyasopun, U., & Che Hasan, M. K. (2023). The effect of mHealth program on behavior modification and health outcomes among patients with diabetes: A randomized controlled trial study. Belitung Nursing Journal, 9(5), 437–447. https://doi.org/10.33546/bnj.2664
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Accepted for publication: 2023-09-23
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Abstract

Background: Mobile health presents a promising alternative in the digital era. Mobile health apps (mHealth), when combined with the concept of self-management, are considered one of the methods for incorporating technology-based interventions into the healthcare system.

Objective: This study aimed to determine the effect of mHealth (specifically, the Diabetic Care App) on foot care behavior, dietary behavior, foot condition, and fasting blood glucose levels among patients with uncontrolled diabetes mellitus.

Methods: A single randomized controlled trial was conducted at a government-run primary clinic in Northern Malaysia, involving 58 patients with uncontrolled diabetes who were assigned to two groups. The intervention group received the Diabetic Care App, attended a 2-hour face-to-face session, and was included in a WhatsApp group, while the control group received standard care. Relevant assessments were conducted for both groups in Week 1 and Week 5. The study was conducted from February 2020 to November 2020, and parametric and non-parametric statistics were used for data analysis.

Results: Pretest-posttest comparisons in both groups revealed significant findings for foot care behavior (p <0.01), dietary behavior (p <0.01), and foot condition (p <0.01), except for fasting blood glucose levels. In inter-group comparisons, a significant difference was observed only in foot care behavior (p <0.01) and dietary behavior (p <0.01).

Conclusion: The results indicate that technology-based interventions are beneficial for modifying behavior, specifically in terms of foot care and dietary behavior, in this study. The study highlights the applicability of mHealth for nurses in patient education and self-management of chronic conditions. Future research should explore app utilization among patients with chronic conditions.

 

Clinical trial registration number: NCT04260100

(registered at https://clinicaltrials.gov/ct2/show/NCT04260100)

https://doi.org/10.33546/bnj.2664
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Supporting Agencies

This work was supported by the Higher Education Research Promotion and Thailand’s Education Hub for the Southern region of ASEAN Countries Project Office of the Higher Education Commission

Copyright

Copyright (c) 2023 Mohd Khairul Zul Hasymi Firdaus, Piyanuch Jittanoon, Umaporn Boonyasopun, Muhammad Kamil Che Hasan

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

The authors declare there is no conflict of interest.

Acknowledgment

The authors would like to thank the clinic and participants for their valuable time spent on this study.

Authors’ Contributions

MKZF: conceptualized, literature search, designed, analyzed, and drafted the study according to the format. PJ: contributed to conceptualization and analysis, reviewed and supported concepts with intellectual content and literature search. UB: supported with intellectual content and literature search. MKCH: supported with intellectual content, drafted and inspected the final draft of the manuscript. All authors substantially contributed with equal efforts until approval of the final.

Data Availability

Available upon reasonable request with the corresponding author.

Declaration of Use of AI in Scientific Writing

Nothing to disclose.


References

Abu-elenin, M. M., Elshoura, A. A., & Alghazaly, G. M. (2018). Knowledge, practice and barriers of foot self-care among diabetic patients at Tanta University Hospitals, Egypt. Egyptian Journal of Community Medicine, 36(4), 94-102.

Ahmad Sharoni, S. K., Abdul Rahman, H., Minhat, H. S., Shariff-Ghazali, S., & Azman Ong, M. H. (2018). The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia. PloS One, 13(3), e0192417. https://doi.org/10.1371/journal.pone.0192417

Ahn, Y., Bae, J., & Kim, H.-S. (2016). The development of a mobile u-Health program and evaluation for self-diet management for diabetic patients. Nutrition Research and Practice, 10(3), 342-351. https://doi.org/10.4162/nrp.2016.10.3.342

Azizi, F. (2010). Islamic fasting and health. Annals of Nutrition and Metabolism, 56(4), 273-282. https://doi.org/10.1159/000295848

Bandura, A. (1969). Social-learning theory of identificatory processes. In D. A. Goslin (Ed.), Handbook of socialization theory and research (pp. 213-262). Rand McNally & Company.

Baumann, L. C., Frederick, N., Betty, N., Jospehine, E., & Agatha, N. (2015). A demonstration of peer support for Ugandan adults with type 2 diabetes. International Journal of Behavioral Medicine, 22, 374-383. https://doi.org/10.1007/s12529-014-9412-8

Biçer, E. K., & Enç, N. (2016). Evaluation of foot care and self-efficacy in patients with diabetes in Turkey: An interventional study. International Journal of Diabetes in Developing Countries, 36, 334-344. https://doi.org/10.1007/s13410-016-0464-y

Borges, W. J., & Ostwald, S. K. (2008). Improving foot self-care behaviors with Pies Sanos. Western Journal of Nursing Research, 30(3), 325-341. https://doi.org/10.1177/0193945907303104

Calle-Pascual, A. L., Durán, A., Benedí, A., Calvo, M. I., Charro, A., Diaz, J. A., Calle, J. R., Gil, E., Ibarra, J., & Marañes, J. P. (2001). Reduction in foot ulcer incidence: Relation to compliance with a prophylactic foot care program. Diabetes Care, 24(2), 405-407. https://doi.org/10.2337/diacare.24.2.405

Chin, Y.-F., & Huang, T.-T. (2013). Development and validation of a diabetes foot self-care behavior scale. Journal of Nursing Research, 21(1), 19-25. https://doi.org/10.1097/jnr.0b013e3182828e59

Ciemins, E. L., Coon, P. J., Coombs, N. C., Holloway, B. L., Mullette, E. J., & Dudley, W. N. (2018). Intent-to-treat analysis of a simultaneous multisite telehealth diabetes prevention program. BMJ Open Diabetes Research and Care, 6(1), e000515. http://dx.doi.org/10.1136/bmjdrc-2018-000515

Coffey, L., Mahon, C., & Gallagher, P. (2019). Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: A qualitative meta‐synthesis. International Wound Journal, 16(1), 183-210. https://doi.org/10.1111/iwj.13010

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Routledge.

Debussche, X., Besançon, S., Balcou-Debussche, M., Ferdynus, C., Delisle, H., Huiart, L., & Sidibé, A. T. (2018). Structured peer-led diabetes self-management and support in a low-income country: The ST2EP randomised controlled trial in Mali. PloS One, 13(1), e0191262. https://doi.org/10.1371/journal.pone.0191262

Dincer, B., & Bahçecik, N. (2021). The effect of a mobile application on the foot care of individuals with type 2 diabetes: A randomised controlled study. Health Education Journal, 80(4), 425-437. https://doi.org/10.1177/0017896920981617

Fan, L., Sidani, S., Cooper-Brathwaite, A., & Metcalfe, K. (2013). Feasibility, acceptability and effects of a foot self-care educational intervention on minor foot problems in adult patients with diabetes at low risk for foot ulceration: A pilot study. Canadian Journal of Diabetes, 37(3), 195-201. https://doi.org/10.1016/j.jcjd.2013.03.020

Feisul, M. I., & Azmi, S. (2013). National Diabetes Registry Report. https://www.moh.gov.my/moh/resources/Penerbitan/Rujukan/NCD/Diabetes/National_Diabetes_Registry_Report_Vol_1_2009_2012.pdf

Fejfarová, V., Jirkovská, A., Dragomirecká, E., Game, F., Bém, R., Dubský, M., Wosková, V., Křížová, M., Skibová, J., & Wu, S. (2014). Does the diabetic foot have a significant impact on selected psychological or social characteristics of patients with diabetes mellitus? Journal of Diabetes Research, 2014, 371938. https://doi.org/10.1155/2014/371938

Firdaus, M. K. Z. H., Jittanoon, P., & Boonyasopun, U. (2022). Developing, validating, and pre-testing of a diabetic care self-management mobile health application: A technology-based intervention for patients with diabetes in Malaysia. Belitung Nursing Journal, 8(4), 365-371. https://doi.org/10.33546/bnj.2127

Green-Morris, G. (2014). An evaluation of the effectiveness of providing foot care education in a rural clinic setting [Doctoral dissertation, The University of Southern Mississippi]. Mississippi.

Handelsman, Y., Bloomgarden, Z. T., Grunberger, G., Umpierrez, G., Zimmerman, R. S., Bailey, T. S., Blonde, L., Bray, G. A., Cohen, A. J., & Dagogo-Jack, S. (2015). American Association of Clinical Endocrinologists and American College of Endocrinology–clinical practice guidelines for developing a diabetes mellitus comprehensive care plan–2015—executive summary. Endocrine Practice, 21(4), 413-437. https://doi.org/10.4158/EP15672.GL

Hashmi, N. R., & Khan, S. A. (2018). Interventional study to improve diabetic guidelines adherence using mobile health (m-Health) technology in Lahore, Pakistan. BMJ Open, 8(5), e020094. http://dx.doi.org/10.1136/bmjopen-2017-020094

Holmen, H., Wahl, A., Torbjørnsen, A., Jenum, A. K., Småstuen, M. C., & Ribu, L. (2016). Stages of change for physical activity and dietary habits in persons with type 2 diabetes included in a mobile health intervention: The Norwegian study in RENEWING HEALTH. BMJ Open Diabetes Research and Care, 4(1), e000193. http://dx.doi.org/10.1136/bmjdrc-2016-000193

Hooshmandja, M., Mohammadi, A., Esteghamti, A., Aliabadi, K., & Nili, M. (2019). Effect of mobile learning (application) on self-care behaviors and blood glucose of type 2 diabetic patients. Journal of Diabetes & Metabolic Disorders, 18, 307-313. https://doi.org/10.1007/s40200-019-00414-1

Inlow, S. (2004). The 60-second foot exam for people with diabetes. Wound Care Canada, 2(2), 10-11.

International Diabetes Federation. (2013). Five questions on the IDF Diabetes Atlas. Diabetes Research and Clinical Practice, 102(2), 147-148. https://doi.org/10.1016/j.diabres.2013.10.013

Ithnain, N., Joslyn Panting, A., Amirudin, N., Suhaimi, S., & Kassim, R. (2020). Health and social behaviour during Movement Control Order (MCO) following COVID-19: An online survey among adult internet users in Malaysia - Key findings. Selangor, Malaysia: Institute for Health Behavioural Research (IHBR),National Institutes for Health. https://doi.org/http://dx.doi.org/10.13140/RG.2.2.28483.63525

Kanfer, F. H., & Gaelick-Buys, L. (1991). Self-management methods. In F. H. Kanfer & A. P. Goldstein (Eds.), Helping people change: A textbook of methods (pp. 305-360). Pergamon Press.

Kebede, M. M., & Pischke, C. R. (2019). Popular diabetes apps and the impact of diabetes app use on self-care behaviour: A survey among the digital community of persons with diabetes on social media. Frontiers in Endocrinology, 10, 135. https://doi.org/10.3389/fendo.2019.00135

Kemp, S. (2015). Digital, social & mobile in 2015. https://www.slideshare.net/secret/gGvylz6900i7fs/download

Kilic, M., & Karadağ, A. (2020). Developing and evaluating a mobile foot care application for persons with diabetes mellitus: A randomized pilot study. Wound Management & Prevention, 66(10), 29-40.

Kim, Y. J., Rhee, S. Y., Byun, J. K., Park, S. Y., Hong, S. M., Chin, S. O., Chon, S., Oh, S., Woo, J.-t., & Kim, S. W. (2015). A smartphone application significantly improved diabetes self-care activities with high user satisfaction. Diabetes & Metabolism Journal, 39(3), 207-217. https://doi.org/10.4093/dmj.2015.39.3.207

King, I. M. (1992). King's theory of goal attainment. Nursing Science Quarterly, 5(1), 19-26. https://doi.org/10.1177/089431849200500107

Knell, G., Robertson, M. C., Dooley, E. E., Burford, K., & Mendez, K. S. (2020). Health behavior changes during COVID-19 pandemic and subsequent “stay-at-home” orders. International Journal of Environmental Research and Public Health, 17(17), 6268. https://doi.org/10.3390/ijerph17176268

Kolltveit, B.-C. H., Gjengedal, E., Graue, M., Iversen, M. M., Thorne, S., & Kirkevold, M. (2017). Conditions for success in introducing telemedicine in diabetes foot care: A qualitative inquiry. BMC Nursing, 16(1), 1-10. https://doi.org/10.1186/s12912-017-0201-y

Lavery, L. A., Higgins, K. R., Lanctot, D. R., Constantinides, G. P., Zamorano, R. G., Athanasiou, K. A., Armstrong, D. G., & Agrawal, C. M. (2007). Preventing diabetic foot ulcer recurrence in high-risk patients: Use of temperature monitoring as a self-assessment tool. Diabetes Care, 30(1), 14-20. https://doi.org/10.2337/dc06-1600

Lucio, J. L. (2013). Foot SFoot self-care among Mexican American adults with type 2 diabetes: a qualitative inquiry of patients’ beliefs [Doctoral Dissertation, Walden University]. Minneapolis.

Mafauzy, M., Hussein, Z., & Chan, S. P. (2011). The status of diabetes control in Malaysia: Results of DiabCare 2008. Medical Journal of Malaysia, 66(3), 175-181.

Mafauzy, M., Zanariah, H., Nazeri, A., & Chan, S. P. (2016). DiabCare 2013: A cross-sectional study of hospital based diabetes care delivery and prevention of diabetes related complications in Malaysia. The Medical Journal of Malaysia, 71(4), 177-185.

Marcolino, M. S., Oliveira, J. A. Q., D'Agostino, M., Ribeiro, A. L., Alkmim, M. B. M., & Novillo-Ortiz, D. (2018). The impact of mHealth interventions: Systematic review of systematic reviews. JMIR mHealth and uHealth, 6(1), e8873. https://doi.org/10.2196/mhealth.8873

Ministry of Health Malaysia. (2014). Annual report 2014. https://hq.moh.gov.my/ohd/images/pdf/annual_rpt/annual_rpt14.pdf

Ministry of Health Malaysia. (2015). Clinical Practice Guidelines management of Type 2 Diabetes. https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Endocrine/3a.pdf

Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3), 835. https://doi.org/10.3390/ijerph17030835

Naghibi, S. A., Moosazadeh, M., Zhyanifard, A., Makrani, Z. J., & Cherati, J. Y. (2015). Analyzing short message services application effect on diabetic patients’ self-caring. International Journal of Preventive Medicine, 6, 75. https://doi.org/10.4103%2F2008-7802.162670

Nguyen, T. P. L., Edwards, H., Do, T. N. D., & Finlayson, K. (2019). Effectiveness of a theory-based foot care education program (3STEPFUN) in improving foot self-care behaviours and foot risk factors for ulceration in people with type 2 diabetes. Diabetes Research and Clinical Practice, 152, 29-38. https://doi.org/10.1016/j.diabres.2019.05.003

Nundy, S., Dick, J. J., Chou, C.-H., Nocon, R. S., Chin, M. H., & Peek, M. E. (2014). Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants. Health Affairs, 33(2), 265-272. https://doi.org/10.1377/hlthaff.2013.0589

Pamungkas, R. A. (2015). The effect of dietary and exercise self-management support program on dietary behavior, exercise behavior, and clinical outcomes in Muslim patientswith poorly controlled Type 2 Diabetes Mellitus in a community setting in Indonesia [Master Thesis, Faculty of Nursing, Prince of Songkla University]. Thailand.

Patout Jr, C. A., Birke, J. A., Horswell, R., Williams, D., & Cerise, F. P. (2000). Effectiveness of a comprehensive diabetes lower-extremity amputation prevention program in a predominantly low-income African-American population. Diabetes Care, 23(9), 1339-1342. https://doi.org/10.2337/diacare.23.9.1339

Polit, D. F., & Gillespie, B. M. (2009). The use of the intention-to-treat principle in nursing clinical trials. Nursing Research, 58(6), 391-399. https://doi.org/10.1097/NNR.0b013e3181bf1505

Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38-48. https://doi.org/10.4278/0890-1171-12.1.38

Quinn, C. C., Gruber-Baldini, A. L., Shardell, M., Weed, K., Clough, S. S., Peeples, M., Terrin, M., Bronich-Hall, L., Barr, E., & Lender, D. (2009). Mobile diabetes intervention study: Testing a personalized treatment/behavioral communication intervention for blood glucose control. Contemporary Clinical Trials, 30(4), 334-346. https://doi.org/10.1016/j.cct.2009.02.004

Ramadas, A., Chan, C. K. Y., Oldenburg, B., Hussein, Z., & Quek, K. F. (2018). Randomised-controlled trial of a web-based dietary intervention for patients with type 2 diabetes: Changes in health cognitions and glycemic control. BMC Public Health, 18, 1-13. https://doi.org/10.1186/s12889-018-5640-1

Ranganathan, P., Pramesh, C. S., & Aggarwal, R. (2016). Common pitfalls in statistical analysis: Intention-to-treat versus per-protocol analysis. Perspectives in Clinical Research, 7(3), 144-146. https://doi.org/10.4103%2F2229-3485.184823

Rossi, M. C., Nicolucci, A., Lucisano, G., Pellegrini, F., Di Bartolo, P., Miselli, V., Anichini, R., & Vespasiani, o. b. o. t. D. I. D. S. G. G. (2013). Impact of the “Diabetes Interactive Diary” telemedicine system on metabolic control, risk of hypoglycemia, and quality of life: A randomized clinical trial in type 1 diabetes. Diabetes Technology & Therapeutics, 15(8), 670-679.

Ryan, P., & Sawin, K. J. (2009). The individual and family self-management theory: Background and perspectives on context, process, and outcomes. Nursing Outlook, 57(4), 217-225. https://doi.org/10.1016/j.outlook.2008.10.004

Saurabh, S., Sarkar, S., Selvaraj, K., Kar, S. S., Kumar, S. G., & Roy, G. (2014). Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India. Indian Journal of Endocrinology and Metabolism, 18(1), 106-110. https://doi.org/10.4103%2F2230-8210.126587

Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. BMC Medicine, 8, 18. https://doi.org/10.1186/1741-7015-8-18

Sittig, S., Wang, J., Iyengar, S., Myneni, S., & Franklin, A. (2020). Incorporating behavioral trigger messages into a mobile health app for chronic disease management: Randomized clinical feasibility trial in diabetes. JMIR mHealth and uHealth, 8(3), e15927. https://doi.org/10.2196/15927

Sullivan, G. M., & Feinn, R. (2012). Using effect size—or why the P value is not enough. Journal of Graduate Medical Education, 4(3), 279-282. https://doi.org/10.4300/JGME-D-12-00156.1

The International Expert Committee. (2009). International Expert Committee report on the role of the A1C Assay in the diagnosis of diabetes. Diabetes Care, 32(7), 1327-1334. https://doi.org/10.2337/dc09-9033

Tripepi, G., Chesnaye, N. C., Dekker, F. W., Zoccali, C., & Jager, K. J. (2020). Intention to treat and per protocol analysis in clinical trials. Nephrology, 25(7), 513-517. https://doi.org/10.1111/nep.13709

Viswanathan, V., Madhavan, S., Rajasekar, S., Chamukuttan, S., & Ambady, R. (2005). Amputation prevention initiative in South India: Positive impact of foot care education. Diabetes Care, 28(5), 1019-1021. https://doi.org/10.2337/diacare.28.5.1019

Wami, W. M., Buntinx, F., Bartholomeeusen, S., Goderis, G., Mathieu, C., & Aerts, M. (2013). Influence of chronic comorbidity and medication on the efficacy of treatment in patients with diabetes in general practice. British Journal of General Practice, 63(609), e267-e273. https://doi.org/10.3399/bjgp13X665233

World Health Organization (WHO). (2016). Diabetes country profiles (Malaysia). World Health Organization. https://www.who.int/publications/m/item/diabetes-mys-country-profile-malaysia-2016


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