Effectiveness of a mobile-based educational intervention on self-care activities and glycemic control among the elderly with type 2 diabetes in southwest of Iran in 2020

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Abstract

Background

The elderly constitute a large fraction of patients with type 2 diabetes worldwide. It has been well documented that the elderly’s adherence to disease control is not adequate. The present study aimed to evaluate the impact of a mobile-based educational intervention on self-care behaviors and glycemic control among elderly with type 2 diabetes.

Methods

The present study was conducted on 118 older people (59 in the intervention group and 59 in the control group) with type 2 diabetes who referred to Golestan Hospital in Ahvaz, southwest of Iran in 2020. Participants were randomly divided into experimental and control groups. Data were collected at baseline and after a 3-month follow-up. At baseline, the participants completed a valid and reliable multi-section questionnaire including items on attitude, the multidimensional scale of perceived social support (MSPSS), the Coping Self-Efficacy Scale (CSES), self-care constructs, and HBA1C. After analyzing the pre-test data, we designed a training program which was offered to the intervention group online via mobile phone in three online sessions. The control group, however, received no intervention except diabetes routine care. Data were analyzed using SPSS-15 at a significance level of 0.05.

Results

Before the intervention, the mean scores of CSES, attitudes towards self-care, MSPSS, and self-care were not statistically significant between study groups ( P > 0.05), but after intervention, the study found significant differences between the groups in terms of CSES, attitude, MSPSS, and self-care ( P = 0.001). Furthermore, after implementation of the intervention, the mean value of HbA1C in the intervention group was significantly less than that of the control group (7.00 vs. 7.32%) ( P = 0.001).

Conclusion

The present results indicated that implementing an educational intervention via mobile phone can improve self-care practice and reduce HbA1C in the elderly with type 2 diabetes. The study also showed a moderate to large effect on the outcome variables. However, further studies with longer follow-up periods are recommended to confirm the results.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00957-5.

Highlights

- The study provided a framework for developing a targeted mobile phone health education intervention.

- Mobile phone education can improve both behavioral and clinical indexes. This intervention increased the scores of perceived social support (MSPSS) and Coping Self-Efficacy Scale (CSES), and self-care practice and reduced HbA1C in the elderly with type 2 diabetes.

- Further studies with longer follow-up periods are warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00957-5.

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Most cited references 31

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Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control.

S. Norris, J. Lau, S Smith … (2002)

To evaluate the efficacy of self-management education on GHb in adults with type 2 diabetes. We searched for English language trials in Medline (1980-1999), Cinahl (1982-1999), and the Educational Resources Information Center database (ERIC) (1980-1999), and we manually searched review articles, journals with highest topic relevance, and reference lists of included articles. Studies were included if they were randomized controlled trials that were published in the English language, tested the effect of self-management education on adults with type 2 diabetes, and reported extractable data on the effect of treatment on GHb. A total of 31 studies of 463 initially identified articles met selection criteria. We computed net change in GHb, stratified by follow-up interval, tested for trial heterogeneity, and calculated pooled effects sizes using random effects models. We examined the effect of baseline GHb, follow-up interval, and intervention characteristics on GHb. On average, the intervention decreased GHb by 0.76% (95% CI 0.34-1.18) more than the control group at immediate follow-up; by 0.26% (0.21% increase - 0.73% decrease) at 1-3 months of follow-up; and by 0.26% (0.05-0.48) at > or = 4 months of follow-up. GHb decreased more with additional contact time between participant and educator; a decrease of 1% was noted for every additional 23.6 h (13.3-105.4) of contact. Self-management education improves GHb levels at immediate follow-up, and increased contact time increases the effect. The benefit declines 1-3 months after the intervention ceases, however, suggesting that learned behaviors change over time. Further research is needed to develop interventions effective in maintaining long-term glycemic control.

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T2DM Self-Management via Smartphone Applications: A Systematic Review and Meta-Analysis

Mingxuan Cui, Xueyan Wu, Jiangfeng Mao … (2016)

Background Mobile health interventions (mHealth) based on smartphone applications (apps) are promising tools to help improve diabetes care and self-management; however, more evidence on the efficacy of mHealth in diabetes care is needed. The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effect of mHealth apps on changes in hemoglobin A1c (HbA1c), blood glucose, blood pressure, serum lipids, and body weight in type 2 diabetes mellitus (T2DM) patients. Methods Two independent reviewers searched three online databases (PubMed, the Cochrane Library, and EMBASE) to identify relevant studies published between January 2005 and June 2016. Of the 2,596 articles retrieved, 13 RCTs were included. We used random effects model to estimate the pooled results. Results Thirteen studies were selected for the systematic review, six of which with data available containing 1,022 patients were included for the meta-analysis. There was a moderate effect on glycemic control after the mHealth app-based interventions. The overall effect on HbA1c shown as mean difference (MD) was -0.40% (-4.37 mmol/mol) (95% confidence interval [CI] -0.69 to -0.11% [-7.54 to -1.20 mmol/mol]; p = 0.007) and standardized mean differences (SMD) was -0.40% (-4.37 mmol/mol) (95% confidence interval [CI] -0.69 to -0.10% [-7.54 to -1.09 mmol/mol]; p = 0.008). A subgroup analysis showed a similar effect with -0.33% (-3.61 mmol/mol) (95% CI -0.59 to -0.06% [-6.45 to -0.66 mmol/mol]; p = 0.02) in MD and -0.38% (-4.15 mmol/mol) (95% CI -0.71 to -0.05% [-7.76 to -0.55 mmol/mol]; p = 0.02) in SMD in studies where patients’ baseline HbA1c levels were less than 8.0%. No effects of mHealth app interventions were found on blood pressure, serum lipids, or weight. Assessment of overall study quality and publication bias demonstrated a low risk of bias among the six studies. Conclusions Smartphone apps offered moderate benefits for T2DM self-management. However, more research with valid study designs and longer follow-up is needed to evaluate the impact of mHealth apps for diabetes care and self-management.

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Web-based care management in patients with poorly controlled diabetes.

B Levine, H Gomes, P Conlin … (2005)

To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes. For this study, 104 patients with diabetes and HbA(1c) (A1C) > or =9.0% who received their care at a Department of Veterans Affairs medical center were recruited. All participants completed a diabetes education class and were randomized to continue with their usual care (n = 52) or receive web-based care management (n = 52). The web-based group received a notebook computer, glucose and blood pressure monitoring devices, and access to a care management website. The website provided educational modules, accepted uploads from monitoring devices, and had an internal messaging system for patients to communicate with the care manager. Participants receiving web-based care management had lower A1C over 12 months (P < 0.05) when compared with education and usual care. Persistent website users had greater improvement in A1C when compared with intermittent users (-1.9 vs. -1.2%; P = 0.051) or education and usual care (-1.4%; P < 0.05). A larger number of website data uploads was associated with a larger decline in A1C (highest tertile -2.1%, lowest tertile -1.0%; P < 0.02). Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure (P < 0.01). HDL cholesterol rose and triglycerides fell in the web-based group (P < 0.05). Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes.

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Author and article information

Contributors

Shahla Vaziri Esferjani: vaziri_esf@yahoo.com

Effat Naghizadeh: e.naghizadeh1372@gmail.com

Mostafa Albokordi: albockordi5836@gmail.com

Mehrnoosh Zakerkish: zakerkish-m@ajums.ac.ir

Marzieh Araban:

ORCID: http://orcid.org/0000-0001-9920-0261

arabanm@ajums.ac.ir , araban62@gmail.com

Journal

Journal ID (nlm-ta): Arch Public Health

Journal ID (iso-abbrev): Arch Public Health

Title: Archives of Public Health

Publisher: BioMed Central (London )

ISSN (Print): 0778-7367

ISSN (Electronic): 2049-3258

Publication date (Electronic): 3 September 2022

Publication date PMC-release: 3 September 2022

Publication date Collection: 2022

Volume: 80

Electronic Location Identifier: 201

Affiliations

[1 ]GRID grid.411230.5, ISNI 0000 0000 9296 6873, Department of Community Medicine, School of Medicine, , Ahvaz Jundishapur University of Medical Sciences, ; Ahvaz, Iran

[2 ]GRID grid.411230.5, ISNI 0000 0000 9296 6873, Student of Medicine, , Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, ; Ahvaz, Iran

[3 ]GRID grid.411230.5, ISNI 0000 0000 9296 6873, Department of Community Medicine, School of Medicine, , Ahvaz Jundishapur University of Medical Sciences, ; Ahvaz, Iran

[4 ]GRID grid.411230.5, ISNI 0000 0000 9296 6873, Diabetes Research Center, Health Research Institute, , Ahvaz Jundishapur University of Medical Sciences, ; Ahvaz, Iran

[5 ]GRID grid.411230.5, ISNI 0000 0000 9296 6873, Menopause & Andropause Research Center, , Ahvaz Jundishapur University of Medical Sciences, ; Ahvaz, Iran

[6 ]GRID grid.411230.5, ISNI 0000 0000 9296 6873, Department of Health Education and Promotion, , Ahvaz Jundishapur University of Medical Sciences, ; Ahvaz, Iran

Author information

Marzieh Araban http://orcid.org/0000-0001-9920-0261

Article

Publisher ID: 957

DOI: 10.1186/s13690-022-00957-5

PMC ID: 9441036

PubMed ID: 36057609

SO-VID: e22bbaba-1227-4f71-a421-380c2ec136b1

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 2 November 2021

Date accepted : 20 August 2022

Custom metadata

ScienceOpen disciplines: Public health

Keywords: type 2 diabetes,the elderly,self-efficacy,self-care,attitude,social support,randomized controlled trial,intervention,education

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ScienceOpen disciplines: Public health

Keywords: type 2 diabetes, the elderly, self-efficacy, self-care, attitude, social support, randomized controlled trial, intervention, education

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Effectiveness of a mobile-based educational intervention on self-care activities and glycemic control among the elderly with type 2 diabetes in southwest of Iran in 2020

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Most cited references 31

Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control.

T2DM Self-Management via Smartphone Applications: A Systematic Review and Meta-Analysis

Web-based care management in patients with poorly controlled diabetes.

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