Tailoring Educational Content for T2DM Patients
A Qualitative Study on Preferences for Interactive Multimedia Applications
DOI:
https://doi.org/10.15605/jafes.040.01.18Keywords:
educational material, diabetes mellitus, multimedia applications, health education, patient communicaitonAbstract
Background. The development of interactive multimedia-based applications has become increasingly important in providing effective health education to Type 2 Diabetes Mellitus (T2DM) patients. Understanding the educational content required for such applications from local patients’ perspectives is crucial for designing a user-friendly and impactful tool for T2DM management.
Objective. This study aims to investigate patients’ views and preferences on the educational content and features of an interactive multimedia-based application for T2DM patients.
Methodology. Semi-structured qualitative interviews were carried out with a sample of T2DM outpatients (n = 16) at a tertiary referral university hospital in Kuala Lumpur between October 2022 and January 2023. The interviews were recorded, transcribed and subjected to thematic analysis.
Result. The majority of participants had been diagnosed with T2DM for less than ten years. The thematic analysis identified several key aspects related to the educational content required for development of a multimedia-based application. These include preference for educational materials, essential contents and interactive features. The participants also proposed a discussion area within such applications that would allow them to communicate and receive immediate advice from healthcare professionals, thus eliminating the need for frequent hospital visits.
Conclusion. The findings of this study highlight the significance of interactive multimedia-based applications in providing health education for T2DM patients. The identified essential content areas from the patients’ perspectives can inform the development of effective tailored educational materials for patient’s benefit.
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References
1. Sanaeinasab H, Saffari M, Yazdanparast D, et al. Effects of a health education program to promote healthy lifestyle and glycemic control in patients with type 2 diabetes: A randomized controlled trial. Prim Care Diabetes. 2021;15(2):275-82. https://pubmed.ncbi.nlm.nih.gov/33055009 https://doi.org/10.1016/j.pcd.2020.09.007 DOI: https://doi.org/10.1016/j.pcd.2020.09.007
2. Ganasegeran K, Hor CP, Jamil MFA, et al. A systematic review of the economic burden of type 2 diabetes in Malaysia. Int J Environ Res Public Health. 2020;17(16):5723. https://pubmed.ncbi.nlm.nih.gov/32784771 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460065 https://doi.org/10.3390/ijerph17165723 DOI: https://doi.org/10.3390/ijerph17165723
3. Institute for Public Health 2020. National Health and Morbidity Survey (NHMS) 2019. Non-communicable diseases, healthcare demand, and health literacy – Key findings. https://iptk.moh.gov.my/images/technical_report/2020/4_Infographic_Booklet_NHMS_2019_-_English.pdf
4. Huang MC, Hung CH, Yu CY, Berry DC, Shin SJ, Hsu YY. The effectiveness of multimedia education for patients with type 2 diabetes mellitus. J Adv Nurs. 2017;73(4):943-54. https://pubmed.ncbi.nlm.nih.gov/27779772 https://doi.org/10.1111/jan.13194 DOI: https://doi.org/10.1111/jan.13194
5. Collis B. Anticipating the impact of multimedia in education: Lessons from literature. In: International journal of computers in adult education and training. 1991;2(2):136-49.
6. Velázquez–López L, Muñoz-Torres AV, Medina-Bravo P, Vilchis-Gil J, Klϋnder-Klϋnder M, Escobedo–de la Peña J. Multimedia education program and nutrition therapy improves HbA1c, weight, and lipid profile of patients with type 2 diabetes: A randomized clinical trial. Endocrine. 2017;58(2):236-45. https://pubmed.ncbi.nlm.nih.gov/28921414 https://doi.org/10.1007/s12020-017-1416-0 DOI: https://doi.org/10.1007/s12020-017-1416-0
7. Kasar KS, Asiret GD, Yilmaz CK, Canlar S. The effect of model-based telephone counseling on HbA1c and self-management for individuals with type 2 diabetes: A randomized controlled trial. Prim Care Diabetes. 2022;16(1):41-8. https://pubmed.ncbi.nlm.nih.gov/34518109 https://doi.org/10.1016/j.pcd.2021.09.005 DOI: https://doi.org/10.1016/j.pcd.2021.09.005
8. Abed MA, Himmel W, Vormfelde S, Koschack J. Video-assisted patient education to modify behavior: a systematic review. Patient Educ Couns. 2014;97(1);16-22. https://pubmed.ncbi.nlm.nih.gov/25043785 https://doi.org/10.1016/j.pec.2014.06.015 DOI: https://doi.org/10.1016/j.pec.2014.06.015
9. Lari H, Tahmadebi R, Noroozi A. Effect of electronic education based on health promotion model on physical activity in diabetic patients. Diabetes Metab Syndr. 2018;12(1):45-50. https://pubmed.ncbi.nlm.nih.gov/28869152 https://doi.org/10.1016/j.dsx.2017.08.013 DOI: https://doi.org/10.1016/j.dsx.2017.08.013
10. Georgieva-Tsaneva GN, Serbezova I. Research on the impact of innovative interactive technologies in the education of health care students. Int J Emerg Technol Learn. 2022;17(20):283-91. https://doi.org/10.3991/ijet.v17i20.32903 DOI: https://doi.org/10.3991/ijet.v17i20.32903
11. Heshmati H, Shakibazadeh E, Foroushani AR, Sadeghi R. A comprehensive model of health education barriers of health-care system in Iran. J Educ Health Promot. 2020;9:106. https://pubmed.ncbi.nlm.nih.gov/32642462 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325757 https://doi.org/10.4103/jehp.jehp_23_20 DOI: https://doi.org/10.4103/jehp.jehp_23_20
12. Huang JP, Chen HH, Yeh ML. A comparison of diabetes learning with and without interactive multimedia to improve knowledge, control, and self-care among people with diabetes in Taiwan. Public Health Nurs. 2009;26(4):317-28. https://pubmed.ncbi.nlm.nih.gov/19573210 https://doi.org/10.1111/j.1525-1446.2009.00786.x DOI: https://doi.org/10.1111/j.1525-1446.2009.00786.x
13. Kandula NR, Nsiah-Kumi PA, Makoul G, et al. The relationship between health literacy and knowledge improvement after a multimedia type 2 diabetes education program. Patient Educ Couns. 2009;75(3):321-7. https://pubmed.ncbi.nlm.nih.gov/19395223 https://doi.org/10.1016/j.pec.2009.04.001 DOI: https://doi.org/10.1016/j.pec.2009.04.001
14. Nkhoma DE, Soko CJ, Bowrin P, et al. Digital interventions self-management education for type 1 and 2 diabetes: A systematic review and meta-analysis. Comput Methods Programs Biomed. 2021;210:106370. https://pubmed.ncbi.nlm.nih.gov/34492544 https://doi.org/10.1016/j.cmpb.2021.106370 DOI: https://doi.org/10.1016/j.cmpb.2021.106370
15. Pai LW, Chiu SC, Liu HL, Chen LL, Peng T. Effects of a health education technology program on long-term glycemic control and self-management ability of adults with type 2 diabetes: A randomized controlled trial. Diabetes Res Clin Pract. 2021;175:108785. https://pubmed.ncbi.nlm.nih.gov/33781794 https://doi.org/10.1016/j.diabres.2021.108785 DOI: https://doi.org/10.1016/j.diabres.2021.108785
16. Fadhilah H, Subkhi MR. Penyuluhan Informasi Konseling Kesehatan Kepada Orang Tua Melalui Media Video Interaktif. 2024;3(2):204-8. https://doi.org/10.58184/mestaka.v3i2.336 DOI: https://doi.org/10.58184/mestaka.v3i2.336
17. Salgueiro LJ, Pereyra-Bencosme K, Vargas-Martínez C, et al. Digital interventions in type 2 diabetes mellitus. Principles and Practice of Clinical Research. 2023;9(2). https://doi.org/10.21801/ppcrj.2023.92.5 DOI: https://doi.org/10.21801/ppcrj.2023.92.5
18. Blythin AM, Elkes J, van Lindholm T, et al. Can digital health apps provide patients with support to promote structured diabetes education and ongoing self-management? A real-world evaluation of myDiabetes usage. Digit Health. 2023;9:20552076221147109 DOI: https://doi.org/10.1177/20552076221147109
19. Yusoff H, Dali WPEW, Ruhaiyem NIR. Evidence-based of interactive multimedia-based nutrition education package efficacy on obesity outcomes through game and video intervention. In: Badioze Zaman H, et al., eds. Advances in Visual Informatics. IVIC 2021. Lecture Notes in Computer Science, vol. 13051. Springer, Cham; 2021: 1319 DOI: https://doi.org/10.1007/978-3-030-90235-3_13
20. Lee JW, Then YL, Lee SW. Health information seeking behaviour using mobile devices among people with diabetes: A comparison between Middle and high income country. Digit Health. 2020;6:2055207620956457. https://pubmed.ncbi.nlm.nih.gov/32963802 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488880 https://doi.org/10.1177/2055207620956457 DOI: https://doi.org/10.1177/2055207620956457
21. Khan AI, Gill A, Cott C, Hans PK, Gray CS. mHealth tools for the self-management of patients with multimorbidity in primary care settings: Pilot study to explore user experience. JMIR MHealth Uhealth. 2018;6(8):e171. https://pubmed.ncbi.nlm.nih.gov/30154073 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134226 https://doi.org/10.2196/mhealth.8593 DOI: https://doi.org/10.2196/mhealth.8593
22. Vo V, Auroy L, Sarradon-Eck A. Patients’ perceptions of mHealth apps: Meta-ethnographic review of qualitative studies. JMIR Mhealth Uhealth. 2019;7(7):e13817. https://pubmed.ncbi.nlm.nih.gov/31293246 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6652126 https://doi.org/10.2196/13817 DOI: https://doi.org/10.2196/13817
23. Kwan YH, Ong ZQ, Choo DYXC, Phang JK, Yoon S, Low LL. A mobile application to improve diabetes self-management using rapid prototyping: Iterative co-design approach in Asian settings. Patient Prefer Adherence. 2023l5:17:1-11. https://pubmed.ncbi.nlm.nih.gov/36636285 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9830050 https://doi.org/10.2147/PPA.S386456 DOI: https://doi.org/10.2147/PPA.S386456
24. Braun V, Clarke V. Using thematic analysis in Psychology. Qual Res Psychol. 2006;3(2):77-101. https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa
25. Sze WT, Know SG. Perspectives and needs of Malaysian patients with diabetes for a mobile health app support on self-management of diabetes: Qualitative study. JMIR Diabetes. 2023;8:e40968. https://pubmed.ncbi.nlm.nih.gov/37870903 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628693 https://doi.org/10.2196/40968 DOI: https://doi.org/10.2196/40968
26. Ramchandani N. Virtual coaching to enhance diabetes care. Diabetes Technol Ther. 2019;21(S2):S248-51. https://pubmed.ncbi.nlm.nih.gov/31169430 https://doi.org/10.1089/dia.2019.0016 DOI: https://doi.org/10.1089/dia.2019.0016
27. Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol. 2017;11(5):1015-27. https://pubmed.ncbi.nlm.nih.gov/28560898 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951000 https://doi.org/10.1177/1932296817713506 DOI: https://doi.org/10.1177/1932296817713506
28. Lorig K, Ritter PL, Turner RM, English K, Laurent DD, Greenberg J. A diabetes self-management program: 12-month outcome sustainability from a nonreinforced pragmatic trial. J Med Internet Res. 2016;18(12):e322. https://pubmed.ncbi.nlm.nih.gov/27979790 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5200842 https://doi.org/10.2196/jmir.6484 DOI: https://doi.org/10.2196/jmir.6484
29. Represas-Carrera FJ, Martínez-Ques AA, Clavería A. Effectiveness of mobile applications in diabetic patients’ healthy lifestyles: A review of systematic reviews. Prim Care Diabetes. 2021;15(5):751-60. https://pubmed.ncbi.nlm.nih.gov/34275771 https://doi.org/10.1016/j.pcd.2021.07.004 DOI: https://doi.org/10.1016/j.pcd.2021.07.004
30. Rogers WA, Stronge AJ, Fisk AD. Technology and aging. Rev Hum Factors Ergon. 2005;9(1):130-71. https://doi.org/10.1518/155723405783703028 DOI: https://doi.org/10.1518/155723405783703028
31. National Research Council (US) Steering Committee for the Workshop on Technology for Adaptive Aging. Pew RW, Van Hemel SB, eds. Washington (DC): National Academies Press (US); 2004.
32. Ministry of Health Malaysia. National Diabetes Registry Report 2020. Disease Control Division; 2021. https://www.moh.gov.my/moh/resources/Penerbitan/Rujukan/NCD/Diabetes/National_Diabetes_Registry_Report_2020.pdf
33. Fleming GA, Petrie JR, Bergenstal RM, Holl RW, Peters AL, Heinemann L. Diabetes digital app technology: Benefits, challenges, and recommendations. A Consensus Report by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) Diabetes Technology Working Group. Diabetes Care. 2020;43(1):250-60. https://pubmed.ncbi.nlm.nih.gov/31806649 https://doi.org/10.2337/dci19-0062 DOI: https://doi.org/10.2337/dci19-0062
34. Tildesley HD, Mazanderani AB, Ross SA. Efficacy of A1C reduction using internet intervention in patients with type 2 diabetes treated with insulin. Diabetes Care. 2010;33(8):1738-40. https://pubmed.ncbi.nlm.nih.gov/20668152 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909052 https://doi.org/10.2337/dc09-2256 DOI: https://doi.org/10.2337/dc09-2256
35. Beckerle CM, Lavin MA. Association of self-efficacy and self-care with glycemic. Diabetes Spectr. 2013;26(3):172-8. https://doi.org/10.2337/diaspect.26.3.172 DOI: https://doi.org/10.2337/diaspect.26.3.172
36. Hermanns N, Ehrmann D, Shapira A, Kulzer B, Schmitt A, Laffel L. Coordination of glucose monitoring, self-care behaviour and mental health: Achieving precision monitoring in diabetes. Diabetologia. 2022;65(11):1883-94. Phttps://pubmed.ncbi.nlm.nih.gov/35380233 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522821 https://doi.org/10.1007/s00125-022-05685-7 DOI: https://doi.org/10.1007/s00125-022-05685-7
37. Lim SL, Ong KW, Johal J, et al. Effect of a smartphone app on weight change and metabolic outcomes in Asian adults with type 2 diabetes: Randomized control trial. JAMA Netw Open. 2021;4(6):e2112417. https://pubmed.ncbi.nlm.nih.gov/34081137 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176331 https://doi.org/10.1001/jamanetworkopen.2021.12417 DOI: https://doi.org/10.1001/jamanetworkopen.2021.12417
38. Malaysia Ministry of Health. Clinical Practice Guidelines on Management of Type 2 Diabetes Mellitus, 6th ed. 2020. https://mems.my/cpg-management-of-type-2-diabetes-mellitus-6th-edition/
39. Boels AM, Rutten G, Zuithoff N, de Wit A,Vos R. Effectiveness of diabetes self-management education via a smartphone application in insulin treated type 2 diabetes patients–design of a randomised controlled trial (‘TRIGGER study’). BMC Endocr Disord. 2018;18(1):74. PMID: 30348142 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196442 https://doi.org/10.1186/s12902-018-0304-9 DOI: https://doi.org/10.1186/s12902-018-0304-9
40. Knudsen LR, Lomborg K, Hauge EM, de Thurah A. Facilitators and challenges of implementing a digital patient education programme for rheumatoid arthritis into clinical practice. BMC Health Serv Res. 2024;24(1):1104. https://pubmed.ncbi.nlm.nih.gov/39304859 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414131 https://doi.org/10.1186/s12913-024-11597-6 DOI: https://doi.org/10.1186/s12913-024-11597-6
41. Nair M, Svedberg P, Larsson I, Nygren JM. A comprehensive overview of barriers and strategies for AI implementation in healthcare: Mixed-method design. Plos One. 2024;19(8):e0305949. Phttps://pubmed.ncbi.nlm.nih.gov/39121051 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315296 https://doi.org/10.1371/journal.pone.0305949 DOI: https://doi.org/10.1371/journal.pone.0305949
42. Ross J, Stevenson F, Lau R, Murray E. Exploring the challenges of implementing e-health: A protocol for an update of a systematic review of reviews. BMJ Open. 2015;5(4):e006773. PMID: 25869685 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401858 https://doi.org/10.1136/bmjopen-2014-006773 DOI: https://doi.org/10.1136/bmjopen-2014-006773
43. Abell B, Naicker S, Rodwell D, et al. Identifying barriers and facilitators to successful implementation of computerized clinical decision support systems in hospitals: A NASSS framework-informed scoping review. Implement Sci 2023;18(1):32. https://pubmed.ncbi.nlm.nih.gov/37495997 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10373265 DOI: 10.1186/s13012-023-01287-y DOI: https://doi.org/10.1186/s13012-023-01287-y
44. Berardi C, Antonini M, Jordan Z, Wechtler H, Palucci F, Hinwood M. Barriers and facilitators to the implementation of digital technologies in mental health systems: A qualitative systematic review to inform a policy framework. BMC Health Serv Res. 2024;24(1):243. https://pubmed.ncbi.nlm.nih.gov/38408938 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898174 https://doi.org/10.1186/s12913-023-10536-1 DOI: https://doi.org/10.1186/s12913-023-10536-1
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