Diabetes Self-care Behaviors Research Articles

Glycemic Control and Its Relationship with Diabetes Self-Care Behaviors Among Patients with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study.

BackgroundType 2 diabetes mellitus (T2DM) is a chronic progressive disease that significantly impacts morbidity and mortality worldwide. Glycemic control is central in diabetes management, yet complex and challenging to achieve; it can be affected by various factors. Diabetes self-care behaviors are vital strategies for effective T2DM management.PurposeTo evaluate the levels of glycemic control and diabetes self-care behaviors, and the significance of each behavior on glycemic control among patients with T2DM in Jordan.Patients and MethodsThis cross-sectional study was conducted in medical and endocrinology outpatient clinics of three hospitals in northern Jordan. A convenience sample of 520 patients with T2DM participated in the study. Diabetes self-care behaviors, including diet, exercise, blood glucose testing, taking medication, and foot care behaviors, were measured using the Arabic version of the Summary of Diabetes Self-Care Activities (SDSCA-Arabic) questionnaire. Psychological distress was measured using the Arabic version of the 4-items Patient Health Questionnaire (PHQ-4). Glycated hemoglobin (HbA1c) levels were used to assess glycemic control.ResultsOut of 520 participants, 92.7% (n= 482) had poor glycemic control (HbA1c ≥7%), with a mean of 9.29% (SD=2.06) for HbA1c. The SDSCA overall mean score was 3.25 days (SD=0.88), indicating an unsatisfactory level, with 79.2% of participants having performed self-care activities 4-days/week. Greater adherence to diabetes self-care behaviors was associated with better glycemic control. Exercise was the most important predictor of HbA1c (p<0.001), followed by general diet (p<0.001), specific diet (p<0.001), and blood sugar testing (p<0.001). Moreover, the Body Mass Index (p<0.001), treatment type (p<0.001), and income (p=0.03) were significant predictors.ConclusionThe proportions of poor glycemic control and unsatisfactory self-care behaviors were high among T2DM patients. To enhance patients’ self-care behaviors and lifestyles changes, the patients need tailored diabetes self-care management educational and supportive programs, conducted by qualified diabetes educators using culturally sensitive strategies.

Gestational Diabetes Self-Care Behavior: An Empowerment Educational Intervention Based on BASNEF Model.

Gestational diabetes is a widespread pregnancy-related health problem. Its associated complications can be minimized by empowering women to enhance their self-care behavior. This study aimed to evaluate the effect of an educational intervention using the Beliefs, Attitudes, Subjective Norms, and Enabling Factors (BASNEF) model on Gestational Diabetes Self-Care Behaviors (GD-SCB) among gestational diabetic woman. A randomized controlled clinical trial was performed at the outpatient clinic, El-Shatby hospital, Alexandria, Egypt, on 180 gestational diabetic women (91 intervention and 89 control groups). Data were collected from April to November 2019 using an interviewing schedule involving sociodemographic characteristics and obstetrics/medical history, BASNEF model questionnaire, and gestational diabetes self-care behavior scale. The findings revealed that an absence of statistically significant differences in sociodemographic characteristics and obstetrics/medical history between the intervention and control groups. Two months post-intervention, all BASNEF model subcontracts and total GD-SCB showed significant improvement in the intervention than the control group; knowledge (F1 = 173.92, p < 0.001), personal beliefs (F1 = 286.54, p < 0.001), subjective norms (F1 = 248.82, p < 0.001), behavioral intention (F1 = 235.43, p < 0.001), enabling factors (F1 = 59.71, p < 0.001), and total GD-SCB (F1 = 775.10, p < 0.001). The effect size showed that 48.60% of the improvement within the intervention group total GD-SCB was due to the intervention. Empowerment through education using the BASNEF model for enhancing GD-SCB was effective and beneficial. Therefore, it can serve as a basic framework for constructing and executing educational programs in the field.

Diabetes Self-Care Behaviors and Barriers to Clinical Care During COVID-19 Pandemic for Marshallese Adults.

The purpose of the study was to explore experiences of Marshallese adults related to diabetes self-care behaviors during the COVID-19 pandemic. A qualitative descriptive design was utilized to understand participants' diabetes self-care behaviors during the pandemic. Nine focus groups with 53 participants were held via videoconference and conducted in English, Marshallese, or a mixture of both languages. A priori codes based on diabetes self-care behaviors provided a framework for analyzing and summarizing participant experiences. Both increases and decreases in healthy eating and exercise were described, with improvements in health behaviors attributed to health education messaging via social media. Participants reported increased stress and difficulty monitoring and managing glucose. Difficulty obtaining medication and difficulty seeing their health care provider regularly was reported and attributed to health care provider availability and lack of insurance due to job loss. The study provides significant insight into the reach of health education campaigns via social media and provides important information about the reasons for delays in care, which extend beyond fear of contracting COVID-19 to structural issues.

A Comparison of the Effectiveness of Rational Emotive Behavior Therapy (REBT), and Acceptance and Commitment Therapy (ACT) in Improving Self-Care Behaviors

Aim: The present study aimed to compare the effectiveness of rational emotive behavior therapy (REBT), and acceptance and commitment therapy (ACT) in improving self-care behaviors (nutritional behaviors, physical activity, blood sugar control, foot care, and medication adherence) in people with type 2 diabetes. Methods: The study was quasi-experimental with a pretest-posttest design, two experimental groups, a control group, and the follow-up stage. The statistical population consisted of all female patients with type 2 diabetes with a record in Parsian Clinic in Eslamshahr in 2019. Among them, 45 women were selected using the convenience sampling method and were randomly assigned to two experimental groups (15 per group), and a control group (n=15). The experimental group received acceptance and commitment therapy by Hayes et al. (2004), and the rational emotive behavior therapy (REBT) by Ellis (1999) in eight 60-minute sessions, and the control group was placed on a waiting list. The research tool included the diabetes self-care behavior questionnaire (Tubert and Glasgow, 1994) that was used at three stages, pre-test, post-test, and follow-up. Data were analyzed using repeated-measures analysis of variance. Results: Both interventions could significantly improve self-care behaviors (nutritional behaviors, physical activity, blood sugar control, foot care, and medication adherence) in patients with type 2 diabetes (P&lt;0.05), but the acceptance and commitment therapy intervention had a greater effect on self-care behaviors in patients with type 2 diabetes. Furthermore, there was not any significant difference at the posttest follow-up stage (p&lt;0.05), indicating the stability of intervention changes. Conclusion: Based on the results, acceptance and commitment therapy, and rational emotive behavior therapy (REBT) had effective interventions in increasing self-care behaviors in patients with diabetes.

AACE2021-A-1029: Identifying and Addressing the Determinants That Affect Successful Control of Diabetes Mellitus Type II

Various life variables are known not essential to the advancement of type 2 diabetes including weight, absence of adequate physical action, terrible eating routine, anxiety, and urbanization. A number of dietary factors such as consumption of sugar-sweetened drinks in excess and the type of fats in the diet also appear to play a role. Objectives: Estimating the prevalence of successful control of type 2 diabetes mellitus (DM) and its determinants at Diabetic Centre, Prince Mansur Military Hospital for Community Medicine, Taif, Kingdom of Saudi Arabia A cross-sectional study was adopted. It included adult DM type 2 patients (18-60 years), at (PMFCH), Armed Forces Hospital, Taif region. Successful control of type 2 DM has been defined strictly by achievement of targeted glycemic control glycated hemoglobin (HBA1C) <7. An Arabic self-administered questionnaire was utilized to collect data from patients. It includes demographic data, disease history, and lifestyle (social factors). HBA1C was recorded from the file of the patient. Trained nurse measured the weight (in kg) and height of each patient to calculate body mass index (BMI). Among 370 diabetic patients, 331 returned completed questionnaire giving a response rate of 89.5%. More than one-quarter of them (27.2%) aged over 60 and 48.4% aged between 40 and 60 years. DM was controlled among only 27.5% of the diabetic patients (HBA1C <7%) while it was uncontrolled among most of them (72.5%). In logistic regression analysis, the duration of DM, diabetes treatment, BMI, family support, and compliance with diabetic diet regimen were all significantly related to glycemic control based on HBA1C value. The patients with poor glycemic control were high, which is nearly comparable to that reported from many countries. Longer duration of diabetes, and not adherent to diabetes self-care management behaviors, obesity, combination therapy, and lack of family support were associated with poor glycemic control.

An estimation of diabetes foot self-care based on validated scores: A systematic review and meta-analysis

A diabetic foot ulcer is a preventable complication of diabetes, which could lead to lower extremity amputation and increased mortality and morbidity. Self-care behaviors play a key role in the prevention of diabetic foot ulcers. This study aimed to estimate the total score of diabetic foot self-care behaviors. We searched databases such as Web of Science, Medline (PubMed), and Scopus using various keywords, including diabetic foot, diabetic feet, diabetic problem, diabetic foot ulcer, and self-care, for relevant articles with no time limit. The heterogeneity of the studies was assessed using Cochran's Q test and I2 statistic. Data were analyzed using STATA software version 12 using the meta-analysis method and a random effects model. In total, eight studies were analyzed with a sample size of 2,493. The pooled score of diabetes foot self-care was 62.84% and this score was higher in the studies conducted on two groups of patients with type I and type II diabetes compared to those performed only on patients with type II diabetes. The results also indicated correlation between the self-care score and year of publication (P < 0.001), and the self-care scores significantly declined during 2015–2021 (P < 0.001). Overall, the diabetic foot self-care score was moderate, which highlights the need to provide self-care education to diabetic patients.

Diabetes education and self-care behaviors in patients with diabetes in Mexico

Diabetes education and self-care behaviors in patients with diabetes in Mexico

Effect of Diabetes Self-Management Education (DSME) with and without Motivational Interviewing (MI) on Glycemic Control among Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial

Background: Type 1 diabetes mellitus (T1DM) is a chronic disease that is difficult to control. Motivational interviewing (MI) is a collaborative style of communication that was designed to strengthen a person’s motivation and commitment to change and improve. We hypothesized that applying MI to diabetes care would lead to improved glycemic control and improved diabetes self-care behavior.&#x0D; Methods: Subjects were T1DM patients aged 10-18 years with HbA1C ≥8% that were recruited from the Outpatient Diabetes Clinic during October 2016 - March 2017. Subjects were randomized into the diabetes self-management education (DSME) or DSME plus MI groups. HbA1C levels, diabetes knowledge test, and diabetes self-care behavioral questionnaire were performed.&#x0D; Results: Thirty-five patients (17 DSME, 18 DSME + MI) completed the study. Baseline HbA1C was not significantly different between groups. At the end of the study, HbA1C levels were not significantly different within or between groups. From pre-intervention to post-intervention, diabetes knowledge scores were significantly increased, and self-care behavioral scores were significantly increased for dietary control and medical taking. Transition to the stages of change action stage was increased from 0 to 12 persons.&#x0D; Conclusions: The effectiveness of MI on glycemic control was not found to be statistically significant at 6 months. However, continuation of DSME in T1DM patients is necessary for improving diabetes knowledge and care. Further study in a larger sample size with longer duration of MI and follow-up is needed to conclusively establish the value of MI on glycemic control in pediatric T1DM.

Self-Instructional Training Application on Diabetic Patients' Self-Care Behaviors

Background: The diabetes mellitus cases have significantly increased in Indonesia over recent years. Health education for patients has often been carried out; however, education using self-instructional methods, which provided self-learning to solve problems by adjusting the patient's ability to improve self-care behaviors, has not been widely used.Purpose: This study aimed to analyze the self-care behaviors of diabetic patients with the application of self-instructional training.Methods: This research was a quasi-experimental study with a non-equivalent pretest-posttest with a control group design. The participants were 73 diabetic patients in the out-patient units selected by a purposive sampling technique, and divided into two groups: the intervention group (n=37) and the control group (n=36). The intervention group received a self-instructional training program which was carried out in two sessions using a booklet; each session lasted for 45 minutes. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire was used to collect diabetic patients' self-care behavior data. Wilcoxon and Mann-Whitney tests were employed for data analysis.Results: Self-care behaviors of patients with diabetes mellitus increased before and after the training in both groups (p=0.000). However, the increase in the intervention group was higher than that in the control group, from 46.46±5.014 to 58.03±7.320 and from 47.78±4.929 to 51.64±6.406, respectively. There was also a significant difference in the self-care behaviors of diabetic patients between the intervention group and the control group (p=0.000).Conclusion: Self-instructional training significantly improves self-care behaviors of diabetic patients. Therefore, self-instructional training can be considered to apply in the clinical setting for improving self-care behaviors of diabetic patients to prevent complications, and for enhancing nursing care of diabetes mellitus.

‘Never again will I be carefree’: a qualitative study of the impact of hypoglycemia on quality of life among adults with type 1 diabetes

IntroductionAchieving glycemic targets and optimizing quality of life (QoL) are important goals of type 1 diabetes care. Hypoglycemia is a common barrier to achieving targets and can be associated with...

Diabetes Self-Management Education and Support to Improve Outcomes for Children and Young Adults With Type 1 Diabetes: An Umbrella Review of Systematic Reviews.

The objectives of this umbrella review were to describe various aspects of diabetes self-management education and support (DSMES)-related interventions and their effect on clinical, behavioral, and psychosocial outcomes among children and young adults with type 1 diabetes (T1DM) and identify gaps in current DSMES-related research. An umbrella review of systematic reviews on DSMES interventions was conducted in accordance with the PRISMA 2009 statement. Four international medical databases were searched for eligible review articles published in English in the last 10 years that dealt with children and youths with T1DM and were conducted in accordance with a priori protocol. Out of the 234 citations screened, only 8 systematic reviews representing 166 studies were considered eligible for further analysis. Glycemic management (A1C) is the most common outcome variable (108 studies). Common behavioral and psychosocial outcome variables examined are episodes of hypoglycemia (27 studies) and diabetic ketoacidosis (21 studies) and self-care behavior and generic quality of life (20 studies each). Several gaps in DSMES-related research studies are identified, including uneven geographical distribution of study population, methodological weaknesses in study designs, missing important outcome variables, use of nonstandardized assessment tools, and lack of assessment of the sustainability of effects. The effects of DSMES interventions on clinical, behavioral, and psychosocial outcomes are varied. The heterogeneity of implementation and evaluation makes it difficult to draw clear conclusions about elements of DSMES that are most effective. There is a need for long-term assessment of the psychosocial and behavioral outcomes using validated and generalizable instruments.

Exploring the Relationship of Health Beliefs and Self-Care Behaviors Related to Diabetic Foot Ulcers of Type II Diabetes Mellitus Patients: A Cross-Sectional Study.

Objective: Diabetic foot ulcers are an invasive complication of diabetes and are increasing. This study investigates the relationship between health beliefs and foot self-care behaviors, among people with type II diabetes. Methods: A cross-sectional design was adopted, and 98 patients were recruited from outpatient clinics of the endocrine department. The questionnaires of Demographic, Diabetes Foot Ulcer Health Belief Scale (Health Beliefs, DFUHBS), and Diabetes Foot Self-Care Behavior Scale (Self Care, DFSBS) were used to collect data. Results: Among the subjects living alone or who had diabetes less than ten years, the score of DFSBS was significantly lower than among those living with families or who had diabetes for ten years or more. The frequency of performing diabetes foot self-care behavior, among males was lower than among females significantly. Although there was no significant difference in the Health Belief total score, there were differences in the benefit subscale. Those who had junior high school level or less or had diabetes less than ten years, their score was significantly lower than those with senior high school level or more or had diabetes ten years or more. In a multivariable regression model, living with family, diabetes duration, and health beliefs explained 42.9% of the variance of diabetic-foot self-care behaviors. Conclusions: Living alone, shorter duration of diabetes, male gender, and lower health belief scores predict less adequate diabetic foot self-care behavior. Health care providers should assess these factors when designing individual care plans.

The experience of type 2 diabetes: Application of the Model of Human Occupation

Introduction Integrating type 2 diabetes (T2DM) self-care behaviors into daily life is complex and poorly understood. Occupational therapists, as experts in life context, habits, roles, and routines, can foster new ways of understanding and promoting daily engagement in T2DM self-care. The Model of Human Occupation (MOHO), a conceptual practice model, may have applicability to better understanding the experience of living with T2DM and engaging in necessary self-care behaviors. Methods We conducted focus group interviews with individuals with T2DM ( n = 10). We applied the MOHO to understand the experience of living with T2DM and engaging in related self-care behaviors. Findings Participants discussed each element of MOHO and how it related to living with and managing type 2 diabetes. Participants identified obtaining skills for self-advocacy with family, individualized/adapted exercise, stable health-promoting environments and routines, and problem-solving skills for disruptions to routine as critical needs for managing T2DM. These intervention strategies are well-aligned with MOHO and occupational therapy practice. Conclusion We found that MOHO was a useful tool for exploring the experience and daily management of T2DM.

Glycaemic control mediates the relationships of employment status and self-stigma with self-care behaviours in young adults with type 2 diabetes.

To investigate the relationships of sociodemographic factors, self-stigma, glycaemic control (measured by glycated haemoglobin (A1C)) and self-care behaviours in young adults with type 2 diabetes. Young adults aged 25-44years are in their most productive period. Once diagnosed with diabetes, this population tends to experience poor glycaemic control and perform poorly in self-care activities. Such patterns may raise perceptions of self-stigma and further decrease motivations to engage in self-care behaviours in patients with diabetes. A cross-sectional, correlational research design. The STROBE guidelines for cross-sectional studies were followed. A convenience sample of 115 participants was recruited from a medical centre in southern Taiwan. Instruments included the Self-Stigma Scale-Chinese version and the Diabetes Self-Care Behaviours Scale. Data were analysed using a three-step hierarchical regression analysis and the Sobel test. The average age of the participants was 36.7years. Marital status, employment status, self-stigma and A1C were significantly associated with self-care behaviours, and these four variables explained 43.6% of the variance in self-care behaviours. However, A1C (β=-.58, p<.001) was found to be the only determinant of self-care behaviours in the last regression model. The Sobel test showed that A1C had mediating effects on self-stigma and self-care behaviours as well as employment status and self-care behaviours. This study supports the interactive relationship among self-stigma, employment status, glycaemic control and self-care behaviours in young adults with type 2 diabetes. Strategies aimed at optimising glycaemic control can help reduce the effects of self-stigma perceptions and employment status on the self-care behaviours of such patients. More effective educational programmes should be designed to improve glycaemic control, lower the effects of employment and decrease perceptions of self-stigma to further motivate young adults to engage in better diabetes self-care behaviours.

Determinants of adherence to dietary guidelines among Type 2 Diabetes Mellitus patients at Moi Teaching and Referral Hospital-Kenya

Diabetes is one of the major non-communicable diseases and an important public health problem not only in Kenya but all over the world. It is estimated that the prevalence of diabetes in Kenya is at 5% among adults. Although the care regimen is complex, patients with good diabetes self-care behaviors can attain excellent glycemic control. It is vital that patients adhere to their stipulated routines to minimize the burden of the disease on the healthcare systems. The objective of this study was to determine the association between socio-economic and demographic factors with adherence to dietary guidelines among Type 2 diabetes mellitus (DM) patients in Moi Teaching and Referral Hospital (MTRH), Eldoret. A cross-sectional study with mixed methods was conducted among 313 Type 2 DM patients at MTRH. Systematic random sampling was used to select the participants,while purposive sampling was used to select 6 key informants and 50 patients who participated in a Focus Group Discussion (FGD). Data were analyzed using descriptive and inferential statistics. Adherence to dietary guidelines was significantly associated with income (p&lt; 0.001) and the frequency of attending clinics (p=0.001).Education levels (p= 0.634), Occupation(p=0.358) and Age (p=0.737) had no significant association with dietary adherence. Better ways should be explored in enhancing adherence to dietary guidelines for Type 2 DM patients with high income levels. The study findings are useful in informing implementation and evaluation of nutrition strategies for the control and management of Type 2 DM. This includes nutrition counseling and education,which would inform decisions leading to optimal quality care and cost-effectiveness in the management of Type 2DM.

Association between subthreshold depression and self-care behaviours in adults with type 2 diabetes: A cross-sectional study.

The aim of the study was to test the association between subthreshold depression and self-care behaviours in adults with type 2 diabetes (T2D) attending a tertiary healthcare service. Suboptimal adherence to self-care behaviours is associated with poor glycaemic control. The estimated point prevalence of subthreshold depression in people with T2D is 17%. Two previous studies have examined the association between subthreshold depression and self-care behaviours in T2D, reported observations were inconsistent. A cross-sectional observational study. We surveyed adults with T2D attending a tertiary healthcare facility in Nepal. Self-care behaviours and subthreshold depression were assessed using the Summary of Diabetes Self-care Activities and the Patient Health Questionnaire-9, respectively. We used linear and logistic regression to test the association of subthreshold depression with total and individual self-care behaviours. Our reporting complies with STROBE reporting guideline for observational research. Just over a third (37%) of the participants had subthreshold depression. People with subthreshold depression had slightly lower total diabetes self-care score compared to those with no depression. More than half of participants with subthreshold depression had suboptimal adherence to diet, physical activity and foot care. Subthreshold depression was associated with total self-care score (B=-0.27, 95% CI: -0.54, -0.01). In addition, association between subthreshold depression and diet adherence was observed (AOR=0.26, 95% CI: 0.15, 0.44). Subthreshold depression is associated with decreased adherence to self-care behaviour in people with T2D. Identification and treatment of subthreshold depression in T2D may lead to better adherence to diabetes self-care behaviours. The recognition and treatment of subthreshold depression warrants further investigation as a strategy to improve the adherence to self-care behaviours.

The Effect of Peers Support on Fear of Hypoglycemia in Iranian Patients with Type 1 Diabetes: A Clinical Trial Study.

Background:Fear of hypoglycemia is a medical emergency which leads to disrupt individuals' normal lives. Peers support is a hopeful approach to improve diabetes self-care behaviors. This study was conducted to assess the effect of peers support on the fear of hypoglycemia in patients with type 1 diabetes.Materials and Methods:This randomized clinical trial study was performed among 60 patients with type 1 diabetes in Qazvin city from September 2019 to October 2020. Patients were assigned to control and intervention groups using a random method. The data collection tools included demographic characteristics and a standard questionnaire for Hypoglycemia Fear Survey (HFS). Patients in the intervention group were trained by skilled peers for 2 months, but those of the control group only received routine hospital training. The data were analyzed by SPSS version 16 and paired and independent t-test.Results:The scores of the fear of hypoglycemia in diabetic patients in the two groups had no significant statistical difference before intervention (t53 = 0.93, p = 0.94). But after the intervention, the independent t-test showed that there was a significant difference between the scores of the fear of hypoglycemia in both groups (t53 = -2.13, p = 0.03).Conclusions:Considering the results of the current study, peer support for diabetic patients is an effective way to reduce the fear of hypoglycemia. Therefore, it is recommended using this training method to train diabetic patients.

Examining the Relationship Between Delay Discounting, Delay Aversion, Diabetes Self-care Behaviors, and Diabetes Outcomes in U.S. Adults With Type 2 Diabetes.

Delay discounting and delay aversion are emerging areas for understanding diabetes management; however, few data exist on their relationship with multiple diabetes self-care behaviors and diabetes outcomes. This cross-sectional study included 356 adults with type 2 diabetes across three racial/ethnic groups receiving care from two primary care clinics. The primary predictors were delay discounting and delay aversion. Outcomes included self-care behaviors, quality of life (QOL; mental health component score [MCS], physical component score), and A1C. Multiple linear regression models were run to examine the association between predictors and the outcomes, A1C, QOL, and each self-care behavior. Higher delay discounting was associated with lower engagement in self-care behaviors for general diet (B = -0.06; 95% CI -0.12; -0.01), specific diet (B = -0.07; 95% CI -0.12; -0.03), and foot care (B = -0.10; 95% CI -0.17; -0.02). Higher delay aversion was associated with lower engagement in self-care behaviors for general diet (B = -0.06; 95% CI -0.10; -0.01), specific diet (B = -0.03; 95% CI -0.07; -0.01), foot care (B = -0.11; 95% CI -0.17; -0.05), and lower MCS (B = -0.38; 95% CI -0.71; -0.06). In a diverse sample of adults with type 2 diabetes, higher delay discounting and higher delay aversion were significantly related to lower engagement in self-care behaviors. High delay aversion was specifically related to lower QOL. These findings offer new knowledge by highlighting the role that delay-related behaviors may have in the performance of self-care behaviors and the impact on QOL. Work is needed to further elucidate these relationships. Specifically, these results highlight the importance of targeting value and decision-making for diabetes self-management.

User Engagement With Smartphone Apps and Cardiovascular Disease Risk Factor Outcomes: Systematic Review.

BackgroundThe use of mobile health (mHealth) interventions, including smartphone apps, for the prevention of cardiovascular disease (CVD) has demonstrated mixed results for obesity, hypercholesterolemia, diabetes, and hypertension management. A major factor attributing to the variation in mHealth study results may be mHealth user engagement.ObjectiveThis systematic review aims to determine if user engagement with smartphone apps for the prevention and management of CVD is associated with improved CVD health behavior change and risk factor outcomes.MethodsWe conducted a comprehensive search of PubMed, CINAHL, and Embase databases from 2007 to 2020. Studies were eligible if they assessed whether user engagement with a smartphone app used by an individual to manage his or her CVD risk factors was associated with the CVD health behavior change or risk factor outcomes. For eligible studies, data were extracted on study and sample characteristics, intervention description, app user engagement measures, and the relationship between app user engagement and the CVD risk factor outcomes. App user engagement was operationalized as general usage (eg, number of log-ins or usage days per week) or self-monitoring within the app (eg, total number of entries made in the app). The quality of the studies was assessed.ResultsOf the 24 included studies, 17 used a randomized controlled trial design, 4 used a retrospective analysis, and 3 used a single-arm pre- and posttest design. Sample sizes ranged from 55 to 324,649 adults, with 19 studies recruiting participants from a community setting. Most of the studies assessed weight loss interventions, with 6 addressing additional CVD risk factors, including diabetes, sleep, stress, and alcohol consumption. Most of the studies that assessed the relationship between user engagement and reduction in weight (9/13, 69%), BMI (3/4, 75%), body fat percentage (1/2, 50%), waist circumference (2/3, 67%), and hemoglobin A1c (3/5, 60%) found statistically significant results, indicating that greater app user engagement was associated with better outcomes. Of 5 studies, 3 (60%) found a statistically significant relationship between higher user engagement and an increase in objectively measured physical activity. The studies assessing the relationship between user engagement and dietary and diabetes self-care behaviors, blood pressure, and lipid panel components did not find statistically significant results.ConclusionsIncreased app user engagement for prevention and management of CVD may be associated with improved weight and BMI; however, only a few studies assessed other outcomes, limiting the evidence beyond this. Additional studies are needed to assess user engagement with smartphone apps targeting other important CVD risk factors, including dietary behaviors, hypercholesterolemia, diabetes, and hypertension. Further research is needed to assess mHealth user engagement in both inpatient and outpatient settings to determine the effect of integrating mHealth interventions into the existing clinical workflow and on CVD outcomes.

The effect of peer group on self-care behaviors and glycemic index in elders with type II diabetes.

BACKGROUND:Diabetes is one of the most expensive and chronic diseases of elderly age. Knowledge and self-care behaviors play an important role in treating diabetes and preventing its side effects. This study aimed to investigate the effect of peer group on self-care behaviors and glycemic index in the elderly with type II diabetes mellitus in Fasa city, Fars province.MATERIALS AND METHODS:This quasi-experimental study was conducted on 100 elderly patients with type II diabetes (50 patients in the intervention group and 50 in control group) referred to the diabetes center. Among the elderly, the intervention group was selected as a trainer based on the checklist of the peer group and was trained by the researcher. In addition to the usual care of the diabetes clinic, the patients in the intervention group received training from their peers for 8 weeks during 8–45 min of training sessions. Data were collected using a valid self-reported questionnaire including demographic variables, awareness, and diabetes self-care behaviors (Summary of Diabetes Self-care Activities), as well as free practice (fasting blood sugar [FBS] and hemoglobin A1c [HbA1c]), which was completed by both groups before and 2 months after the intervention. Then, the data were entered into the SPSS statistical software, version 22 and were analyzed using Chi-square test, independent t-test, and descriptive statistical methods. P < 0.05 was considered statistically significant.RESULTS:The results showed that the two groups of intervention and test were identical in terms of demographic information. In the intervention group, before and after 2 months of educational intervention, there was a significant difference in increasing awareness and self-care behavior in diet, physical activity, blood sugar testing, foot care, and medication (P < 0.001). However, this difference was not significant in the control group (P < 0.05). In the intervention group, the mean FBS and quarterly (HbA1c) index decreased significantly (P < 0.05).CONCLUSION:This study showed that teaching self-care program, in the same way, has been effective in improving self-care behavior and blood sugar index in the elderly with diabetes and suggested that this educational method be used in other chronic diseases.