The effect of Mobile eHealth Education to Improve Knowledge, Skills, Self-care and Mobile eHealth Literacy among Patients with Diabetes: Mixed methods Study (Preprint)

Abstract

The explosive development and uptake of mobile eHealth technology offer the opportunity for people with chronic conditions to manage their diseases effectively and competently. However, there are literacy-related disparities in the access to eHealth resources and health app use among patients with chronic conditions, including diabetes. The diabetic population with inadequate literacies either has failed to access new technology or used inaccurate health information.

This study aims to develop a mobile eHealth education program for patients with type 2 diabetes to evaluate its effect on patients’ short-and long-term outcomes.

This study adopted a mixed-method design with both a quasi-experimental, a longitudinal approach, an intervention, and a control study site, conducted in three hospitals in Taiwan. The intervention involves the development of two modules of the mobile eHealth educational program to provide instructions on health websites and diabetes apps on iPad devices. A total of 132 patients with type 2 diabetes voluntarily completed the baseline and post-intervention questionnaires as well as the 3-month follow-up measures, assessing sociodemographic characteristics; diabetes status; knowledge and skills of computers, the internet, and mobile apps; mobile eHealth literacy; and patient outcomes (self-care behaviors, hemoglobin A1C).

There were significant differences comparing the mean scores of knowledge (P = 0.008) and skills (P < 0.001) in computer/web/mobile apps following the completion of the intervention. At the 3-month follow-up, the results of repeated measured ANOVA revealed that mobile eHL (P = .001) has significant improvement in the intervention group, but not in the control group. Results indicated trends toward improvement in long-term outcomes. The differences in hemoglobin A1C (HbA1C) levels at the follow-up showed greater reduction in the intervention group. Moreover, the results of effect sizes indicate that the mean increases of mobile eHL, versus the HbA1C measured within the intervention group are stronger than the control group, d = 0.249 vs d = -0.14; d = 0.33 vs d = 0.16, respectively.

This study reinforces the need of patient education on how to access credible health websites, as well as diabetes apps. The findings from this study provide insights into the development of mobile eHealth education, and needed evidence that mobile eHealth education can be an effective mean of enhancing patients’ ability to meet the challenges of new health technology. These results also have the potential to provide greater insight and understanding regarding early expansion of mHealth and eHealth for patients with various chronic conditions. A further suggestion would be to integrate the intervention into clinical practice and diabetes education.

IRB# 17MMHIS003e and CGH-OP105003