Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Oct 12, 2019
Date Accepted: Dec 15, 2019
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Nurse Coaching and mHealth compared to Usual Care to Improve Diabetes Self-Efficacy: A Randomized Controlled Trial
ABSTRACT
Background:
This study addressed the growing public health problem of Type-2 diabetes (T2DM) and its complications. Physical activity and nutritional intake can influence health for persons with Type 2 diabetes; however, traditional approaches have not been sufficient to improve health in patients with diabetes.
Objective:
To evaluate the effectiveness of a nurse coaching program using motivational interviewing paired with mobile health technology on diabetes self-efficacy and self-management for persons with type 2 diabetes.
Methods:
This randomized control trial compared usual care to the intervention. Inclusion criteria were: 1) enrolled at one of three primary care clinics; 2) 18 years or older; 3) living with type 2 diabetes; and 4) English-speaking. We collected outcome measures at baseline, 3 months and 9 months. The primary outcome was diabetes self-efficacy; secondary outcomes were: depressive symptoms, perceived stress, physical functioning and emotional distress anxiety. Linear regression mixed modeling estimated population trends and individual differences in change.
Results:
We enrolled 319 participants; 287 participants completed the study (155 control and 132 intervention). Participants in the intervention had significant improvements in diabetes self-efficacy and a decrease in depressive symptoms compared to usual care at 3 months, with no differences in the other outcomes. The differences in self-efficacy and depression scores between the two arms at 9-months were not sustained. Participants in the intervention demonstrated a significant increase in physical activity (from 23,770 steps per week to 39,167 steps at 3 months, and 32,601 at 9 months).
Conclusions:
This study demonstrated the short-term effectiveness of an innovative diabetes intervention using nurse health coaching and mHealth technology on diabetes self-efficacy, depressive symptoms, and improving physical activity. However, by 6 months post-intervention (final data measurement after 9 months), while physical activity remained above baseline, the differences in self-efficacy and depressive symptoms were not sustained. There were no improvements in the PROMIS measures of physical activity and emotional distress anxiety. Further research should address the connection between self-efficacy and improvements in clinical outcomes, such as A1C, evaluating the minimum dose of coaching required to continue progress after the active intervention period, and the potential of technology to provide effective ongoing automated prompts and reinforcement for behavior change. Clinical Trial: This trial was registered in January 2016 on at ClinicalTrials.gov, #NCT02672176
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.