Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jun 20, 2022
Date Accepted: Mar 1, 2023
Effectiveness of an eHealth family-based intervention program in patients with uncontrolled type 2 diabetes mellitus (T2DM) in the community via WeChat: A randomized controlled trial in Shanghai, China
ABSTRACT
Background:
Community health service centers are facing great challenges in managing patients with poorly controlled type 2 diabetes. Social support and particularly family support has a strong association with type 2 diabetes patients’ self-management behaviors . Implement intervention focus on family or via mobile phone was comfirmed an effective way to improve the patients’ situation of poorly type 2 diabetes control.
Objective:
The objective of this randomized controlled trial (RCT) was to assess the effectiveness of mhealth and ehealth interventions based on family support and risk perception for family members in patients with poorly controlled diabetes via WeChat to provide evidence for community-based type 2 diabetes management.
Methods:
This single-centre, two-parallel-group RCT was conducted between 2019 and 2020. Overall, 228 patients were recruited from Jiading District, Shanghai, and randomly divided into the intervention and control groups. The intervention group received a mhealth and ehealth family intervention based on community management via WeChat, whereas the control group received routine management. The primary outcome was patients’ haemoglobin A1c (HbA1c), and the secondary outcomes were self-management behaviour, risk perception, and family support. A paired-sample t-test was used to compare the baseline and follow-up within control and intervention group, and difference-in-difference model was used to measure the difference between control and intervention group.
Results:
Results:
In total, 225 patients were followed up for 1 year. In the intervention group, the HbA1c decreased from 7.9% to 7.3% (62.87 mmol/mol to 56.30 mmol/mol) after the intervention (P<.001), and the score of general diet, specific diet, exercise, blood sugar testing, foot care, risk knowledge, personal control, worry, optimism bias, supporive behaviours and non-supportive behavipurs were better after the intervention (P<0.001, P<.001, P=.002, P=.02, P<.001, P<.001, P<.001,P=.02, P=.03, P<.001, P=.03, respectively). In the control group, there were no significant differences in any of the indicators, except for general diet (P=.002). The difference-in-difference model demonstrated that the intervention had an influence on HbA1c (β=-.750, P<.001; β=-.201, P<.001), specific diet (β=.944, P=.002), foot care (β=.445, P=.001), risk knowledge (β=.874, P<.001), personal control (β=.253, P<0.001), worry (β=.235, P=.04) and supportive behaviours (β=5.773, P<.001). Additionaly, they and other aspects also got influenced by patients’ sex and age and family members’ education and identity.
Conclusions:
The mhealth and ehealth family-based intervention in community based on risk perception are effective to enhance self-management support of uncontrolled type 2 diabetes patient. Clinical Trial: ChiCTR1900020736. Registered 15 January 2019.
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