Evaluating Self-Management Behaviors of Diabetic Patients in a Telehealthcare Program: Longitudinal Study Over 18 Months

• Published in: Journal of medical Internet research Vol. 15; no. 12; p. e266
• Main Authors: Chen, Lichin, Chuang, Lee-Ming, Chang, Chia-Hsiun, Wang, Chiou-Shiang, Wang, I-Ching, Chung, Yufang, Peng, Hui-Yu, Chen, Hui-Chuen, Hsu, Yu-Ling, Lin, Yu-Sheng, Chen, Huang-Jen, Chang, Tieng-Chun, Jiang, Yi-Der, Lee, Hung-Chang, Tan, Ching-Ting, Chang, Hsin-Lu, Lai, Feipei
• Format: Journal Article
• Language: English
• Published: Canada Journal of Medical Internet Research 01.12.2013; Gunther Eysenbach MD MPH, Associate Professor; JMIR Publications Inc; JMIR Publications
• Subjects: Activities of daily living; Adult; Behavior change; Behavior Modification; Behaviour modification; Blood; Blood Glucose Self-Monitoring; Blood pressure; Blood sugar; Blood sugar monitoring; Caregivers; Clinical outcomes; Continuity of care; Coping; Data encryption; Data transmission; Development and progression; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - psychology; Diabetes Mellitus, Type 1 - therapy; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - psychology; Diabetes Mellitus, Type 2 - therapy; Diabetics; Disease management; Drugs; Education; Electronic media; Female; Glucose; Glucose metabolism; Glycaemic control; Glycated Hemoglobin - metabolism; Glycemic control; Haemoglobin; Health Behavior; Health care; Healthy food; Heart rate; Hemoglobin; Hospitals; Hospitals, University; Humans; Information systems; Information technology; Internet; Interoperability; Intervention; Laboratories; Longitudinal Studies; Male; Management development programmes; Managerial skills; Medical research; Medicine, Experimental; Middle Aged; Modification; Original Paper; Patient Education as Topic; Patient Participation; Patients; Personal health; Pilot Projects; Problem solving; Self Care; Selfmanagement; Taiwan; Telecommunications; Telemedicine; Telemedicine - methods; Text messaging; Type 2 diabetes; Variability; Taiwan; patient access to records; telemedicine; personal health record; diabetes mellitus; Internet; online systems; self-care
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/jmir.2699

Self-management is an important skill for patients with diabetes, and it involves frequent monitoring of glucose levels and behavior modification. Techniques to enhance the behavior changes of diabetic patients have been developed, such as diabetes self-management education and telehealthcare. Although the patients are engaged in self-management activities, barriers to behavior changes remain and additional work is necessary to address the impact of electronic media and telehealthcare on patient self-care behaviors. The aims of this study were to (1) explore the behaviors of diabetic patients interacting with online applications, (2) determine the impact of a telehealthcare program among 7 self-care behaviors of the patients, and (3) determine the changes in glycosylated hemoglobin (HbA1c) levels. A telehealthcare program was conducted to assist the patients with 7 self-care activities. The telehealthcare program lasted for 18 months and included the use of a third-generation mobile telecommunications glucometer, an online diabetes self-management system, and a teleconsultant service. We analyzed the data of 59 patients who participated in the telehealthcare program and 103 who did not. The behavioral assessments and the HbA1c data were collected and statistically analyzed to determine whether the telehealthcare services had an impact on the patients. We divided the 18-month period into 3 6-month intervals and analyzed the parameters of patients assisted by the telehealthcare service at different time points. We also compared the results of those who were assisted by the telehealthcare service with those who were not. There was a significant difference in monitoring blood glucose between the beginning and the end of the patient participation (P=.046) and between the overall period and the end of patient participation (P<.001). Five behaviors were significantly different between the intervention and control patients: being active (P<.001), healthy eating (P<.001), taking medication (P<.001), healthy coping (P=.02), and problem solving (P<.001). Monitoring of blood glucose was significantly different (P=.02) during the 6-12 month stage of patient participation between the intervention and control patients. A significant difference between the beginning and the 6-12 month stage of patient participation was observed for the mean value of HbA1c level (P=.02), and the differences between the overall HbA1c variability and the variability of each 6-month interval was also significant. Telehealthcare had a positive effect on diabetic patients. This study had enhanced blood glucose monitoring, and the patients in the program showed improvements in glycemic control. The self-care behaviors affect patient outcomes, and the changes of behavior require time to show the effects.