The impact of a self-management educational program coordinated through WhatsApp on diabetes control
Background: Social media can effectively mediate digital health interventions and thus, overcome barriers associated with face-to-face interaction.
Objective: To assess the impact of patient-centered diabetes education program administered through WhatsApp on glycosylated hemoglobin (HbA1c) values, assess the correlation, if any, between health literacy and numeracy on intervention outcomes
Methods: During an ‘intervention phase’ spread over six months, target diabetic patients (N=109) received structured education through WhatsApp as per the American Association of Diabetes Educators Self-Care Behaviors recommendations. The control group with an equal number of participants received ‘usual care’ provided by health professionals void of the social media intervention. Changes in HbA1c levels were recorded thrice (at baseline, 3 and 6 months) for the test group and twice (baseline and 6 months) for the control group. Change in HbA1c values were compared and statistical significance was defined at p<0.05. Baseline health literacy and diabetes numeracy were assessed for both groups (N=218) using the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT), respectively, and values were correlated with HbA1c change p<0.05. Participants’ satisfaction with the intervention was also assessed.
Results: The average age of respondents was 41.98 (SD 15.05) years, with a diabetes history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively. After six months, a significant drop in HbA1c value was noticed in intervention group (7.7; SD 1.35; p= 0.001); with no significance in the control group (8.4; SD 1.32; p=0.032, paired t-test). Moreover, the reduction in HbA1c was more in the test group (0.7%) than the control group (0.1%) with a difference of 0.6% which is considered clinically significant. There was no significant correlation between LAD score and HbA1c at baseline (r=-0.203, p=0.064), 3 months (r=-0.123, p=0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar result was observed with DNT, where DNT score and HbA1c at baseline, 3 months and 6 months showed no correlation (r=0.112, 0.959 and 0.886; respectively) with HbA1c levels. Eighty percent of the respondents found the social media intervention ‘beneficial’ and suggested it be used long term.
Conclusions: Diabetes education via WhatsApp showed promising outcomes regardless of the level of patients’ health literacy or numeracy.
Kitsiou S, Pare G, Jaana M, Gerber B. Effectiveness of mHealth interventions for patients with diabetes: an overview of systematic reviews. PLoS One. 2017;12(3):e0173160. https://doi.org/10.1371/journal.pone.0173160
International Diabetes Federation. IDF Diabetes Atlas, 8th edn. Brussels: International Diabetes Federation;2017. Available at https://diabetesatlas.org/IDF_Diabetes_Atlas_8e_interactive_EN/ (accessed Feb 1, 2019).
Alanzi T. Role of social media in diabetes management in the Middle East region: systematic Review. J Med Internet Res. 2018;13;20(2):e58–e58. https://doi.org/10.2196/jmir.9190
Gabarron E, Arsand E, Wynn R. Social media use in interventions for diabetes: rapid evidence-based review. J Med Internet Res. 2018;20(8):e10303. https://doi.org/10.2196/10303
Pal K, Dack C, Ross J, Michie S, May C, Stevenson F, Farmer A, Yardley L, Barnard M, Murray E. Digital health interventions for adults with type 2 diabetes: qualitative study of patient perspectives on diabetes self-management education and support. J Med Internet Res. 2018;20(2):e40. https://doi.org/10.2196/jmir.8439
Toma T, Athanasiou T, Harling L, Darzi A, Ashrafian H. Online social networking services in the management of patients with diabetes mellitus: systematic review and meta-analysis of randomised controlled trials. Diabetes Res Clin Pract. 2014;106(2):200-211. https://doi.org/10.1016/j.diabres.2014.06.008
Cooper A. New dawn: the role of social media in diabetes education. J Diabetes Nurs. 2014;18(2):68–71.
Quinn CC, Butler EC, Swasey KK, Shardell MD, Terrin MD, Barr EA, Gruber-Baldini AL. Mobile diabetes intervention study of patient engagement and impact on blood glucose: mixed methods analysis. JMIR Mhealth Uhealth. 2018;6(2):e31. https://doi.org/10.2196/mhealth.9265
Whitley HP, Fermo JD, Ragucci KR, Chumney EC. Assessment of patient knowledge of diabetic goals, self-reported medication adherence, and goal attainment. Pharm Pract (Granada). 2006;4(4):183. https://doi.org/10.4321/s1885-642x2006000400006
Adisa R, Alutundu MB, Fakeye TO. Factors contributing to nonadherence to oral hypoglycemic medications among ambulatory type 2 diabetes patients in Southwestern Nigeria. Pharm Pract (Granada) 2009;7(3):163-169. https://doi.org/10.4321/s1886-36552009000300006
Petrovski G, Zivkovic M, Stratrova SS. Social media and diabetes: can facebook and skype improve glucose control in patients with type 1 diabetes on pump therapy? One-year experience. Diabetes Care. 2015;38(4):e51-e52. https://doi.org/10.2337/dc14-2487
Ventola CL. Social media and health care professionals: benefits, risks, and best practices. P T. 2014;39(7):491-520.
Veazie S, Winchell K, Gilbert J, Paynter R, Ivlev I, Eden K, Nussbaum K, Weiskopf N, Guise J-M, Helfand M. Mobile applications for self-management of diabetes. Technical Brief No. 31. Rockville, MD: Agency for Healthcare Research and Quality; 2018.
Qin L, Xu H. A cross-sectional study of the effect of health literacy on diabetes prevention and control among elderly individuals with prediabetes in rural China. BMJ Open. 2016;6(5):e011077. https://doi.org/10.1136/bmjopen-2016-011077
Moss TR. The impact of health literacy on clinical outcomes for adults with type 2 Diabetes Mellitus. Adv Diabetes Metab. 2014;2(1):10–9. https://doi.org/10.13189/adm.2014.020103
Hussein SH, Almajran A, Albatineh AN. Prevalence of health literacy and its correlates among patients with type II diabetes in Kuwait: A population-based study. Diabetes Res Clin Pract. 2018;141:118-125. https://doi.org/10.1016/j.diabres.2018.04.033
White RO, Wolff K, Cavanaugh KL, Rothman R. Addressing health literacy and numeracy to improve diabetes education and care. Diabetes Spectr. 2010;23(4):238-243. https://doi.org/10.2337/diaspect.23.4.238
Haun JN, Valerio MA, McCormack LA, Sorensen K, Paasche-Orlow MK. Health literacy measurement: an inventory and descriptive summary of 51 instruments. J Health Commun. 2014;19(Suppl 2):302-333. https://doi.org/10.1080/10810730.2014.936571
Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns. 2003;51(3):267-275. https://doi.org/10.1016/s07383991(02)00239-2
Nath CR, Sylvester ST, Yasek V, Gunel E. Development and validation of a literacy assessment tool for persons with diabetes. Diabetes Educ. 2001;27(6):857-864. https://doi.org/10.1177/014572170102700611
Hasan S, Mahameed S, AlHariri Y. Translation and culture adaptation of the simplified diabetes knowledge test, the literacy assessment for diabetes and the diabetes numeracy test. Res Soc Adm Pharm. 2019 [Epub ahead of print]. https://doi.org/10.1016/j.sapharm.2019.11.003
Huizinga MM, Elasy TA, Wallston KA, Cavanaugh K, Davis D, Gregory RP, Fuchs LS, Malone R, Cherrington A, Dewalt DA, Buse J, Pignone M, Rothman RL. Development and validation of the diabetes numeracy test (DNT). BMC Health Serv Res. 2008;8:96. https://doi.org/10.1186/1472-6963-8-96
Alanzi T, Istepanian R, Philip N. Design and usability evaluation of social mobile diabetes management system in the gulf region. JMIR Res Protoc. 2016 Sep 26;5(3):e93–e93. https://doi.org/10.2196/resprot.4348
American Association of Diabetes Educators. AADE7 Self-Care Behaviors. 2019. Available from: https://www.diabeteseducator.org/living-with-diabetes/aade7-self-care-behaviors#.XagszI1hKJU.mendeley (accessed Sep 22, 2019)
Benetoli A, Chen TF, Aslani P. The use of social media in pharmacy practice and education. Res Social Adm Pharm. 2015;11(1):1-46. https://doi.org/10.1016/j.sapharm.2014.04.002
Alkhateeb FM, Clauson KA, Latif DA. Pharmacist use of social media. Int J Pharm Pract. 2011;19(2):140-142. https://doi.org/10.1111/j.2042-7174.2010.00087.x
Grindrod K, Forgione A, Tsuyuki RT, Gavura S, Giustini D. Pharmacy 2.0: a scoping review of social media use in pharmacy. Res Social Adm Pharm. 2014;10(1):256-270. https://doi.org/10.1016/j.sapharm.2013.05.004
Benetoli A, Chen TF, Schaefer M, Chaar B, Aslani P. Do pharmacists use social media for patient care?. Int J Clin Pharm. 2017;39(2):364-372. https://doi.org/10.1007/s11096-017-0444-4
O’Hara B, Fox BI, Donahue B. Social media in pharmacy: heeding its call, leveraging its power J Am Pharm Assoc (2003). 2013;53(6):565. https://doi.org/10.1331/JAPhA.2013.13536
Standards of medical care in diabetes. American Diabetes Association, 2014. Diabetes Care. 2014;37(Suppl 1):S14-S80. https://doi.org/10.2337/dc14-S014
Williams G, Hamm MP, Shulhan J, Vandermeer B, Hartling L. Social media interventions for diet and exercise behaviours: a systematic review and meta-analysis of randomized controlled trials. BMJ Open. 2014;4(2):e003926. https://doi.org/10.1136/bmjopen-2013-003926
Döğer E, Bozbulut R, Soysal Acar AŞ, Ercan Ş, Kılınç Uğurlu A, Akbaş ED, Bideci A, Çamurdan O, Cinaz P. Effect of telehealth system on glycemic control in children and adolescents with type 1 diabetes. J Clin Res Pediatr Endocrinol. 2019;11(1):70-75. https://doi.org/10.4274/jcrpe.galenos.2018.2018.0017
Quinn CC, Gruber-Baldini AL, Shardell M, Weed K, Clough SS, Peeples M, Terrin M, Bronich-Hall L, Barr E, Lender D. Mobile diabetes intervention study: testing a personalized treatment/behavioral communication intervention for blood glucose control. Contemp Clin Trials. 2009;30(4):334-346. https://doi.org/10.1016/j.cct.2009.02.004
Tao D, Or CK. Effects of self-management health information technology on glycaemic control for patients with diabetes: a meta-analysis of randomized controlled trials. J Telemed Telecare. 2013 Apr;19(3):133-143. https://doi.org/10.1177/1357633X13479701
Sahin C, Courtney KL, Naylor PJ, E Rhodes R. Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis. Digit Heal. 2019 5:2055207619845279. https://doi.org/10.1177/2055207619845279
Yoshida Y, Boren SA, Soares J, Popescu M, Nielson SD, Simoes EJ. Effect of health information technologies on glycemic control among patients with type 2 diabetes. Curr Diab Rep. 2018;18(12):130. https://doi.org/10.1007/s11892-018-1105-2
Weingarten SR, Henning JM, Badamgarav E, Knight K, Hasselblad V, Gano AJ, Ofman JJ. Interventions used in disease management programmes for patients with chronic illness-which ones work? Meta-analysis of published reports. BMJ. 2002;325(7370):925. https://doi.org/10.1136/bmj.325.7370.925
Petrovski G, Zivkovic M. Impact of facebook on glucose control in type 1 diabetes: a three-year cohort study. JMIR diabetes. 2017;2(1):e9. https://doi.org/10.2196/diabetes.7693
American Association of Diabetes Educators (AADE). AADE7TM self-care behaviors american association of diabetes educators (aade) position statement. 2014. Available at: https://www.diabeteseducator.org/docs/default-source/practice/practice-resources/position-statements/aade7-self-care-behaviors-position-statement.pdf?sfvrsn=6 (accessed Nov 22, 2019)
Kim SH, Utz S. Effectiveness of a social media – based, health literacy – sensitive diabetes self-management intervention: A Randomized Controlled Trial. J Nurs Scholarsh. 2019;51(6):661-669. https://doi.org/10.1111/jnu.12521
Davis T. Health literacy: hidden barriers and practical strategies. 2015. Available at: https://www.ahrq.gov/healthliteracy/qualityresources/tools/literacytoolkit/tool3a/index.html (accessed Nov 2, 2019)
Dhar VK, Kim Y, Graff JT, Jung AD, Garrett J, Dick LE, Harris J. Shan S, Benefit of social media on patient engagement and satisfaction: results of a 9-month, qualitative pilot study using Facebook. Surgery. 2018;163(3):565-570. https://doi.org/10.1016/j.surg.2017.09.056
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