Social Media-Delivered Patient Education to Enhance Self-management and Attitudes of Patients with Type 2 Diabetes During the COVID-19 Pandemic: Randomized Controlled Trial

Cheng Man Leong, Ting-I Lee, Yu-Mei Chien, Li-Na Kuo, Yu-Feng Kuo, Hsiang-Yin Chen, Cheng Man Leong, Ting-I Lee, Yu-Mei Chien, Li-Na Kuo, Yu-Feng Kuo, Hsiang-Yin Chen

Abstract

Background: The use of mobile health technologies has been necessary to deliver patient education to patients with diabetes during the COVID-19 pandemic.

Objective: This open-label randomized controlled trial evaluated the effects of a diabetes educational platform-Taipei Medical University-LINE Oriented Video Education-delivered through a social media app.

Methods: Patients with type 2 diabetes were recruited from a clinic through physician referral. The social media-based program included 51 videos: 10 about understanding diabetes, 10 about daily care, 6 about nutrition care, 21 about diabetes drugs, and 4 containing quizzes. The intervention group received two or three videos every week and care messages every 2 weeks through the social media platform for 3 months, in addition to usual care. The control group only received usual care. Outcomes were measured at clinical visits through self-reported face-to-face questionnaires at baseline and at 3 months after the intervention, including the Simplified Diabetes Knowledge Scale (true/false version), the Diabetes Care Profile-Attitudes Toward Diabetes Scales, the Summary of Diabetes Self-Care Activities, and glycated hemoglobin (HbA1c) levels. Health literacy was measured at baseline using the Newest Vital Sign tool. Differences in HbA1c levels and questionnaire scores before and after the intervention were compared between groups. The associations of knowledge, attitudes, and self-care activities with health literacy were assessed.

Results: Patients with type 2 diabetes completed the 3-month study, with 91 out of 181 (50.3%) patients in the intervention group and 90 (49.7%) in the control group. The change in HbA1c did not significantly differ between groups (intervention group: mean 6.9%, SD 0.8% to mean 7.0%, SD 0.9%, P=.34; control group: mean 6.7%, SD 0.6% to mean 6.7%, SD 0.7%, P=.91). Both groups showed increased mean knowledge scores at 12 weeks, increasing from 68.3% (SD 16.4%) to 76.7% (SD 11.7%; P<.001) in the intervention group and from 64.8% (SD 18.2%) to 73.2% (SD 12.6%; P<.001) in the control group. Positive improvements in attitudes and self-care activities were only observed in the intervention group (attitudes: mean difference 0.2, SD 0.5, P=.001; self-care activities: mean difference 0.3, SD 1.2, P=.03). A 100% utility rate was achieved for 8 out of 21 (38%) medication-related videos. Low health literacy was a significant risk factor for baseline knowledge scores in the intervention group, with an odds ratio of 2.80 (95% CI 1.28-6.12; P=.01); this became insignificant after 3 months.

Conclusions: The social media-based program was effective at enhancing the knowledge, attitudes, and self-care activities of patients with diabetes. This intervention was also helpful for patients with low health literacy in diabetes knowledge. The program represents a potentially useful tool for delivering diabetes education to patients through social media, especially during the COVID-19 pandemic.

Trial registration: ClinicalTrials.gov NCT04876274; https://ichgcp.net/clinical-trials-registry/NCT04876274.

Keywords: COVID-19; attitude; diabetes; education; health literacy; mHealth; self-care activity; social media; type 2 diabetes; video.

Conflict of interest statement

Conflicts of Interest: None declared.

©Cheng Man Leong, Ting-I Lee, Yu-Mei Chien, Li-Na Kuo, Yu-Feng Kuo, Hsiang-Yin Chen. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 23.03.2022.

Figures

Figure 1
Figure 1
Program development. The number of videos in each category are reported within parentheses. AADE7: American Association of Diabetes Educators 7 Self-Care Behaviors; FAQ: frequently asked questions; TADE: Taiwanese Association of Diabetes Educators; TMU-LOVE: Taipei Medical University–LINE Oriented Video Education.
Figure 2
Figure 2
Delivery schedule of videos. HbA1c: glycated hemoglobin.
Figure 3
Figure 3
The CONSORT flow diagram. CONSORT: Consolidated Standards of Reporting Trials; TMU-LOVE: Taipei Medical University–LINE Oriented Video Education.
Figure 4
Figure 4
Utility rate for each video in each of the five categories. Rates are shown on each bar. HbA1c: glycated hemoglobin.

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