Integration of Hybrid Model Diabetes Self-Management Education and Support at Primary Health Care During COVID-19 Pandemic: Protocol Paper of DIAJAPRI Health Coaching Study
Authors: Yunir Em , Wafa Syahidatul , Tahapary Dicky L. , Rusdi Lusiani , Lestari Yeni D. , Nugroho Pringgodigdo , Nachrowi Annisa P. , Khumaedi Anandhara I. , Tarigan Tri J.E. , Salim Simon , Adriono Gitalisa A. , Mansjoer Arif , Waspadji Sarwono , Subekti Imam , Harbuwono Dante S. , Soebardi Suharko , Darmowidjojo Budiman , Purnamasari Dyah , Wisnu Wismandari , Kurniawan Farid , Rosana Martha , Wildan Ardy , Christabel Eunike V. , Pradnjaparamita Tika , Amalina Nida , Wahyuningsih Endang S. , Novita SW , Damayanti Fitri , Vanessa Vinny , Alwi Idrus , Dwi Oktavia TLH , Sitompul Ratna , Soewondo Pradana 
Published: December 2022

Introduction

COVID -19 pandemic has threatened the optimal achievement on type-2 diabetes mellitus (T2DM) target in primary health care (PHC), due to our priority in COVID-19 management, limited access of patients to PHC and their lifestyle changes as the impact of social restrictions. Therefore, the empowerment of capability of patients on diabetes self-care is required through optimal education and support. The use of telehealth in T2DM management has benefits on improving outcomes of patients. We aim to assess the role of telehealth diabetes self-management education (DSME) versus hybrid (telehealth and face-to-face method) diabetes self-management education and support (DSMES) to improve T2DM outcomes in PHC during COVID-19 pandemic.

Methods and analysis

This study is an open label randomized-controlled trial that will be conducted in 10 PHCs in Jakarta, Indonesia, involving patients with T2DM. Subjects are classified into 2 groups: DSME group and DSMES group. Intervention will be given every 2 weeks. DSME group will receive 1 educational video every 2 weeks discussing topics about diabetes self-management, while DSMES group will receive 1 educational video and undergo 1 coaching session every 2 weeks. All interventions will be conducted by trained health workers of PHC, who are physicians, nurses, and nutritionists. Our primary outcome is the change of HbA1C level and our secondary outcomes are the changes of nutritional intake, physical activity, quality of life, anthropometric parameter, fasting blood glucose, lipid profile, inflammatory markers, and progression of diabetes complications at 3 and 6 months after intervention compare to the baseline.

Ethics and dissemination

This study protocol has been approved by the Health Research Ethics Committee University of Indonesia. Subjects agree to participate will be given written informed consent prior to data collection. Findings from this study will be published in peer-reviewed journals and presented at conferences.

Trial Registration

http://www.clinicalstrials.govwith identifier numberNCT05090488.

Strengths and limitations of the study

This study evaluates the role of hybrid DSMES, which is useful in areas with limited access or on lockdowns.

This study will evaluates the implementation of hybrid DSMES, its benefits, difficulties, and obstacles.

We uses validated questionnaire instruments and routinely collected clinical data.

Because all of our interventions will be conducted by PHCs’ health workers, our results depend on the ability and adherence of PHCs’ health workers.