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 (Preprint)
Authors: Leong Cheng Man , Lee Ting-I , Chien Yu-Mei , Kuo Li-Na , Kuo Yu-Feng , Chen Hsiang-Yin 
Published: March 2022

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 (HbA<sub>1c</sub>) levels. Health literacy was measured at baseline using the Newest Vital Sign tool. Differences in HbA<sub>1c</sub> 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 HbA<sub>1c</sub> did not significantly differ between groups (intervention group: mean 6.9%, SD 0.8% to mean 7.0%, SD 0.9%, <i>P</i>=.34; control group: mean 6.7%, SD 0.6% to mean 6.7%, SD 0.7%, <i>P</i>=.91). Both groups showed increased mean knowledge scores at 12 weeks, increasing from 68.3% (SD 16.4%) to 76.7% (SD 11.7%; <i>P</i>&lt;.001) in the intervention group and from 64.8% (SD 18.2%) to 73.2% (SD 12.6%; <i>P</i>&lt;.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, <i>P</i>=.001; self-care activities: mean difference 0.3, SD 1.2, <i>P</i>=.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; <i>P</i>=.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.

CLINICALTRIAL

ClinicalTrials.gov NCT04876274; https://clinicaltrials.gov/ct2/show/results/NCT04876274