Table 1 presents participants' demographic and disease details. Of the 176 participating patients, 97 (55.1%) were women. Participants' mean age was 53.18 years (SD=15.5), the majority were high school dropouts (56.8%), and 152 (86.6%) lived in the city. Eighty-two patients had other chronic diseases (46.6%), of whom, 15 had hypertension, 8 had cardiac problems, and 4 had asthma, and the rest had other diseases including neurological, gastric, thyroid, kidney, and high blood lipids. Participants' mean BMI was 28.42 kg/m2 (SD=5.1).
Table 1: Participants' demographic and disease details (n=176)
Demographic details
|
Frequency
|
Percentage
|
Mean ± SD
|
Gender
|
Female
|
97
|
55.1
|
|
Male
|
79
|
44.9
|
|
Age
|
|
|
|
53.18(±15.05)
|
Education level
|
Below high school diploma
|
100
|
56.8
|
|
High school diploma
|
40
|
22.7
|
|
Advanced diploma
|
7
|
4
|
|
Bachelor's degree
|
20
|
11.4
|
|
Master's degree and higher
|
9
|
5.1
|
|
Occupation
|
Retired
|
21
|
11.9
|
|
Full-time employment
|
30
|
17
|
|
Part-time employment
|
8
|
4.5
|
|
Housewife
|
63
|
35.8
|
|
Unemployed
|
7
|
4
|
|
Other
|
47
|
26.7
|
|
Place of residence
|
Urban
|
152
|
86.4
|
|
Rural
|
24
|
13.6
|
|
Duration of the disease
|
Less than 6 months
|
35
|
19.9
|
|
6 months to one year
|
27
|
15.3
|
|
1 to 3 years
|
38
|
21.6
|
|
3 to 5 years
|
25
|
14.2
|
|
5 years and longer
|
50
|
28.4
|
|
Other chronic diseases
|
Yes
|
82
|
46.6
|
|
No
|
92
|
52.3
|
|
|
Do not know
|
2
|
1.1
|
|
BMI*
|
|
|
|
28.42 (±5.1)
|
* BMI: Body mass index.
Table 2 shows general findings about participants' use of mobile phone and the Internet and their intention to use them for controlling their diabetes. Of the 176 participants, 167 (94.9%) had mobile phones, 109 (61.9%) had smartphones, and 143 (81.3%) had daily Internet access. On average, participants spent two hours per day using mobile phones (141, 80.1%) and the Internet (100, 56.8%). Participants mostly used their mobile phones to contact friends (89.2%) and search for information (50.6%). They used their mobile phones the least for sending and receiving emails (9.1%), and shopping online (15.9%). Mobile phones and the Internet were used by most participants for planning their diet (96%), checking blood glucose and other relevant clinical parameters (90.9%), and contacting their physicians (87.5%).
Table 2: Frequency percentage of participants' use and intention to use mobile phones and the Internet for diabetes control (n=176)
Question
|
Number (percentage)
|
Yes
|
No
|
Do not know
|
Use
|
Having a mobile phone
|
167 (94.9)
|
9 (5.1)
|
-
|
Having a smartphone
|
109 (61.9)
|
67 (38.1)
|
-
|
Having daily access to the Internet
|
143 (81.3)
|
33 (18.8)
|
-
|
Intention to use mobile phone and the Internet for diabetes control
|
Dietary planning
|
169 (96)
|
4 (2.3)
|
3 (1.7)
|
Checking blood glucose and other parameters
|
160 (90.9)
|
4 (2.3)
|
12 (6.8)
|
Contacting specialists
|
154 (87.5)
|
5 (2.8)
|
17 (9.7)
|
Using text messages as a reminder for diabetes self-management
|
145 (82.4)
|
4 (2.3)
|
27 (15.3)
|
Planning physical activity
|
143 (81.3)
|
9 (5.1)
|
24 (13.6)
|
Contacting other healthcare providers (nutritionist and nurses)
|
100 (56.8)
|
20 (11.4)
|
56 (31.8)
|
Contacting other diabetic patients
|
45 (25.6)
|
63 (35.8)
|
68 (38.6)
|
Table 3 shows participants' attitude and intention regarding the use of smartphone apps for diabetes self-management. Half of the participants stated that using apps to help manage diabetes can be interesting (54%) and useful (50%), 85 (48.3%) stated that they intended to use apps for diabetes control "much more" in future (48.3%), and 57 (32.4%) stated that they were 61% to 80% confident that they would use apps for controlling their diabetes.
Table 3: Mean and standard deviation of participants' attitude and intention to use smartphone apps to control their diabetes (n=176)
Question
|
Mean (out of 5)
|
Patients' attitude toward using apps for diabetes control
|
4.18 ± 0.68
|
Patients' intention to use apps for diabetes control in the future
|
4.34 ± 0.75
|
*Attitudes & Intention rated 1-5.
Table 4 shows the results relating to participants' problems in diabetes self-management. The majority of the participants stated that their problems are mostly related to choosing an appropriate diet (81.8%), adequate physical activity (69.9%), and blood glucose diary (64.8%).
Table 4: Frequency percentage of participants' problems in diabetes self-management
Diabetes self-management problems
|
Number (percentage)
|
Yes
|
No
|
Choosing the right diet
|
144 (81.8)
|
32 (18.2)
|
Doing adequate physical activity
|
123 (69.9)
|
53 (30.1)
|
Blood glucose diary
|
114 (64.8)
|
62 (35.2)
|
Contacting the physician
|
86 (48.9)
|
90 (51.1)
|
Not having clear and precise goals for diabetes management
|
77 (43.7)
|
99 (56.3)
|
Contacting other healthcare providers (nutritionists and nurses)
|
37 (21)
|
139 (79)
|
Contacting friends and family (for diabetes control)
|
11 (6.3)
|
165 (93.8)
|
Table 5 shows the correlation of participants' demographic characteristics, attitude and intention to use smartphone apps for diabetes self-management and their Internet and mobile phone use. Compared to older participants, younger ones were significantly more interested (P<0.001) in using apps, and had greater intention (P=0.012) and higher confidence (P<0.001) in using these tools in future. Moreover, younger participants spent significantly more time per day using their mobile phones (P<0.001).
Table 5: Correlation between participants' demographic characteristics, attitude and intention in relation to the use of smartphone apps for diabetes self-management
Demographic variables
|
Attitude
|
Intention
|
Confidence
|
Internet use
|
Mobile use
|
Age
|
-0.373**
|
-0.190*
|
-.470**
|
.290**
|
-.249**
|
Gender
|
0.092
|
0.066
|
.116
|
-.075
|
.030
|
Education
|
0.254**
|
0.083
|
.387**
|
.245**
|
.172*
|
Occupation
|
-0.157*
|
-0.044
|
-.229**
|
.074
|
-.053
|
Duration of diabetes
|
-0.161*
|
-0.060
|
-.203**
|
.225**
|
-.072
|
** Correlation is significant at the 0.01 level (1-tailed).
* Correlation is significant at the 0.05 level (2-tailed).
Participants' gender had no significant relationship with attitude toward, intention to, and confidence in using smartphone apps and also daily use of the Internet and mobile phones. Patients with higher education levels had significantly better attitude toward (P<0.001) and greater confidence (P<0.001) in using smartphone apps, and also higher use of mobile phones (P=0.022) and the Internet (P=0.001). A significant difference was observed between patients' occupation and confidence (P<0.001) in using smartphone apps, such that the post hoc test results showed that participants in full-time employment had greater confidence in using apps. Type II diabetic patients for a longer time had poorer attitude toward (P=0.033) and less confidence in (P=0.007) using apps compared to those having type II diabetes for a shorter time. On the other hand, the Internet use significantly increased in those who had diabetes for a longer time (P=0.003).
According to the results, 171 (97.2%) of the participants stated that they wished to receive help from other family members (namely spouse and children) if they were unable to use mobile phones for self-management purposes. Also, 125 (71%) wished to take part in future studies assessing the effect of using apps in diabetes control.