Effects of a Diabetes Self-Management Training Program Using Mobile Technology and Intergenerational Support on Older Adults with Diabetes

Background and Purpose: Mobile technology is gaining its popularity among older adults, but the potential to improve their health outcomes and reduce disparities is underutilized. Given the overwhelming prevalence of chronic disease in this population, Intergenerational Mobile Technology Opportunities Program (IMTOP) tested using the technology to facilitate self-management training among older adults with diabetes. The program curriculum combined key elements of diabetes self-management education with Internet and tablet skill training as well as training to use a mobile application specifically designed to engage older adults in diabetes self-management. During the 8 weeks of two-hour per week program delivered in a small class setting, college student volunteers provided support in the technology training in a ratio of 4 volunteers for 10 older adults so the barriers of learning mobile technology can be mitigated while increasing motivation of learning. This study investigated the effects of the IMTOP on older diabetes patients’ health outcomes, quality of life, and technology usage.

Methods: A waitlist comparison trial was conducted in two general hospital outpatient clinics in Taiwan. Type 2 diabetes patients age 55 and older were referred by providers to participate in the study. Using rolling recruitment, eligible patients were first recruited to the immediate intervention group (N = 155) and later to the waitlist group (N = 182) and waited for 4-month to serve as control for the study. The data for assessing the differential program effects were collected through in-person interviews conducted at baseline and at 4-month follow-up. The measures included diabetes related such as symptoms, self-care behaviors, and empowerment; psychosocial well-being measures such as Patient Activation Measure, Life Satisfaction Scale, and WHO Quality of Life; as well as older adult attitude toward young adults and use of technology. All analyses were carried out according to the intention-to-treat rule consistent with standard practice in most clinical trials. No statistically significant group differences were identified on sociodemographic or health-related measures. Thus, no controlling covariate or adjustment was required in outcome data analyses. Unadjusted Differences-in-Differences (D-in-D) analyses hence were conducted to compare means of the two samples.

Results: The sample include 58% male, mean age 64.63 (SD 6.77), majority with high school or higher education, and 77% married. Compared to the waitlist group, the intervention group patients had significantly less diabetes symptoms (p<0.05) and severity level (p<0.001), and they reported less complications (p<0.02). However, there was no significant group difference in days of diabetes self-care. The intervention group patients also reported significantly greater life satisfaction and overall quality of life (p<.05). They significantly increased use of mobile device (p<0.0001), but did not change attitude toward young adults.

Conclusions and Implications: The IMTOP helped older patients mitigate diabetes symptoms and improve quality of life and life satisfaction without having to significantly increase days of self-care. The mechanism of improvement should be further researched. Nevertheless, the positive findings in patient-reported outcomes encourages clinical social workers and other health educators to adopt and regularly use evidence-based self-management technology.