Supporting Diabetes Self-Management Among Older Adults through Mobile Technology Application and Intergenerational Support: Imtop Program Design and Effectiveness

Background and Purpose: Better chronic condition management and greater social integration are effective means to contribute to active and healthy aging. As the Internet and mobile computing technology become increasingly prevalent, they offer great potentials to improve chronic disease self-management and social integration. Older adults, however, are less likely to use such technology. Intergenerational Mobile Technology Opportunities Program (IMTOP) is designed to motivate and train older adults with diabetes to use the technology for better self-management. The IMTOP curriculum is based on the evidence-based Chronic Disease Self-Management Program (CDSMP) combined with tablet and Internet skill training, and delivered in 8 weekly sessions of 2-hour long small group classes. Two innovative components of the IMTOP include: 1) using a graphic-based aging-friendly touchscreen diabetes self-management application, or “app”, to activate self-monitoring and behavior change; and 2) deploying college students as volunteer teaching assistants to provide intergenerational support to close digital divide and increase social integration. The purpose of this study is to evaluate the IMTOP program effectiveness on improving health and well-being of older diabetes patients.

Methods: A quasi-experimental research design was used where adults age 50 and older with diabetes were assigned to immediate intervention or 4-month wait-list control group to learn the IMTOP curriculum. Patients were recruited from outpatient clinics of 2 hospitals in Taiwan through clinician referrals. Patient interviews using a multi-scale questionnaire were conducted at baseline, an additional 4-month survey for wait-list group right before the curriculum started, and 3 follow-ups every 4 months. Patient assessments include health status, diabetes symptoms and self-management, social engagements, patient empowerment and activation, use of technology, depression, and quality of life. Health outcomes and utilization were also tracked. This study compared the differences-in-differences on patient self-reported data between the two groups during the first 4 months of the program. Additionally, the diabetes app usage pattern was analyzed and compared effects on patient outcomes between regular and temporary app users. A total of 219 older adults with type 2 diabetes were included in the analysis (101 in the immediate intervention and 118 in the waitlist group).

Results: The patients’ average age was 64.02 (range 50-87), 62% male, majority with high school or higher education, and 80% married. The intervention group were significantly better than the waitlist group in terms of physical health status, diabetes self-management, use of mobile technology, and satisfaction with health and social services. In addition, the intervention group was less depressed compared to its counterpart (p<0.01). However, they did not significantly improve their attitude toward young adults. The diabetes app usage declined as time progressed; nonetheless, regular app users significantly reduced diabetes symptoms compared to temporary app users. 

Conclusions and Implications: The study demonstrates that the IMTOP curriculum with the support of mobile technology application and intergenerational interactions can be effective in improving diabetes self-management and physical and mental health among older adults. Clinical social workers or other health educators should encourage patients to adopt and regularly use evidence-based self-management technology.