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.