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      Use of Electronic Health (eHealth) Among Saudi Type 2 Diabetic Patients and Its Association With Their Diabetic Self-Management: A Cross-Sectional Study

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      1 , , 2 , 2 , 3
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      Cureus
      Cureus
      electronic health, ehealth, type 2 dm, health care visits, self-care management

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          Abstract

          Background

          Type 2 diabetes mellitus (T2DM) is a prevalent, chronic, non-communicable disease that requires continuous multidisciplinary health care. Electronic health (eHealth) refers to “the transfer of health information resources and health care services using different electronic platforms.” This may have an effect on diabetes self-management (DSM).

          Objectives

          This study aimed to identify the use of eHealth among patients with T2DM as well as its association with DSM.

          Method

          An analytical cross-sectional study was conducted online using a newly adapted three-part questionnaire using Google Forms through different social media platforms. A total of 2,228 adult Saudi T2DM patients from different provinces were selected based on the non-probability voluntary response sampling technique. The survey included demographic, clinical, and eHealth data, and diabetic self-care management.

          Results

          The study results revealed an average DSM score of 5.2/10, and 74.1% were receiving diabetes care at primary health care centers. Of these, 87.1% used eHealth, mainly through Google (55.7%) and other social media (12.9%), and were satisfied with the quality of health care (70.4%). Moreover, 82% wanted to discuss the eHealth information with their physicians, but some (34.5%) had no online access to them. eHealth dependency was 44.2% and was associated with a lower mean DSM (5.6 vs. 5.3; p = 0.000) with significantly lower health care use (6.7 vs. 5.6; p = 0.000) and glucose management (4.7 vs. 4.0, p=0.000) compared to the independent group. The DSM total score was a significant predictor of eHealth dependency (OR: 1.022; 95% CI: 1.006-1.039; p = 0.007).

          Conclusion

          Most Saudi T2DM patients with an average DSM use different eHealth resources and are satisfied with their quality. Dependency to eHealth is significantly associated with lower DSM, especially for health care use and glucose management, a finding that could affect patient outcomes. Still, patients need to communicate with their physicians in person who should have different options for remote consultation, such as telemedicine, to support their patients.

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          Most cited references28

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          The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control

          Background Though several questionnaires on self-care and regimen adherence have been introduced, the evaluations do not always report consistent and substantial correlations with measures of glycaemic control. Small ability to explain variance in HbA1c constitutes a significant limitation of an instrument’s use for scientific purposes as well as clinical practice. In order to assess self-care activities which can predict glycaemic control, the Diabetes Self-Management Questionnaire (DSMQ) was designed. Methods A 16 item questionnaire to assess self-care activities associated with glycaemic control was developed, based on theoretical considerations and a process of empirical improvements. Four subscales, ‘Glucose Management’ (GM), ‘Dietary Control’ (DC), ‘Physical Activity’ (PA), and ‘Health-Care Use’ (HU), as well as a ‘Sum Scale’ (SS) as a global measure of self-care were derived. To evaluate its psychometric quality, 261 patients with type 1 or 2 diabetes were assessed with the DSMQ and an established analogous scale, the Summary of Diabetes Self-Care Activities Measure (SDSCA). The DSMQ’s item and scale characteristics as well as factorial and convergent validity were analysed, and its convergence with HbA1c was compared to the SDSCA. Results The items showed appropriate characteristics (mean item-total-correlation: 0.46 ± 0.12; mean correlation with HbA1c: -0.23 ± 0.09). Overall internal consistency (Cronbach’s alpha) was good (0.84), consistencies of the subscales were acceptable (GM: 0.77; DC: 0.77; PA: 0.76; HU: 0.60). Principal component analysis indicated a four factor structure and confirmed the designed scale structure. Confirmatory factor analysis indicated appropriate fit of the four factor model. The DSMQ scales showed significant convergent correlations with their parallel SDSCA scales (GM: 0.57; DC: 0.52; PA: 0.58; HU: n/a; SS: 0.57) and HbA1c (GM: -0.39; DC: -0.30; PA: -0.15; HU: -0.22; SS: -0.40). All correlations with HbA1c were significantly stronger than those obtained with the SDSCA. Conclusions This study provides preliminary evidence that the DSMQ is a reliable and valid instrument and enables an efficient assessment of self-care behaviours associated with glycaemic control. The questionnaire should be valuable for scientific analyses as well as clinical use in both type 1 and type 2 diabetes patients.
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            Patients using the Internet to obtain health information: how this affects the patient-health professional relationship.

            Health information is one of the most frequently sought topics on the Internet. A review of the literature was carried out to determine the use of the Internet for health information by the patient and how this could affect the patient-health professional relationship. This study is a literature review, summarizing multiple empirical studies on a single subject and is not intended to be a meta-analysis. The review showed that the majority of health related Internet searches by patients are for specific medical conditions. They are carried out by the patient: (1) before the clinical encounter to seek information to manage their own healthcare independently and/or to decide whether they need professional help; (2) after the clinical encounter for reassurance or because of dissatisfaction with the amount of detailed information provided by the health professional during the encounter. There has been a shift in the role of the patient from passive recipient to active consumer of health information. Health professionals are responding to the more 'Internet informed' patient in one or more of three ways: (1) the health professional feels threatened by the information the patient brings and responds defensively by asserting their 'expert opinion' (health professional-centred relationship). (2) The health professional and patient collaborate in obtaining and analysing the information (patient-centred relationship). (3) The health professional will guide patients to reliable health information websites (Internet prescription). It is important that health professionals acknowledge patients' search for knowledge, that they discuss the information offered by patients and guide them to reliable and accurate health websites. It is recommended that courses, such as 'patient informatics' are integrated in health professionals' education.
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              Diabetes Self-management Education and Support in Type 2 Diabetes.

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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                14 March 2021
                March 2021
                : 13
                : 3
                : e13882
                Affiliations
                [1 ] Medical Education, Faculty of Medicine, Suez Canal University, Ismailia, EGY
                [2 ] Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
                [3 ] Internal Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
                Author notes
                Article
                10.7759/cureus.13882
                8043569
                d6e2a94a-dfb6-4720-ad94-4317a9b75bd7
                Copyright © 2021, Abdel Nasser et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 March 2021
                Categories
                Endocrinology/Diabetes/Metabolism
                Family/General Practice
                Healthcare Technology

                electronic health,ehealth,type 2 dm,health care visits,self-care management

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