| Objective:1.To understand the key issues such as the status quo of out of hospital self-management and health needs of patients with diabetes retinopathy(DR)in China through research,so as to provide an upfront basis for the development of diabetes retinopathy health management APP.2.Research and develop diabetic retinal health management app and explore its role in the health management of diseases in Dr patients,aiming to provide a new basis for improving the effectiveness of health management for Dr patients.Methods:1.Analysis of the current situation of out of hospital health management of Dr patientsThis study mainly adopts a combination of quantitative and qualitative research methods.The quantitative study applied the convenient sampling method,and used the selfdeveloped general information questionnaire,the simplified KAB evaluation scale for selfmanagement of diabetes patients,the diabetes self-efficacy scale,and the Morisky medication compliance scale.From March 2022 to June 2022,250 DR patients in the ophthalmic outpatient clinics of two public tertiary hospitals in Jinan,Shandong Province were surveyed to understand the disease management status and health needs of patients outside the hospital,SPSS27.0 software was used to analyze and process the data,and single factor analysis,correlation analysis,and multiple linear regression analysis were used to further identify and explore the main influencing factors on the self-disease health management of DR patients,in order to provide a reliable basis for the determination of the function and content of the APP in this study and its development and application.At the same time,the purpose sampling method was used to conduct face-to-face semi-structured interviews with 8 DR patients and 7 clinical medical staff with poor self-management ability,so as to deeply understand the health management status and the true feelings of diabetes retinopathy patients,and further supplement the quantitative research.Apply Nvivo 12.0software for data analysis and processing.2.Development and testing of DR patient health management APPThrough literature review and previous research results,the functional modules and contents of the APP were initially formulated,and the contents and functions of the platform were finally determined after the framework and contents of the APP were adjusted and modified according to the experts’ scores and opinions after a total of 2 rounds of expert correspondence by selecting experts from relevant disciplines.After determining the content of the platform,the software engineer and the research team will work together to develop the data management system of the Android system of the platform using the rapid prototype interaction model.After several rounds of module function test,the system availability test is completed.3.Availability evaluation of DR patient health management APPThis study adopts the research method of a self-controlled before and after design,60 DR patients in the previous study were randomly selected as subjects from January 2023 to February 2023.After four weeks of APP use,diabetes patients’ self-management knowledge,attitude and behavior simplified scale,diabetes self-efficacy scale,Morisky medication adherence scale and health management APP use effect satisfaction questionnaire were used to evaluate their self-management ability,self-efficacy changes,medication adherence and satisfaction with use.SPSS.27.0 was used to sort and analyze the data.The score of the scale obeys normal distribution and is analyzed by paired sample T test;Wilcoxon signed rank sum test was used to investigate the effect of health management APP for DR patients who did not obey normal distribution.Results:1.After the investigation of 250 patients with Dr,a total of 230 valid questionnaires were returned,and the valid recovery rate of the questionnaires was 92%,and the quantified diabetes self-management KAB evaluation simplified Scale total score was 96.67 points with the highest score,27.62 points with the lowest score,and 64.76(59.04,71.07)points,of which 67.8% of the patients had a score at an intermediate level,26.1% of the patients had a score at a low level,and only 6.1% of the patients had a score at a high level.The total score of the knowledge subscale was 65.90(54.54,77.27)points;The total score of attitude subscale was 96.00(92.00,96.00)points;The behavioral subscale total score was 53.33(45.33,60.00).Dr patients had a maximum score of 9.88 points,a minimum score of 3.25 points,and 6.25(5.46,7.00)points on the diabetes self efficacy scale,with 88.3% of patients scoring at an intermediate level,1.7% scoring at a low level,and 10.0% scoring at a high level.The Morisky medication adherence questionnaire of Dr patients had the highest score of 8 and the lowest score of 1.4,with a mean score(5.24 ± 1.49)points,of which 68.3% had poor medication adherence,24.8% had good medication adherence in general,and only 7.0%had good medication adherence.2.The results of univariate analysis of Dr patients with different demographic and disease characteristics showed that the overall self-management KAB scores of Dr patients were statistically different in terms of education level,diabetes duration(P < 0.05);The scores of the total score of self-management knowledge dimension of Dr patients were statistically different between professional and educational levels(P < 0.05);The summed scores of the self-management attitude and behavior dimensions of Dr patients were statistically different among the education levels(P < 0.05).The differences in the total scores of self-efficacy between Dr patients according to occupation,marital status,duration of diabetes,and burden of medical expenses were statistically significant(P < 0.05).The differences in the total score of medication adherence between patients with Dr according to occupation,education level,complications,medical payment method and medical expense burden were statistically significant(P < 0.05).3.The results of the correlation analysis showed that the total scores of diabetes selfmanagement KAB were positively correlated with the total scores of diabetes self efficacy and medication adherence among the patients with Dr(all P < 0.05).4.the results of multivariate analysis showed that education level,diabetes duration,total score of diabetes self ‐ efficacy and total score of medication adherence were the main influencing factors of the total score of KAB for diabetes self ‐ management among Dr patients(P < 0.05);The total score of diabetes duration,degree of heavy medical cost burden and medication adherence from 5 to 10 years were the main influencing factors for the total score of diabetes self-efficacy among the patients with Dr(P < 0.05;Occupation,college and above education were significant influencing factors on the total score of medication adherence in patients with Dr(P < 0.05).5.Qualitative findings revealed that the overall health management outside the hospital of Dr patients mainly showed the following problems: poor glycemic control,poor vision status,poor sleep,occurrence of complications,and recurrent admissions;Cognitive aspects of illness,exhibiting low illness concerns and low cognitive abilities;In terms of selfmanagement,performance was characterized by low-quality glucose monitoring behaviors,low rates of regular return visits,and poor medication adherence;In terms of the level of self-efficacy,lack of self-confidence in disease management,need to improve family care and support;Meanwhile,most patients have disease emotions especially negative emotions,which is unfavorable for the health management of patients’ diseases.The results of the medical interview showed that the health management problems of patients with Dr were mainly related to: 1.disease management,with low levels of medication adherence,blood glucose management,and self-management behaviors;2.Illness recognition,the lack of comprehensive and correct perceptions of the self and related basics;3.In disease attitude,it is required to improve the family care and support strength of patients and transform treatment attitude;4.In disease needs,the need for disease knowledge of patients remains a major focus of clinical work.Meanwhile,the interview results also showed that the pick-up workload in clinic has some influence on popular science work.6.Delphi expert inquiry results: The experts in the two rounds of inquiry were consistent,and a total of 15 experts were invited to participate.15 valid consultation questionnaires were collected in each round,with a recovery rate of 100%.Experts’ opinions accounted for53.33% and 13.3% respectively;The authority coefficient of the experts in the two rounds of consultation is 0.88,and the coordination of their opinions is good.The Kendall harmony coefficients of the two rounds of expert consultation are 0.197(P < 0.05)and 0.222(P <0.05),respectively.The coefficient of variation of the importance of each item is 0-0.14.After two rounds of expert inquiries,a total of 10 new functional items were added,and it was finally determined that the app will have "Science Popularization","Health Records",and "Personal Settings" as its main functional modules.The science popularization function module is mainly a search and learning page for health education knowledge,which includes overview,etiology,symptoms,treatment,daily care,and multimedia learning content of related diseases.It realizes multi format switching learning mode,and also sets up functions such as reading voice broadcasts,learning favorites,taking photos,photo albums,and magnifying glass,making it convenient for patients to use.The health record function module mainly records the numerical values of monitoring indicators related to DR patients,such as weight,blood sugar,blood pressure,diet,exercise,sleep,vision,and medication.At the same time,it reasonably sets up the risk value warning and reminder function of relevant monitoring indicators and the overall trend analysis chart,which is conducive to patients’ overall understanding of their own health situation.The personal settings function module mainly includes personal information maintenance and system settings,which is beneficial for patients to personalize and humanize the use of the APP.7.After the health management mobile app use intervention,the total scores of diabetes selfmanagement KAB scale,diabetes self efficacy subscale and Morisky medication adherence questionnaire scores of Dr patients were 90.00(88.21,91.42),7.11 ± 0.52,6.80(6.60,7.45),respectively,compared with those before the intervention(P < 0.001).Dr patients were satisfied with the use of the diabetes health management app well,and the proportion of patients who selected the options " agree "," fully agree " in the scale entries was 91.6%.Conclusion:1.Diabetic retinopathy health management app can effectively improve the disease selfmanagement ability,self-efficacy and medication adherence of Dr patients.2.The mobile app for health management of diabetic retinopathy,which is convenient,practical and full of high user satisfaction,can be considered for promoting applications in hospitals or community health centers. |
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