Discussion Board

Group Literature Review Table:

Group # 18

PICOT Question: In individuals with type 2 diabetes how does a multimedia diabetes mellitus education program compared to standard diabetes mellitus education program influence health literacy over one year?

Author (year) and country Purpose Study Design Sample size and site Treatment/ Intervention Results Implications for Nursing Level of Evidence
Dong, Y. …et al (2018) China To determine if the use of health education via WeChat effects on self-care and glycemic control in patients with Type II DM Randomized repeated measures experimental study 120 patients with Type II DM aged ranged from 23 to 60 from Second Affiliated Hospital of Hainan Medical University Conventional health education and nursing care for diabetes guided by the WeChat platform HbA1c levels were lower intervention groups via WeChat platform health education than that control groups The use of WeChat allowed patients to communicate with providers, saved traveling time to appointments, cost effective to use and allowed for communication with others with Type II DM Level II
Didarloo, A. et al (2016) Iran To examine if an interactive care program could improve glycemic control and influence health beliefs and behaviors of women with Type II DM Randomized repeated measures experimental study 90 female patients at a Diabetes Clinic (2) Interactive – hours session lead by trained nurse 60 min long Intervention group had statistically significant reduction in the mean of HbA1c from 9.42 to 7.81

Intervention group had statistically significant increase in the mean score of knowledge, attitude and self-efficacy

Practitioners should consider interactive education as a core element in delivering health care to diabetic patients to improve glycemic control and have effect on health belief and behaviors. Furthermore, patients with Type II DM should receive on going education. Level II
Hochsmann, PhD, … et al. (2019) Australia To determine the effectiveness of smartphone game’s ability to improve T2DM patients daily physical activity behavior (steps/day). Systematic review and meta-analysis of randomized controlled trial. 36

Department of Sport,

Exercise and Health, University of Basel, Basel, Switzerland

Intervention group were tasked to play the innovative smartphone game autonomously during the 24-week intervention period. Control group given recommendations from the baseline T2DM lifestyle counseling. Intervention group= Daily physical activity increased by average of 3,998 (1,293 steps per day).

Control group= Daily physical activity average of 939 (1,156 steps per day). No change in glycemic control (HbA1c) was able to be measured in the 24 weeks course of intervention.

Adding an interactive program to the care plan of inactive target groups with chronic diseases/ comorbidities. Level 1
Huang, M., Hung, C., Yu, C., Berry, D., Shin, S., & Hsu, Y. (2017). Taiwan. Explore the effectiveness of two types of health education on improving diabetes knowledge and insulin injection, insulin injection ability and self-efficacy, and health education satisfaction as well as HbA1c and creatinine levels in patients with T2D using insulin pen injector Randomized repeated measures experimental study 72 participants during hospitalization A multimedia health program consisting of information regarding diabetes introduction, medication, treatment, glycemic management, complications, and insulin injection Compared to regular health education, the multimedia health program had greater efficacy in improving diabetes and insulin understanding insulin injection ability, self-efficacy with insulin injection, and health education satisfaction. However, changes in HbA1c and creatine levels did not differ significantly between groups. Improving diabetes health education in insulin naïve patients with a multimedia program due to limitations of standard approach in effectively improving health outcomes as well as considering existing time constraints and provider shortages Level II
Pai, L., Chiu, S., Liu, H., Chen, L., & Peng, T. (2021). Taiwan Explore the effects of a health technology education program on long-term glycemic control and self-management of adults with T2D Randomized controlled trial with repeated measure design 114 participants in a family medicine outpatient setting A health technology education program involving self-learning multimedia videos introducing T2D, action mechanisms, adverse effects, side-effect management, blood glucose self-monitoring, and physical activity Perceived diabetes self-management scale was significantly higher and HbA1c levels were significantly lower among the intervention group compared to the control group after 6 months Adapt the use of health education technology to support self-management of and glycemic control in individuals with T2D Level II
Velázquez-López L, et al. (2017). Mexico To evaluate the effect of a multimedia education program and nutrition therapy on metabolic control in patients with type 2 diabetes. Experimental Design: Randomized clinical trial


N=351 patients.

Hospital “Carlos Mac Gregor Sánchez Navarro”, México City, Mexico

An experimental group received a multimedia diabetes education program (MDE) and nutrition therapy (NT) (n = 173), and a control group who received nutrition therapy only (n = 178).

At baseline, 7, 14, and 21 months, the HbA1c, glucose, cholesterol, triglycerides, LDL, and HDL were measured. Weight, body mass index (BMI), waist circumference (WC), fat percentage, fat and lean mass, systolic blood pressure (SBP), and diastolic (DBP) were also recorded.

HbA1c and glucose decreased in both groups, although the group with NT + MDE had a greater reduction. Triglycerides and the atherogenic index decreased in both groups at 7 and 14 months; while only in the NT + MDE group did it decrease at 21 months. Weight decreased at 21 months in the NT + MDE group (-1.23, -2.29 at -0.16; p < 0.05). Nutrition therapy and a multimedia diabetes education program have a favorable impact on achieving metabolic control goals in type 2 diabetes. Level II
Plotnikoff, R.C. et al



Assess T2D participants physical activity as compared to Assessor blinded, parallel-group randomized controlled trial (RCT). 42

University of Newcastle, Australia.

Over the course of 20 weeks patients completed 2 phases. Phase 1: Participants were asked to use eCoFit smartphone application while participating face to face mentoring groups aimed at using the app for behavior therapy, education, and outdoor training sessions. Phase 2: Participants asked to use the application and its recourses alone. Results showed a significant increase in the study groups’ physical activity, upper and lower body muscular fitness, decreased systolic blood pressure, reduced waist circumference. Adding an innovative technology to lifestyle modification interventions to improve social support and physical activity in T2D patients. Level II
Brunk, D., Taylor, A., William, I., Cox, D., & Clark, M. (2017). United States. Assess the feasibility of using a patient-centered educational intervention for T2D self-management in a Hispanic population with low health literacy Descriptive qualitative study using a phenomenological approach 9 participants at a rural community health center Four weekly, 2-hour evening education sessions using the GEM manual on T2D self-management Participants expressed improved knowledge about T2D, increased motivation to change behaviors, adapted self-management behaviors, and accepted personal responsibility for disease management Incorporating health literacy in professional education to improve patient education techniques with individuals and family members with low health literacy leading to decreased cost of care, improved patient outcomes, and saved lives Level VII
Elsabrout K. (2018). United States. This project examines how providing an online, multimedia self-management program affects patient engagement and self-reported medication adherence scores compared with preprogram scores. Qualitative study/ descriptive study 14 adult diabetic outpatient patients receiving care at a Wound Care Center in New York. Participants watched a Type 2 diabetes Emmi educational module on an electronic tablet during a routine wound treatment visit. Self-reported medication adherence was measured immediately before and at 4-6 weeks after the educational intervention. Patient engagement was measured immediately before, immediately after, and at 4-6 weeks postintervention. Self-reported medication adherence results demonstrated a modest increase at the delayed postintervention time. In addition, there was a large increase in engagement scores at the delayed postintervention time. The direction of change for both measures was consistent with the intervention being effective. Incorporating this type of novel, multimedia patient education resource may provide opportunities to enhance diabetes care. Level VII
Jiwani, PhD, RN. et al. (2020). United States. To show the use of Fitbit has the potential to management of T2D in overweight/ obese older adults. Qualitative Descriptive study.

Thematic analysis to conduct qualitative coding. The Look AHEAD (Action for Health in Diabetes) study is a longitudinal, multi-center, randomized clinical trial.


School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA

Interview questions were given to gauge the participant’s acceptability and experiences while using Fitbit. Participants were asked to wear their Fitbit at all times and monitored food and activity using Fitbit application on their smart phones; Results showed a high rate of acceptability of the program and positive improvement on health behavior knowledge, diabetes management, and behavioral lifestyle intervention. Adding an interactive technology/personal fitness device to lifestyle changes to assist with positive outcome and better understanding of lifestyle modifications. Level VII


Brunk, D., Taylor, A., William, I., Cox, D., & Clark, M. (2017). A culturally appropriate self-management program for Hispanic adults with type 2 diabetes and low health literacy skills. Journal of Transcultural Nursing, 28(2), 187-194. https://doi.org/10.1177/1043659615613418

Didarloo, A., Shojaeizadeh, D., & Alizadeh, M. (2016). Impact of Educational Intervention Based on Interactive Approaches on Beliefs, Behavior, Hemoglobin A1c, and Quality of Life in Diabetic Women. International journal of preventive medicine7, 38. https://doi.org/10.4103/2008-7802.176004

Dong, Y., Wang, P., Dai, Z., Liu, K., Jin, Y., Li, A., Wang, S., & Zheng, J. (2018). Increased self-care activities and glycemic control rate in relation to health education via Wechat among diabetes patients: A randomized clinical trial. Medicine97(50), e13632. https://doi.org/10.1097/MD.0000000000013632

Elsabrout K. (2018). Increasing diabetic patient engagement and self-reported medication adherence using a web-based multimedia program. Journal of the American Association of Nurse Practitioners, 30(5), 293-298. https://doi:10.1097/JXX.0000000000000045

Höchsmann, C., Müller, O., Ambühl, M., Klenk, C., Königstein, K., Infanger, D., Walz, S. P., & Schmidt-Trucksäss, A. (2019). Novel Smartphone Game Improves Physical Activity Behavior in Type 2 Diabetes. American Journal of Preventive Medicine57(1), 41–50. https://doi.org/10.1016/j.amepre.2019.02.017

Huang, M., Hung, C., Yu, C., Berry, D., Shin, S., & Hsu, Y. (2017). The effectiveness of multimedia education for patients with type 2 diabetes. Journal of Advanced Nursing, 73(4), 943-954. https://doi-org.access.library.miami.edu/10.1111/jan.13194

Jiwani, R., Dennis, B., Bess, C., Monk, S., Meyer, K., Wang, J., & Espinoza, S. (2021). Assessing acceptability and patient experience of a behavioral lifestyle intervention using fitbit technology in older adults to manage type 2 diabetes amid COVID-19 pandemic: A focus group study. Geriatric Nursing42(1), 57–64. https://doi.org/10.1016/j.gerinurse.2020.11.007

Pai, L., Chiu, S., Liu, H., Chen, L., & Peng, T. (2021). Effects of a health education technology program on long-term glycemic control and self-management ability of adults with type 2 diabetes: A randomized controlled trial. Diabetes Research and Clinical Practice, 175, 108785. https://doi.org/10.1016/j.diabres.2021.108785

Plotnikoff, R. C., Wilczynska, M., Cohen, K. E., Smith, J. J., & Lubans, D. R. (2017). Integrating smartphone technology, social support and the outdoor physical environment to improve fitness among adults at risk of, or diagnosed with, Type 2 Diabetes: Findings from the ‘eCoFit’ randomized controlled trial. Preventive Medicine105, 404–411. https://doi.org/10.1016/j.ypmed.2017.08.027

Velázquez-López L, Muñoz-Torres AV, Medina-Bravo P, Vilchis-Gil J, Klϋnder-Klϋnder M, Escobedo-de la Peña J. (2017). Multimedia education program and nutrition therapy improves HbA1c, weight, and lipid profile of patients with type 2 diabetes: a randomized clinical trial. Endocrine. 58(2), 236-245. https://doi:10.1007/s12020-017-1416-0