Building diabetes literacy through smartphone application: feasibility and challenges

Abstract

Background: Mobile devices such as smartphones are becoming popular and mobile application software (app) creates an excellent platform for health promotion due to its popularity and convenience. Online application software, named Hong Kong University Diabetes Risk Score (HKUDRS) App, has been developed in 2014 as a diabetic risk calculator for general population and a provider of individualized health education. Method: This is a feasibility study assessing the use of HKUDRS app in Hong Kong Chinese population. Target population was: 1) Chinese aged 18 or above; 2) Hong Kong residents; 3) able to use a smartphone to download the HKUDRS app; 4) able to key in the information into the app by him/herself. Users of the app were asked to enter their age, sex, BMI, waist, drug history, history of high blood glucose level, pattern of physical activity, dietary habit and other lifestyles. Diabetes risk was calculated based on Finnish Diabetes Risk Score (FINDRISC) model. DRS score which was greater than 9 was considered as “high risk”. Tailor-made health education messages were given and users could share these messages with friends and relatives in the Facebook so as to seek their supports in lifestyle modification. Results: After launching 43 days in the app stores, 6,905 entries were received. Among these, 5,169 were considered as valid records in which the input in body height, body weight and waist circumference were not outliers or the same as the default. The information given was sufficient to calculate the risk score. About half (55.9%) were aged 45 or below, and 38.3% attained their highest education as bachelor degree. Majority (65.2%) were male. The median of risk score was 3 (interquartile range: 2-6) and 12.8% had high risk (DRS ≥ 9). A total of 2,829 (54.7%) were Android users. Among all valid records, 1,131 (21.9%) users provided their email addresses and indicated their interest to be followed up by professionals. Among the users whom could be followed up, 183 (16.1%) were at high risk of having diabetes in the coming 5 years. Conclusion: HKUDRS app is the first health-related web-based tool developed by HKU multidisciplinary team comprising endocrinologist, family medicine expert and nursing/health literacy faculty. This study showed the feasibility of using app in self-screening and witnessed the possibility of using app in health education. The challenges are the sustainability of the use of app in subsequent self-reported change of behavior after counselling.