Research article on development study and utility of Swayam Diabetes m- health application, nutrition informatics platform for self-care management of Type 2 Diabetes in home settings

Research article on development study and utility of Swayam Diabetes m- health application, nutrition informatics platform for self-care management of Type 2 Diabetes in home settings | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Research article on development study and utility of Swayam Diabetes m- health application, nutrition informatics platform for self-care management of Type 2 Diabetes in home settings Abhijeet Prasad Sinha, Manmohan Singhal, Ashish Joshi, Rohitashwa Kumar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4276812/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Type 2 diabetes mellitus (T2DM) prevalence is alarmingly rising in India, one of the nations most affected by this epidemic. Mobile health (mHealth) interventions offer a promising approach to improving diabetes management by providing tools for self-monitoring, education, and support. This article explores the development and utility of mHealth interventions, focusing on Swayam Diabetes mHealth research in the Indian context. Drawing upon existing literature and empirical evidence, the article discusses the effectiveness, challenges, and future directions of m-Health interventions in T2DM management. Materials and methods A mixed research study qualitative n = 18 for testing of deigned interventions and quantitative n = 278 people conducted a DBMS questionnaire survey SUS global testing tool was needed for m-Health interventions on diabetes self-care management applications, with n = 55 participants evaluated using the System Usability Score and DBMS a using globally tested tool Result 78% of participants preferred using an app to monitor their self-care routine, including food intake, nutrition, physical activity, medication usage, and diabetes-related details. The study found a 5.1% improvement in self-care administration, with gender having little influence. Over 55% of participants used a daily diary and found self-management with m-health interventions beneficial. The study found three key themes: a user-centered tool, an interactive interface, and learning from other users. Conclusion The results of this study significantly support the alternative hypothesis of the research study and demonstrate a relationship between m-health and improved at-home diabetic self-care management. Selfcare management chronic care management Swayam diabetes diabetes management type 2 diabetes mobile health m-health human centered user centered Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Introduction Type 2 diabetes is a global health issue affecting 463 million people worldwide, with a projected global prevalence of 578 million by 2030. India, with one in every six diabetics, is affected by the pandemic, causing $ 8 billion in health spending [ 1 ]. Factors such as age, obesity, poor eating habits, and poor nutritional practices increase the risk of early morbidity and mortality. Appropriate blood pressure, lipids, and blood sugar control are essential for prevention and treatment, but barriers like lack of multisectoral strategies and healthcare access hinder progress [1,2]. The combination of intricate self-management therapies and everyday diabetes challenges can result in large levels of sorrow, frustration, and discouragement, all of which have an impact on a person's well-being. However, patients and their families handle most of the diabetes care at home, and a self-management program has proven to be the cornerstone of diabetes therapy[3].To actively participate in self-care management activities and achieve goals, one can enhance behaviors that aid the use of the self-management regime in m-health[3].Meal planning, exercise, blood sugar monitoring, diabetes medication, and handling high and low blood sugar during illness episodes are all examples of self-management. One in two T2D patients remains undiagnosed, leading to delayed diagnosis and treatment. The alarming increase in diabetes incidence and prevalence necessitates global health system reform. Uncontrolled diabetes results in hyperglycinemia, damaging blood vessels and neurons. The rising incidence and prevalence of diabetes necessitate sustainable patient-centered spending. Materials and method A study involving 278 people was conducted to understand the extent and importance of mobile health apps (m-health) in chronic care management and self-care management at home. The research aimed to develop and design type 2 diabetes m-health interventions based on self-care management and nutrition informatics in the Indian regime, with a focus on diabetes type 2. The study also evaluated the app's value in terms of self-care interventions, nutrition informatics, patient outcomes, support groups, and healthcare provider connections [4,5,15]. The research was divided into three phases: scoping review using the PRISMA method, designing and creating a human-cantered design mobile application on type 2 diabetes m-health and nutrition informatics regime, and analyzing the efficacy and utility of a self-care management m-health application designed with a nutrition informatics regime using System Usability Scale (SUS) usability and a mixed research evaluation with end-users using DBMS questionnaire. The study was conducted at urban hospitals and private clinics, with a sample of 278 participants completing a pretested DBMS questionnaire and consent forms. Data were gathered using globally proven approaches such as diabetes-based management system (DBMS) surveys and the SUS tool. Qualitative research was used for exploratory and sequential studies, followed by quantitative techniques. The System Usability Scale (SUS), an internationally tested tool, was employed for user follow-up and experience. The findings are reported using SPSS's latest version 18.2 at 95% CIs and P = 0.05.[14, 15] Study Design and setting. The mixed research study included 278 participants recruited via telephone, clinics, and health apps. The registered users went through self-assessment of Diabetes Based Management System Questionnaires (DBMS), daily diaries, exercise, diet, nutrition tracking, and health application follow-up. The system usability scale (SUS) global tool was used to assess the usability and usefulness of the application in a sample of 55 users. Both quantitative and qualitative findings were made using the most recent 18.2 version of SPSS and NVIVO. This study uses a mixed research strategy, combining qualitative and quantitative methodologies to investigate the use of the Swayam Diabetes Care app for self-care management in individuals with type 2 diabetes. The study aims to understand user preferences and requirements for the app, as well as the protocols for everyday life to better control disease at home. The qualitative research involved in-depth interviews with n = 18 respondents, with an average age of 50 years [6,15]. Design of user-centred application and testing The Swayam Diabetes Care application was created to aid in self-care management for people with type 2 diabetes, with a focus on patient-centric design principles. The Android platform is used to run mobile applications. Swayam Diabetes Care was created with a heavy emphasis on user-centric design concepts in mind. A sample size of n = 18 participants was used for the qualitative sequential study. In-depth interviews were conducted as part of the research [7,16]. Based on the user-cantered factors, the Swayam Diabetes Healthcare app was developed, and possible actions were tested with users n = 18 with qualitative In-depth interviews are to be conducted with the prototype application, taking inputs into the design of this health application. The study used a qualitative sequential analysis to gather input from a sample size of 55 participants. The Swayam Diabetes Care app design and integrated self-care management were the focus of the study. The app had a daily notebook, diet tracking, exercise tracking, medication intake tracking, and nutrition informatics. The creators designed these aspects to enhance self-care, adherence, and management. Furthermore, the system seeks to identify the users' characteristics, requirements, and preferences for using the diabetic self-management program. This study employs a mixed research strategy, using both qualitative and quantitative methodologies separately. We then merge the data gathered from each part to confirm the research findings [16]. The study implemented the practice of informed consent and adhered to data protection rules as per the study protocol [14,15]. Study Participants and sampling. We used the purposeful or convenience sampling method in the qualitative research. The qualitative method involved conducting 15 IDIs and 6 FGDs for the study. However, in the quantitative research part of the study, stratified random sampling was employed. Sample size n = 278 (stratified random). Study samples were divided into age groups between 20 and 78, and samples were stratified based on age groups and religious background. The samples (n = 120) are retained in the study for more than 6 months [15,16,17]. Sample size calculation The study is on Android platform user testing, so a sample size of 250 was chosen as per (278 to Registered) * (90% Retained) = the required sample size. Therefore, N (278) = required sample size/ (90% kept) N = 250/0.90 = 278 Table 1 Criteria for inclusion and exclusion of samples Target population CATEGORY CRITERIA 1. Populations Include Population 20 years to 79 years diagnosed with type 2 diabetes in Urban. Exclude Pregnant women, adolescents, Children, gestational diabetes, pre-diabetes Rural 2. Interventions Include Android phone users Exclude Feature 3. Comparators Inclusion Consent and signed Swayam diabetes Mobile led m-health for diabetes self-management 4. Outcomes Include To include patient outcomes on self-care management and user testing of platform and home setting Exclude Health service provider outcomes, clinical outcomes 5. Timing/Setting Include 6 months registration and follow ups 6. Study design Include Mixed Research study design Qualitative + Quantitative Sequential Exclude Patient not enrolled in m-health app study 7. Sample 278 Stratified Radom Sampling and Qualitive- purposive/convenience sampling Data collection tools and technique The study team obtained the informed consent form approved by the institutional review board for all eligible participants in the study. The research team explained the study to the participants, highlighted the time commitment and benefits of the study results, and enrolled those willing to participate and grant consent. Participants were able to read and understand the questionnaire and consent form, which were in Hindi. If any participant is illiterate, ethical authorization was obtained with the help of a representative or a neutral witness. We also provided the questionnaire to illiterate participants in local Indian languages to enhance the study's significance and feasibility [12,14]. Process of gathering information or data All respondents provided written informed consent in their native Hindi language. Researchers notified participants of their withdrawal at any time, without requiring them to defend their reasons. In doing so, participants were provided with a written consent form in Hindi that outlined the details of the investigation [16,18]. Subsequently, they were requested to provide written consent, and the consent was read and signed off at the outset of the study. Data on participant characteristics were obtained through a self-administered questionnaire (DBMS) in the local language Hindi. Additionally, the research method included the collection of survey data for in-depth interviews [22, 23, 25]. Ethical consideration DIT University Research Ethics Committee accepted the protocol number study. The Helsinki Declaration (Protocol number UREC/2021/07/10) has govern the investigation because it includes human research subject. The survey's findings have been issued through peer-reviewed publications as well as presentations at national and international conferences. The findings help them make data-driven, evidence-based decisions. As qualitative methodologies, semi-structured interviews and focus group discussions were employed. Participants were allotted individual time slots. Participants were notified that they were taking part in a study and would be asked to sign a consent form. They were debriefed, and a permission document showing the number of study participants was signed. SUS and DBMS are globally tested tools, it was translated with professional translators, check, and tested by experts and it was reviewed by Research Ethics committee. The study has been conducted on smartphone Android users and in the urban population in home settings. Results The study found that 78% of the respondents suggested the app needs help tracking daily and weekly self-care management and important regimes such as food intake, nutrition, exercise, medicine tracking, key diabetes information, and WhatsApp integration. Additionally, 83% of the participants preferred frequent asked questions (FAQs) to demystify myths and that the application should be in Hindi for better understanding. The study also found that 88% of the respondents preferred daily tracking or a digital diary to assist them in following self-care management goals. The study analyzed the data using NVIVO software and a structured approach consisting of six steps. Themes Three major themes emerged from the qualitative investigation: The study found that focusing on more than one aspect of Type 2 diabetes self-care management led to a significant 5.1% improvement in self-care management, indicating a positive effect on diabetes self-care and management. Gender had a statistically significant but minor impact. This study examines the associations between a number of variables, including age, gender, diabetes status, marital status, diabetes in other household members, work hours, educational attainment, preferred language, preferred religion, special dietary preferences, chronic complications, diabetes health attitude, medical history, family history of the disease, healthy eating habits, and additional procedures. The study followed 55 users over four months to determine if using health apps helped with self-care, diabetes type 2 management, and Hb1AC improvement. The results showed that 93.8% of respondents followed a healthy diet, with 91.2% choosing Hindi. The most popular religion preference was Hindu, with 76% of respondents claiming to be Hindu. Marital status was the most common, with 93.1% being married. In terms of medical history, 74.9% of respondents answered "yes" while 25.1% said "no." In terms of diabetes health attitude, 93.8% had a positive attitude. The study found that Christians have the highest level of religious preference, followed by Hindus and Muslims. Those without a medical history had a higher preference. People who follow good eating habits enjoy them more than those who do not. Both Hindi speakers and non-Hindi speakers scored equally. Table No.:2 Qualitative study Total sample (N = 18) Gender: Male Female 10 (55%) 8 (45%) Age, years 50 ± 10 Socio-economic status BPL 3(21%) Above BPL 15 (35%) Own mobile(android) 18(100%) Education, highest level: Matric 3 (19%) Intermediate 8 (41%) Graduate/post-graduate 7 (39%) Diabetes duration, years 5 ± 7 Working Non-working 75% 25% HbA1c: unknown 70% HbA1c self-reported %(mmol/mol) 30% Registration Currently Swayam Diabetes app(s)for self-care management Yes Daily diary filled (daily/ weekly) 100% 55% 1 The study analyzed the impact of a two-way ANOVA on the improvement of HB1AC through two variables. The results showed that 93.8% of participants followed a healthy diet, with 91.2% choosing Hindi as their language preference. The most common religious preference was Hindu, with 18.5% of respondents identifying as such. Most respondents were married, with 74.9% reporting improvement in their HbA1c over the period of 6 months. Table 3 Frequency of the sample Quantitative study Parameters Variables Frequency % % valid Eating Healthy No 17 6.2 6.2 Yes 258 93.8 93.8 Preference of the local languages Hindi 252 91.2 91.2 Other 23 8.4 8.4 Preference on Religion Christian 3 1.1 1.1 Other 51 18.5 18.5 Hindu 209 76.0 76.0 Muslim 11 4.0 4.0 Panjabi 1 0.4 0.4 Status marital Married 256 93.1 93.1 Single 8 2.9 2.9 Unmarried 11 4.0 4.0 History (medical NO 69 25.1 25.1 YES 206 74.9 74.9 Attitude on self care management NO 17 6.2 6.2 YES 258 93.8 93.8 The study also found that a significant 5.1% increase in overall health knowledge and attitude reported in self-care management goals was observed. Notable improvements in healthy eating and diabetes health attitude were also found to have led to better results. Language preference had a negligible impact. Table-4 Testing of the variables. Subgroup Mean SD 95% CI Testing Value Religion Preference Christion 0.8451 0.0070 0.062 ± 0.082 chi-value = 2.0145, p-value = 0.0001 Other 0.1452 0.0058 0.068 ± 0.084 Hindu 0.1254 0.0086 0.063 ± 0.082 Muslim 0.0114 0.0058 0.073 ± 0.082 Punjabi 0.1433 0.0058 0.073 ± 0.082 Medical History NO 0.89741 0.0063 0.058 ± 0.082 chi-value = 21.1105, p-value = 0.0000 YES 0.1236 0.0093 0.073 ± 0.080 Diabetes Health Attitude NO 0.8974 0.0070 0.062 ± 0.085 chi-value = 4.0744, p-value = 0.0052 YES 0.1423 0.0062 0.067 ± 0.078 Healthy Eating No 0.7856 0.0086 0.063 ± 0.079 chi-value = 3.0145, p-value = 0.0012 Yes 0.1483 0.0058 0.073 ± 0.079 Language Preference Hindi 0.1447 0.0056 0.058 ± 0.080 chi-value = 2.0145, p-value = 0.0012 Other 0.1483 0.0087 0.064 ± 0.082 Age 20 TO 35 0.5741 0.0078 0.058 ± 0.080 chi-value = 6.1452, p-value = 0.0001 36 TO 50 0.4571 0.0095 0.056 ± 0.081 51 TO 65 0.2631 0.0062 0.056 ± 0.083 66 TO 80 0.124 0.0063 0.062 ± 0.084 According to the above-mentioned chi-square test, Christians have the highest level of religious preference (mean = 0.8451), followed by Hindus (mean = 0.1452) and Muslims (mean = 0.0114). Those without a medical history had a higher preference (mean = 0.89741) than those with one (mean = 0.1236). Respondents who do not have a favourable attitude towards their diabetic health have a higher preference (mean = 0.8974) than those who do (mean = 0.1423). People who follow good eating habits enjoy them more (mean = 0.1483) than those who do not (mean = 0.7856). Both Hindi speakers and non-Hindi speakers scored equally (mean = 0.1483). Preference ratings are higher for younger age groups (20 to 35) and older age groups (36 to 50) (means = 0.5741 and 0.4571, respectively). Table 5 ANOVA testing of two-way HBA1C improvement. Item DF SS MS T-test P-value correct Model 5 2141 428.2 78.53 < 0000 Intercept 1 5412 5412 9145.25 < 0000 Gender 1 1250 1250 0.582 0.0042 Hb1AC improvement 2 129 64.5 18952 < 0000 Gender*Hb1AC improvement 2 1464 732 7.264 < 0000 Error 263 7812 29.70342 Total 274 18208 The two-way ANOVA table (Table 1.3) presents the findings of assessing the improvement in HB1AC through two variables. The exact model has a mean square (MS) of 428.2 and shows considerable variance (p 0.0000). With an MS of 5412, the intercept likewise showed a large variance (p 0.0000). Gender had a statistically significant but somewhat small influence (p = 0.05). MS = 1250). The part that improved Hb1AC showed a very significant impact (p 0.05, MS = 64.5. Moreover, a statistically significant interaction was seen between gender and Hb1AC improvement (p 0.05, MS = 732). The misplaced phrase's MS was 29. 70342.With a total of 18208 squares, 274 degrees of freedom were employed in the study. The cumulative improvements in these variables led to a significant 5.1% increase in overall health knowledge and attitude reported in self-care management goals. The Swayam Diabetes app was evaluated using a system usability scale with n = 55 participants three months after using the app. The SUS Tools research evaluated the efficacy of mobile health informatics and nutrition interventions for type 2 diabetes self-care and at-home care using qualitative techniques. Using a Likert scale, the 10-item System Usability Scale (SUS) was straightforward. According to the research, regular journal reminders can enhance self-care management techniques and general health. The SUS form was used to assess a total of 55 users of the Swayam Diabetes app. The total SUS score for this application's usefulness and simplicity of use. X = 5, which is the total number of points for all odd-numbered questions. When the scores for all questions have an even number of answers, you get Y = 25, or 25. [14,16]. The SUS score is 2.5 times (X + Y). X = 16.6 + Y + 17.1 = 33.7 * 2.5 = 84.25. The total score is a Grade A, which is excellent. SUS users discover health applications that are intended to be useful, simple to use, and beneficial. The fact that utility and usability ratings surpass 80 on the scale [4] demonstrates this. 14.1 out of n = 55 reported improvement in Hb1AC over the period of 6 months. 1.1% suggested daily diary to be in translated language. 3.2% overall improvement was reported in Healthy eating due to daily diary and 5.1% Overall improvement was reported in n = 55 selfcare management using Swayam Diabetes app. Discussion The study underscores the need for diabetes self-management education and continuing support for patients with type 2 diabetes. It argues that treatment, attitudes, and prior information impact choices. However, some users want more advanced resources. Shorter-term diabetics employ tools for routines, whereas longer-term diabetics use technology to improve self-care behaviors. Diabetes education is vital for self-management, yet most courses do not cover it. Mobile apps can provide educational, nutritional, and professional help. Two-way communication and collaboration between healthcare practitioners and app developers can increase app use. 1. Self-care management at home using mHealth can improve patient-level outcomes. The study found that patients' ability to manage their diabetes at home and keep control over the illness will significantly affect their health outcomes. As a result, education about the proper use of m-health applications is critical for enhancing illness self-management. Research on nutrition informatics and a self-management care module for m-Health diabetic home care management will be highly beneficial [17, 18, 20]. The self-management program, patient follow-up for improved healthcare service use, are tested in various and diverse groups. 2. Human-cantered design: The user at the core for mHealth application development. Human-centered design to support self-care management can help effectively control the difficulties associated with type 2 diabetes. Recovering from difficulties requires keeping a balanced diet and leading a physically fit lifestyle. With the advancement of information about self-care management that aims to control difficulties in the home environment, the perspective on balanced eating has also evolved [21,24,25]. By designing mobile applications with the user's needs in mind, we can enhance their usability and utility. Self-care tools such as keeping a daily diary on one's diet, exercise routine, blood sugar levels, and medication intake can help one better manage their diseases and lead a healthy lifestyle [26]. 3. The health application can be tested in a wider population and in rural areas. Despite many barriers to a clear picture of how to use the applications, the study can be conducted in a variety of populations and demographics to better understand diabetes self-care management in home settings as well as overall health outcomes by understanding the interaction of demographic characteristics and health-related variables. However, the study's focus on diabetes self-care management makes it valuable for future research and implementation in this field [25,26]. Recommended tested framework. The study proposes a framework for designing and developing self-care management m-health apps. It involves conceptualizing, defining necessity, designing an informatics app, developing a prototype, implementing the app, and evaluating it with users. The framework is designed for future development and assessment. Conceptualize – Why m-health intervention Define need. Ideate Informatics, Self-care management prototype app features. D-Design (User centred) Prototype Design with User consultation Human-cantered design, User pretesting testing of the app, Contextual user journey and Ease of use. I- Implement- Deploy the app, consultation, Modification, Completion, Customization, Visualization, and informatics for users on selfcare management. U-User Evaluation- Evaluation of the app with users, Use of the globally tested tool, Evaluate the outcome of apps & and further improvement and periodic evaluation with users to improve the application. The QIMA framework provides guidance for designing m-health applications for self-care management of type 2 diabetes at home, applicable to all m-health self-care management apps. Limitation and recommendation More comprehensive study designs and methodologies are needed for future scoping reviews and assessments of mHealth treatments for type 2 diabetes management. AI-enabled systems can build evidence-based treatments based on user experiences, ratings, and interactions. mHealth interventions offer benefits like enhanced self-management, improved adherence to treatment, increased healthcare access, and better communication with healthcare providers. However, challenges like digital literacy, connectivity barriers, privacy concerns, healthcare provider engagement, regulatory frameworks, and sustainability need to be addressed. The effectiveness of mHealth interventions may vary depending on user demographics, socioeconomic status, cultural norms, and healthcare infrastructure. Conclusion m-Health approaches can transform diabetes management and improve health outcomes, especially in countries like India with high disease loads and limited healthcare resources. The Swayam Diabetes initiative shows mHealth's ability to empower patients, boost self-care practices, and improve communication between patients and healthcare professionals. Education on m-health applications is vital for improved self-management. The study's findings will guide m-health's development for India and worldwide applications. Swayam Diabetes applications are generally recognized for m-health selfcare management, presenting unique potential in healthcare, such as avoiding type 2 diabetes and boosting self-management. Mobile health applications (mHealth) are viewed as the future for chronic care management and self-care management. Future study should focus on diabetes self-management, its effect, and the utility of m-health treatments. These programs can also contain nutrition informatics modules for local and regional diets. Declarations Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Author Contribution APS and MS prepared Manuscript, AS and RK prepared figures and tables. All authors have revieved the manuscript Data Availability The dataset generated and or analysed during the current study are available with corresponding author on reasonable request Additional Information: Disclosures UREC approval ; The Study was approved DIT University Research Ethics Committee UREC 2021/07/10. Global DBMS and SUS tool was approved and informed consent forms in local language were obtained from all participants signed by the participants to take part in this study. Human subjects: All authors have confirmed that this study did not involve human participants or tissue. DIT University Research Ethics Committee (UREC) accepted the protocol number study. The Helsinki Declaration (Protocol number UREC/2021/07/10) has govern the investigation. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Intellectual property info: I have submitted a patent of integrated diabetes management system in Indian Government patent application in January 2023, it is due for approval. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. Data- The dataset generated or analysed during the study are available from corresponding author on reasonable request. 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Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Sinha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYDACCR6GAxJgFmMDMwODDYjReIAYLRJQLWlgvQS1gCkQAdRyGMzDq4V/du/BAxYVNnXm/IfbHhfUnLdb234YaEuNTTROS+6cSzggcSZNwnJGYrvxjGO3k7edSQRqOZaW24BLz40cgwOSbYclDG4wtknzsN1ONjsA1MLYcBinFnmwln//JQzOHwRq+Xcu2ez8Q/xaDMBaGg5IGBxIbJPmbTtgZ3aDgC2Gd84YHJA4liy5cwZIS19ygtkNoC0JePwid7vH+LNEjR2/Of/xZ9I83+zszc6nP3zwocYGt/eBgBkUKQZQTiJYZQIe5SDA+AFJiz0BxaNgFIyCUTACAQDqOGY+oBMLCQAAAABJRU5ErkJggg==","orcid":"","institution":"DIT university Dehradun","correspondingAuthor":true,"prefix":"","firstName":"Abhijeet","middleName":"Prasad","lastName":"Sinha","suffix":""},{"id":299212292,"identity":"e71c67b2-f84f-47d5-9e47-ae8e75850fee","order_by":1,"name":"Manmohan Singhal","email":"","orcid":"","institution":"DIT university 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14:44:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4276812/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4276812/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56200473,"identity":"0ec3cb2c-b1ec-4763-ac48-0d5c56287428","added_by":"auto","created_at":"2024-05-09 19:09:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":21976,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSWAYAM Diabetes care application, HCD design, and features\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/aea19271ccb96d8631296450.png"},{"id":56199411,"identity":"c005a0b4-1d49-4730-996c-9b1aebab0868","added_by":"auto","created_at":"2024-05-09 18:44:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":155942,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eOverall design of SWAYAM Diabetes health care for type 2 management at urban home setting (smartphone android users)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/d63680606fefed63010733e6.png"},{"id":56200076,"identity":"e0a80315-8f83-4da4-98c0-41d2bffb1634","added_by":"auto","created_at":"2024-05-09 19:00:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":61006,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSelf-care management of diabetes-steps.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/ea470e4cbda01bbe681d9769.png"},{"id":56200492,"identity":"64f2ec39-c12b-4670-91f5-fd4020dc9ca0","added_by":"auto","created_at":"2024-05-09 19:09:35","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":468367,"visible":true,"origin":"","legend":"\u003cp\u003eSwayam Diabetes m-health application design screen shots\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/ba0d2ed400c6328bcf0185ea.png"},{"id":56200458,"identity":"5d8d8943-72c4-48db-82c7-09e1d7f2e3f6","added_by":"auto","created_at":"2024-05-09 19:09:22","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":65081,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe qualitative themes input to design the user centred (HCD) Swayam Diabetes Care application.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e1) a diabetes self-care management tool that checks and reminds users of their daily regimen and a daily journal where they may record food and nutrition information.\u003c/p\u003e\n\u003cp\u003e2) an interactive and simple-to-use element in the application, as well as the program being in Hindi (the local language); and\u003c/p\u003e\n\u003cp\u003e3) learning about nutrition, daily routines, and apps from other users to address inquiries and queries.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/3eeb2c1464125bd31de797ba.png"},{"id":56199697,"identity":"5a5dc1f9-3ddc-427c-be45-a0fa13acf7f9","added_by":"auto","created_at":"2024-05-09 18:52:44","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":104219,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePie chart representation samples\u003c/em\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/15b738149a3672de1fbf1fcb.png"},{"id":56199703,"identity":"de181930-aabe-4f60-9f70-26f20377a6e2","added_by":"auto","created_at":"2024-05-09 18:52:44","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":42162,"visible":true,"origin":"","legend":"\u003cp\u003eTheory of change selfcare management of T2 DM\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/2f69315e5ea9593d2830bd6a.png"},{"id":56199419,"identity":"be9d55e6-9b7e-4dfc-a567-cb1310c83179","added_by":"auto","created_at":"2024-05-09 18:44:45","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":13360,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eGraph 8- Ease of use score n=18 Users\u003c/em\u003e\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/924ff98d0b8480cca157ee0e.png"},{"id":56200080,"identity":"2dbc568c-3097-4215-be06-1ddff158a683","added_by":"auto","created_at":"2024-05-09 19:00:45","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":13228,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eGraph 9: Utility and usability of app N=18 users\u003c/em\u003e\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/de885948b0b50ee9c9cdf8c2.png"},{"id":56200482,"identity":"43551f18-2abf-40c7-af42-42a63d989176","added_by":"auto","created_at":"2024-05-09 19:09:32","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":39165,"visible":true,"origin":"","legend":"\u003cp\u003eGraph 10- Self-care management outcomes using a health app designed.\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/1b11a2d35b9c2fac67a2ce3e.png"},{"id":56200081,"identity":"06fb6c8e-e247-4efe-946d-1101504fda35","added_by":"auto","created_at":"2024-05-09 19:00:46","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":63481,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eRecommended framework CDIU outcome of the study\u003c/em\u003e\u003c/p\u003e","description":"","filename":"11.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/bbc32f9ab7c8ec645aabb511.png"},{"id":56199704,"identity":"d36b8c0c-5b5b-4d38-90cf-b2d27360bcf0","added_by":"auto","created_at":"2024-05-09 18:52:46","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":107162,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 11 QIMA Framework outcome of research\u003c/p\u003e","description":"","filename":"12.png","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/0ab043c8100309cfed5166f1.png"},{"id":79657744,"identity":"01ea36f5-6e21-4e3f-9feb-1824f2cf6d74","added_by":"auto","created_at":"2025-04-01 09:09:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2312990,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4276812/v1/03ce1391-bd88-4f4e-899c-2a5e1b83e5c7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Research article on development study and utility of Swayam Diabetes m- health application, nutrition informatics platform for self-care management of Type 2 Diabetes in home settings","fulltext":[{"header":"Introduction","content":"\u003cp\u003eType 2 diabetes is a global health issue affecting 463\u0026nbsp;million people worldwide, with a projected global prevalence of 578\u0026nbsp;million by 2030. India, with one in every six diabetics, is affected by the pandemic, causing \u003cspan\u003e$\u003c/span\u003e8\u0026nbsp;billion in health spending [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Factors such as age, obesity, poor eating habits, and poor nutritional practices increase the risk of early morbidity and mortality. Appropriate blood pressure, lipids, and blood sugar control are essential for prevention and treatment, but barriers like lack of multisectoral strategies and healthcare access hinder progress [1,2]. The combination of intricate self-management therapies and everyday diabetes challenges can result in large levels of sorrow, frustration, and discouragement, all of which have an impact on a person's well-being. However, patients and their families handle most of the diabetes care at home, and a self-management program has proven to be the cornerstone of diabetes therapy[3].To actively participate in self-care management activities and achieve goals, one can enhance behaviors that aid the use of the self-management regime in m-health[3].Meal planning, exercise, blood sugar monitoring, diabetes medication, and handling high and low blood sugar during illness episodes are all examples of self-management. One in two T2D patients remains undiagnosed, leading to delayed diagnosis and treatment. The alarming increase in diabetes incidence and prevalence necessitates global health system reform. Uncontrolled diabetes results in hyperglycinemia, damaging blood vessels and neurons. The rising incidence and prevalence of diabetes necessitate sustainable patient-centered spending.\u003c/p\u003e"},{"header":"Materials and method","content":"\u003cp\u003eA study involving 278 people was conducted to understand the extent and importance of mobile health apps (m-health) in chronic care management and self-care management at home. The research aimed to develop and design type 2 diabetes m-health interventions based on self-care management and nutrition informatics in the Indian regime, with a focus on diabetes type 2. The study also evaluated the app's value in terms of self-care interventions, nutrition informatics, patient outcomes, support groups, and healthcare provider connections [4,5,15].\u003c/p\u003e \u003cp\u003eThe research was divided into three phases: scoping review using the PRISMA method, designing and creating a human-cantered design mobile application on type 2 diabetes m-health and nutrition informatics regime, and analyzing the efficacy and utility of a self-care management m-health application designed with a nutrition informatics regime using System Usability Scale (SUS) usability and a mixed research evaluation with end-users using DBMS questionnaire.\u003c/p\u003e \u003cp\u003eThe study was conducted at urban hospitals and private clinics, with a sample of 278 participants completing a pretested DBMS questionnaire and consent forms. Data were gathered using globally proven approaches such as diabetes-based management system (DBMS) surveys and the SUS tool. Qualitative research was used for exploratory and sequential studies, followed by quantitative techniques. The System Usability Scale (SUS), an internationally tested tool, was employed for user follow-up and experience. The findings are reported using SPSS's latest version 18.2 at 95% CIs and P\u0026thinsp;=\u0026thinsp;0.05.[14, 15]\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy Design and setting.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe mixed research study included 278 participants recruited via telephone, clinics, and health apps. The registered users went through self-assessment of Diabetes Based Management System Questionnaires (DBMS), daily diaries, exercise, diet, nutrition tracking, and health application follow-up. The system usability scale (SUS) global tool was used to assess the usability and usefulness of the application in a sample of 55 users. Both quantitative and qualitative findings were made using the most recent 18.2 version of SPSS and NVIVO. This study uses a mixed research strategy, combining qualitative and quantitative methodologies to investigate the use of the Swayam Diabetes Care app for self-care management in individuals with type 2 diabetes. The study aims to understand user preferences and requirements for the app, as well as the protocols for everyday life to better control disease at home. The qualitative research involved in-depth interviews with n\u0026thinsp;=\u0026thinsp;18 respondents, with an average age of 50 years [6,15].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign of user-centred application and testing\u003c/h2\u003e \u003cp\u003eThe Swayam Diabetes Care application was created to aid in self-care management for people with type 2 diabetes, with a focus on patient-centric design principles. The Android platform is used to run mobile applications. Swayam Diabetes Care was created with a heavy emphasis on user-centric design concepts in mind. A sample size of n\u0026thinsp;=\u0026thinsp;18 participants was used for the qualitative sequential study. In-depth interviews were conducted as part of the research [7,16].\u003c/p\u003e \u003cp\u003eBased on the user-cantered factors, the Swayam Diabetes Healthcare app was developed, and possible actions were tested with users n\u0026thinsp;=\u0026thinsp;18 with qualitative In-depth interviews are to be conducted with the prototype application, taking inputs into the design of this health application. The study used a qualitative sequential analysis to gather input from a sample size of 55 participants. The Swayam Diabetes Care app design and integrated self-care management were the focus of the study. The app had a daily notebook, diet tracking, exercise tracking, medication intake tracking, and nutrition informatics. The creators designed these aspects to enhance self-care, adherence, and management. Furthermore, the system seeks to identify the users' characteristics, requirements, and preferences for using the diabetic self-management program. This study employs a mixed research strategy, using both qualitative and quantitative methodologies separately. We then merge the data gathered from each part to confirm the research findings [16]. The study implemented the practice of informed consent and adhered to data protection rules as per the study protocol [14,15].\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy Participants and sampling.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWe used the purposeful or convenience sampling method in the qualitative research. The qualitative method involved conducting 15 IDIs and 6 FGDs for the study. However, in the quantitative research part of the study, stratified random sampling was employed. Sample size n\u0026thinsp;=\u0026thinsp;278 (stratified random). Study samples were divided into age groups between 20 and 78, and samples were stratified based on age groups and religious background. The samples (n\u0026thinsp;=\u0026thinsp;120) are retained in the study for more than 6 months [15,16,17].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size calculation\u003c/h3\u003e\n\u003cp\u003eThe study is on Android platform user testing, so a sample size of 250 was chosen as per (278 to Registered) * (90% Retained)\u0026thinsp;=\u0026thinsp;the required sample size. Therefore, N (278)\u0026thinsp;=\u0026thinsp;required sample size/ (90% kept) N\u0026thinsp;=\u0026thinsp;250/0.90\u0026thinsp;=\u0026thinsp;278\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCriteria for inclusion and exclusion of samples Target population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCATEGORY\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCRITERIA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePopulations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eInclude\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePopulation 20 years to 79 years diagnosed with type 2 diabetes in Urban.\u003c/p\u003e \u003cp\u003e\u003cb\u003eExclude\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePregnant women, adolescents, Children, gestational diabetes, pre-diabetes Rural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eInterventions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eInclude\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAndroid phone users\u003c/p\u003e \u003cp\u003e\u003cb\u003eExclude\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFeature\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eComparators\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eInclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eConsent and signed Swayam diabetes Mobile led m-health for diabetes self-management\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eInclude\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo include patient outcomes on self-care management and user testing of platform and home setting\u003c/p\u003e \u003cp\u003e\u003cb\u003eExclude\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHealth service provider outcomes, clinical outcomes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTiming/Setting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eInclude\u003c/b\u003e\u003c/p\u003e \u003cp\u003e6 months registration and follow ups\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eInclude\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMixed Research study design Qualitative\u0026thinsp;+\u0026thinsp;Quantitative Sequential\u003c/p\u003e \u003cp\u003e\u003cb\u003eExclude\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePatient not enrolled in m-health app study\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSample\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e278 Stratified Radom Sampling and Qualitive- purposive/convenience sampling\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eData collection tools and technique\u003c/h3\u003e\n\u003cp\u003e The study team obtained the informed consent form approved by the institutional review board for all eligible participants in the study. The research team explained the study to the participants, highlighted the time commitment and benefits of the study results, and enrolled those willing to participate and grant consent. Participants were able to read and understand the questionnaire and consent form, which were in Hindi. If any participant is illiterate, ethical authorization was obtained with the help of a representative or a neutral witness. We also provided the questionnaire to illiterate participants in local Indian languages to enhance the study's significance and feasibility [12,14].\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eProcess of gathering information or data\u003c/h2\u003e \u003cp\u003e All respondents provided written informed consent in their native Hindi language. Researchers notified participants of their withdrawal at any time, without requiring them to defend their reasons. In doing so, participants were provided with a written consent form in Hindi that outlined the details of the investigation [16,18]. Subsequently, they were requested to provide written consent, and the consent was read and signed off at the outset of the study. Data on participant characteristics were obtained through a self-administered questionnaire (DBMS) in the local language Hindi. Additionally, the research method included the collection of survey data for in-depth interviews [22, 23, 25].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003e DIT University Research Ethics Committee accepted the protocol number study. The Helsinki Declaration (Protocol number \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eUREC/2021/07/10)\u003c/span\u003e has govern the investigation because it includes human research subject. The survey's findings have been issued through peer-reviewed publications as well as presentations at national and international conferences. The findings help them make data-driven, evidence-based decisions. As qualitative methodologies, semi-structured interviews and focus group discussions were employed. Participants were allotted individual time slots. Participants were notified that they were taking part in a study and would be asked to sign a consent form. They were debriefed, and a permission document showing the number of study participants was signed. SUS and DBMS are globally tested tools, it was translated with professional translators, check, and tested by experts and it was reviewed by Research Ethics committee. The study has been conducted on smartphone Android users and in the urban population in home settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study found that 78% of the respondents suggested the app needs help tracking daily and weekly self-care management and important regimes such as food intake, nutrition, exercise, medicine tracking, key diabetes information, and WhatsApp integration. Additionally, 83% of the participants preferred frequent asked questions (FAQs) to demystify myths and that the application should be in Hindi for better understanding. The study also found that 88% of the respondents preferred daily tracking or a digital diary to assist them in following self-care management goals.\u003c/p\u003e \u003cp\u003eThe study analyzed the data using NVIVO software and a structured approach consisting of six steps.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eThemes\u003c/h2\u003e \u003cp\u003eThree major themes emerged from the qualitative investigation:\u003c/p\u003e \u003cp\u003eThe study found that focusing on more than one aspect of Type 2 diabetes self-care management led to a significant 5.1% improvement in self-care management, indicating a positive effect on diabetes self-care and management. Gender had a statistically significant but minor impact. This study examines the associations between a number of variables, including age, gender, diabetes status, marital status, diabetes in other household members, work hours, educational attainment, preferred language, preferred religion, special dietary preferences, chronic complications, diabetes health attitude, medical history, family history of the disease, healthy eating habits, and additional procedures.\u003c/p\u003e \u003cp\u003eThe study followed 55 users over four months to determine if using health apps helped with self-care, diabetes type 2 management, and Hb1AC improvement. The results showed that 93.8% of respondents followed a healthy diet, with 91.2% choosing Hindi. The most popular religion preference was Hindu, with 76% of respondents claiming to be Hindu. Marital status was the most common, with 93.1% being married. In terms of medical history, 74.9% of respondents answered \"yes\" while 25.1% said \"no.\" In terms of diabetes health attitude, 93.8% had a positive attitude. The study found that Christians have the highest level of religious preference, followed by Hindus and Muslims. Those without a medical history had a higher preference. People who follow good eating habits enjoy them more than those who do not. Both Hindi speakers and non-Hindi speakers scored equally.\u003c/p\u003e \u003cp\u003e \u003cem\u003eTable No.:2 Qualitative study\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eTotal sample\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender: Male\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e10 (55%)\u003c/p\u003e \u003cp\u003e8 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSocio-economic status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eBPL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3(21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAbove BPL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e15 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eOwn mobile(android)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e18(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEducation, highest level:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMatric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eIntermediate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e8 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eGraduate/post-graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiabetes duration, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWorking\u003c/p\u003e \u003cp\u003eNon-working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHbA1c: unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHbA1c self-reported %(mmol/mol)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRegistration Currently Swayam Diabetes app(s)for self-care management Yes\u003c/p\u003e \u003cp\u003eDaily diary filled (daily/ weekly)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe study analyzed the impact of a two-way ANOVA on the improvement of HB1AC through two variables. The results showed that 93.8% of participants followed a healthy diet, with 91.2% choosing Hindi as their language preference. The most common religious preference was Hindu, with 18.5% of respondents identifying as such. Most respondents were married, with 74.9% reporting improvement in their HbA1c over the period of 6 months.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of the sample Quantitative study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e% valid\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEating Healthy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePreference of the local languages\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHindi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003ePreference on Religion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePanjabi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eStatus marital\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHistory (medical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAttitude on self care management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe study also found that a significant 5.1% increase in overall health knowledge and attitude reported in self-care management goals was observed. Notable improvements in healthy eating and diabetes health attitude were also found to have led to better results. Language preference had a negligible impact.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable-4 Testing of the variables.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubgroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTesting Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eReligion Preference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.062\u0026thinsp;\u0026plusmn;\u0026thinsp;0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003echi-value\u0026thinsp;=\u0026thinsp;2.0145, p-value\u0026thinsp;=\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.068\u0026thinsp;\u0026plusmn;\u0026thinsp;0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.063\u0026thinsp;\u0026plusmn;\u0026thinsp;0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.073\u0026thinsp;\u0026plusmn;\u0026thinsp;0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePunjabi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.073\u0026thinsp;\u0026plusmn;\u0026thinsp;0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMedical History\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.058\u0026thinsp;\u0026plusmn;\u0026thinsp;0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003echi-value\u0026thinsp;=\u0026thinsp;21.1105, p-value\u0026thinsp;=\u0026thinsp;0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.073\u0026thinsp;\u0026plusmn;\u0026thinsp;0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDiabetes Health Attitude\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.062\u0026thinsp;\u0026plusmn;\u0026thinsp;0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003echi-value\u0026thinsp;=\u0026thinsp;4.0744, p-value\u0026thinsp;=\u0026thinsp;0.0052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.067\u0026thinsp;\u0026plusmn;\u0026thinsp;0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHealthy Eating\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.063\u0026thinsp;\u0026plusmn;\u0026thinsp;0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003echi-value\u0026thinsp;=\u0026thinsp;3.0145, p-value\u0026thinsp;=\u0026thinsp;0.0012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.073\u0026thinsp;\u0026plusmn;\u0026thinsp;0.079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLanguage Preference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHindi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.058\u0026thinsp;\u0026plusmn;\u0026thinsp;0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003echi-value\u0026thinsp;=\u0026thinsp;2.0145, p-value\u0026thinsp;=\u0026thinsp;0.0012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.064\u0026thinsp;\u0026plusmn;\u0026thinsp;0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 TO 35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.058\u0026thinsp;\u0026plusmn;\u0026thinsp;0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003echi-value\u0026thinsp;=\u0026thinsp;6.1452, p-value\u0026thinsp;=\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 TO 50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.056\u0026thinsp;\u0026plusmn;\u0026thinsp;0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 TO 65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.056\u0026thinsp;\u0026plusmn;\u0026thinsp;0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 TO 80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.062\u0026thinsp;\u0026plusmn;\u0026thinsp;0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the above-mentioned chi-square test, Christians have the highest level of religious preference (mean\u0026thinsp;=\u0026thinsp;0.8451), followed by Hindus (mean\u0026thinsp;=\u0026thinsp;0.1452) and Muslims (mean\u0026thinsp;=\u0026thinsp;0.0114). Those without a medical history had a higher preference (mean\u0026thinsp;=\u0026thinsp;0.89741) than those with one (mean\u0026thinsp;=\u0026thinsp;0.1236). Respondents who do not have a favourable attitude towards their diabetic health have a higher preference (mean\u0026thinsp;=\u0026thinsp;0.8974) than those who do (mean\u0026thinsp;=\u0026thinsp;0.1423). People who follow good eating habits enjoy them more (mean\u0026thinsp;=\u0026thinsp;0.1483) than those who do not (mean\u0026thinsp;=\u0026thinsp;0.7856). Both Hindi speakers and non-Hindi speakers scored equally (mean\u0026thinsp;=\u0026thinsp;0.1483). Preference ratings are higher for younger age groups (20 to 35) and older age groups (36 to 50) (means\u0026thinsp;=\u0026thinsp;0.5741 and 0.4571, respectively).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eANOVA testing of two-way HBA1C improvement.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT-test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecorrect Model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e428.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9145.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb1AC improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender*Hb1AC improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eError\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.70342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe two-way ANOVA table (Table\u0026nbsp;1.3) presents the findings of assessing the improvement in HB1AC through two variables. The exact model has a mean square (MS) of 428.2 and shows considerable variance (p 0.0000). With an MS of 5412, the intercept likewise showed a large variance (p 0.0000). Gender had a statistically significant but somewhat small influence (p\u0026thinsp;=\u0026thinsp;0.05). MS\u0026thinsp;=\u0026thinsp;1250). The part that improved Hb1AC showed a very significant impact (p 0.05, MS\u0026thinsp;=\u0026thinsp;64.5. Moreover, a statistically significant interaction was seen between gender and Hb1AC improvement (p 0.05, MS\u0026thinsp;=\u0026thinsp;732). The misplaced phrase's MS was 29. 70342.With a total of 18208 squares, 274 degrees of freedom were employed in the study.\u003c/p\u003e \u003cp\u003eThe cumulative improvements in these variables led to a significant 5.1% increase in overall health knowledge and attitude reported in self-care management goals. The Swayam Diabetes app was evaluated using a system usability scale with n\u0026thinsp;=\u0026thinsp;55 participants three months after using the app. The SUS Tools research evaluated the efficacy of mobile health informatics and nutrition interventions for type 2 diabetes self-care and at-home care using qualitative techniques. Using a Likert scale, the 10-item System Usability Scale (SUS) was straightforward. According to the research, regular journal reminders can enhance self-care management techniques and general health.\u003c/p\u003e \u003cp\u003eThe SUS form was used to assess a total of 55 users of the Swayam Diabetes app. The total SUS score for this application's usefulness and simplicity of use. X\u0026thinsp;=\u0026thinsp;5, which is the total number of points for all odd-numbered questions. When the scores for all questions have an even number of answers, you get Y\u0026thinsp;=\u0026thinsp;25, or 25. [14,16]. The SUS score is 2.5 times (X\u0026thinsp;+\u0026thinsp;Y). X\u0026thinsp;=\u0026thinsp;16.6\u0026thinsp;+\u0026thinsp;Y\u0026thinsp;+\u0026thinsp;17.1\u0026thinsp;=\u0026thinsp;33.7 * 2.5\u0026thinsp;=\u0026thinsp;84.25. The total score is a Grade A, which is excellent.\u003c/p\u003e \u003cp\u003eSUS users discover health applications that are intended to be useful, simple to use, and beneficial. The fact that utility and usability ratings surpass 80 on the scale [4] demonstrates this. 14.1 out of n\u0026thinsp;=\u0026thinsp;55 reported improvement in Hb1AC over the period of 6 months. 1.1% suggested daily diary to be in translated language. 3.2% overall improvement was reported in Healthy eating due to daily diary and 5.1% Overall improvement was reported in n\u0026thinsp;=\u0026thinsp;55 selfcare management using Swayam Diabetes app.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study underscores the need for diabetes self-management education and continuing support for patients with type 2 diabetes. It argues that treatment, attitudes, and prior information impact choices. However, some users want more advanced resources. Shorter-term diabetics employ tools for routines, whereas longer-term diabetics use technology to improve self-care behaviors. Diabetes education is vital for self-management, yet most courses do not cover it. Mobile apps can provide educational, nutritional, and professional help. Two-way communication and collaboration between healthcare practitioners and app developers can increase app use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Self-care management at home using mHealth can improve patient-level outcomes.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found that patients\u0026apos; ability to manage their diabetes at home and keep control over the illness will significantly affect their health outcomes. As a result, education about the proper use of m-health applications is critical for enhancing illness self-management. Research on nutrition informatics and a self-management care module for m-Health diabetic home care management will be highly beneficial [17, 18, 20]. The self-management program, patient follow-up for improved healthcare service use, are tested in various and diverse groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Human-cantered design: The user at the core for mHealth application development.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHuman-centered design to support self-care management can help effectively control the difficulties associated with type 2 diabetes. Recovering from difficulties requires keeping a balanced diet and leading a physically fit lifestyle. With the advancement of information about self-care management that aims to control difficulties in the home environment, the perspective on balanced eating has also evolved [21,24,25]. By designing mobile applications with the user\u0026apos;s needs in mind, we can enhance their usability and utility. Self-care tools such as keeping a daily diary on one\u0026apos;s diet, exercise routine, blood sugar levels, and medication intake can help one better manage their diseases and lead a healthy lifestyle [26].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. The health application can be tested in a wider population and in rural areas.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite many barriers to a clear picture of how to use the applications, the study can be conducted in a variety of populations and demographics to better understand diabetes self-care management in home settings as well as overall health outcomes by understanding the interaction of demographic characteristics and health-related variables. However, the study\u0026apos;s focus on diabetes self-care management makes it valuable for future research and implementation in this field [25,26].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommended tested framework.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study proposes a framework for designing and developing self-care management m-health apps. It involves conceptualizing, defining necessity, designing an informatics app, developing a prototype, implementing the app, and evaluating it with users. The framework is designed for future development and assessment.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eConceptualize\u003c/strong\u003e \u0026ndash; Why m-health intervention Define need. Ideate Informatics, Self-care management prototype app features.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eD-Design\u003c/strong\u003e (User centred) Prototype Design with User consultation Human-cantered design, User pretesting testing of the app, Contextual user journey and Ease of use.\u003c/li\u003e\n \u003cli\u003eI-\u003cstrong\u003eImplement-\u003c/strong\u003eDeploy the app,\u0026nbsp;consultation,\u0026nbsp;Modification,\u0026nbsp;Completion,\u0026nbsp;Customization,\u0026nbsp;Visualization, and informatics for users on selfcare management.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eU-User Evaluation-\u0026nbsp;\u003c/strong\u003eEvaluation of the app with users, Use of the globally tested tool, Evaluate the outcome of apps \u0026amp; and further improvement and periodic evaluation with users to improve the application.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe \u003cstrong\u003eQIMA\u003c/strong\u003e framework provides guidance for designing m-health applications for self-care management of type 2 diabetes at home, applicable to all m-health self-care management apps.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation and recommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMore comprehensive study designs and methodologies are needed for future scoping reviews and assessments of mHealth treatments for type 2 diabetes management. AI-enabled systems can build evidence-based treatments based on user experiences, ratings, and interactions. mHealth interventions offer benefits like enhanced self-management, improved adherence to treatment, increased healthcare access, and better communication with healthcare providers. However, challenges like digital literacy, connectivity barriers, privacy concerns, healthcare provider engagement, regulatory frameworks, and sustainability need to be addressed. The effectiveness of mHealth interventions may vary depending on user demographics, socioeconomic status, cultural norms, and healthcare infrastructure.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003em-Health approaches can transform diabetes management and improve health outcomes, especially in countries like India with high disease loads and limited healthcare resources. The Swayam Diabetes initiative shows mHealth's ability to empower patients, boost self-care practices, and improve communication between patients and healthcare professionals. Education on m-health applications is vital for improved self-management. The study's findings will guide m-health's development for India and worldwide applications. Swayam Diabetes applications are generally recognized for m-health selfcare management, presenting unique potential in healthcare, such as avoiding type 2 diabetes and boosting self-management. Mobile health applications (mHealth) are viewed as the future for chronic care management and self-care management. Future study should focus on diabetes self-management, its effect, and the utility of m-health treatments. These programs can also contain nutrition informatics modules for local and regional diets.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflicts of interest:\u003c/h2\u003e \u003cp\u003eIn compliance with the ICMJE uniform disclosure form, all authors declare the following:\u003c/p\u003e \u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAPS and MS prepared Manuscript, AS and RK prepared figures and tables. All authors have revieved the manuscript\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe dataset generated and or analysed during the current study are available with corresponding author on reasonable request\u003c/p\u003e\n\u003ch2\u003eAdditional Information: Disclosures\u003c/h2\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eUREC approval\u003c/strong\u003e; The Study was approved DIT University Research Ethics Committee UREC 2021/07/10. Global DBMS and SUS tool was approved and informed consent forms in local language were obtained from all participants signed by the participants to take part in this study.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHuman\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003esubjects:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAll authors have confirmed that this study did not involve human participants or tissue. DIT University Research Ethics Committee (UREC) accepted the protocol number study. The Helsinki Declaration (Protocol number \u003cu\u003eUREC/2021/07/10)\u003c/u\u003e has govern the investigation.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAnimal subjects:\u0026nbsp;\u003c/strong\u003eAll authors have confirmed that this study did not involve animal subjects or tissue.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConflicts of interest:\u0026nbsp;\u003c/strong\u003eIn compliance with the ICMJE uniform disclosure form, all authors declare the following:\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePayment/services info:\u0026nbsp;\u003c/strong\u003eAll authors have declared that no financial support was received from any organization for the submitted work.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFinancial relationships:\u0026nbsp;\u003c/strong\u003eAll\u0026nbsp;authors\u0026nbsp;have\u0026nbsp;declared\u0026nbsp;that\u0026nbsp;they\u0026nbsp;have\u0026nbsp;no financial relationships at present or within the previous three years with any organizations that might\u0026nbsp;have an interest in the submitted work.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIntellectual property info:\u0026nbsp;\u003c/strong\u003eI have submitted a patent of integrated diabetes management system in Indian Government patent application in January 2023, it is due for approval.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eOther relationships:\u0026nbsp;\u003c/strong\u003eAll authors have\u0026nbsp;declared that there are no other relationships or activities\u0026nbsp;that\u0026nbsp;could\u0026nbsp;appear\u0026nbsp;to\u0026nbsp;have\u0026nbsp;influenced\u0026nbsp;the\u0026nbsp;submitted\u0026nbsp;work.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eData-\u003c/strong\u003eThe dataset generated or analysed during the study are available from corresponding author on reasonable request.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eIDF Diabetes, 9th ed., International Diabetes Federation, 2019. on the internet at https://www.diabetesatlas.org. Atlas, Brussels.\u003c/li\u003e\n \u003cli\u003eE. \u0026Aring;rsand et al., \u0026quot;Design implications and lessons learned from mobile health applications to support patients with diabetes,\u0026quot; doi:10.1177/193229681200600525, J. Diabetes Sci. Technol., vol. 6, no. 5, pp. 1197-1206, 2012.\u003c/li\u003e\n \u003cli\u003eAHRSQ, 2018, Mobile health apps for diabetes self-management, Technical Brief No. 2018-EHC010-EF, Agency for Healthcare Research and Quality Publication No.\u003c/li\u003e\n \u003cli\u003eT. Blevins, \u0026quot;The importance and practicality of blood glucose self-monitoring in patients with type 2 diabetes mellitus who are not receiving insulin,\u0026quot; 2013; doi:10.3810/pgm. Postgrad. Med., vol. 125, no. 3, pp. 191-204.2013.05.2668.\u003c/li\u003e\n \u003cli\u003eM. Castellana and colleagues, \u0026quot;A comprehensive review and meta-analysis on the effectiveness and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes,\u0026quot; BMJ Open Diabetes Res. Care, vol. 8, no. 1, p. e001092, 2020. doi:10.1136/bmjdrc-2019-001092.\u003c/li\u003e\n \u003cli\u003eK. G. Dobson and P. Hall \u0026quot;A pilot study examining patient attitudes and intentions to adopt assistive technologies into Type 2 diabetes self-management,\u0026quot; by, Journal of Diabetes Science and Technology, 9(2), 309-315, 2015. doi:10.1177/1932296814560395.\u003c/li\u003e\n \u003cli\u003eE. Gong et al., \u0026quot;A Randomised Effectiveness-Implementation Trial to Support Type 2 Diabetes Self-Management with My Diabetes Coach, a Mobile App-Based Interactive Conversational Agent,\u0026quot; 2020; doi:10.2196/20322. J. Med. Internet Res., vol. 22, no. 11, e20322.\u003c/li\u003e\n \u003cli\u003eP. M. Gee et al. \u0026quot;The ehealth enhanced chronic care model: A theory derivation approach,\u0026quot; J. Med. Internet Res., 2015; doi:10.2196/jmir.4067; vol. 17, no. 4, p. e86.\u003c/li\u003e\n \u003cli\u003eThe article \u0026quot;An exploratory study of predictors of self-care behavior in persons with type 2 diabetes\u0026quot; was published in 2008 by S. Gatt and R. Sammut in the International Journal of Nursing Studies. It can be accessed at Doi: 10.1016/j.ijnurstu.2008.02.006.\u003c/li\u003e\n \u003cli\u003eGrover, A. and Joshi, A., \u0026quot;A comprehensive literature review on chronic disease models,\u0026quot; Glob. J. Health Sci., vol. 7, no. 2, 210-227, 2014. doi:10.5539/gjhs. v7n2p210.\u003c/li\u003e\n \u003cli\u003eH. M. Young et al., \u0026quot;A randomized controlled trial comparing nurse coaching and mobile health to usual care to improve diabetes self-efficacy for persons with Type 2 diabetes,\u0026quot; mHealth uHealth JMIR. Available at: doi:10.2196/16665. Vol. 8, no. 3, e16665, 2020.http://mhealth.jmir.org.\u003c/li\u003e\n \u003cli\u003eM. W. J. Huygens et al In BMC Health Serv. Res., vol. 16, no. 1, 232, 2016, \u0026quot;Expectations and needs of patients with a chronic disease towards self-management and ehealth for self-management purposes,\u0026quot; doi:10.1186/s12913-016-1484-5.\u003c/li\u003e\n \u003cli\u003eAbhijeet Sinha, Manmohan Singhal et.al. A mixed research study on the design, development, and SUS assessment of m-health mobile applications with a focus on users\u0026apos; utility and usability for managing type-2 diabetes in urban home settings 2023. Clin. Pharmacol. J. Popul. Ther., 2023; doi:10.53555/jptcp. v30i16.2484.\u003c/li\u003e\n \u003cli\u003eAbhijeet Sinha, Manmohan Singhal et al. present \u0026quot;User-centered \u0026apos;Swayam Diabetes\u0026apos; m-health application for self-care management of Type 2 diabetes in urban home settings, the usability and utility testing of mobile application and perspectives. In the ISO-International Journal of Chemical and Biochemical Sciences, vol. 24, no. 5, pp. 141\u0026ndash;146\u0026quot;\u003c/li\u003e\n \u003cli\u003eAbhijeet Sinha, Manmohan Singhal et al., \u0026quot;Development and utility of nutrition informatics programme enabled by m-health for Type 2 diabetes self-care management in home settings,\u0026quot; J. Posit. Sch. Psychol., vol. 6, no. 12, pp. 1261-1279, 2022. In J. Nutr. Food Sci., vol. 12, p. 864, 2022,\u003c/li\u003e\n \u003cli\u003eAbhijeet Sinha, Manmohan Singhal et al. a scoping review using PRISMA-SCR on m-health interventions on self-care management of type 2 diabetes at home.\u003c/li\u003e\n \u003cli\u003eA. Lyndsay et al., 2020, Results of a Randomized Controlled Trial on User Engagement Among Diverse Adults in a 12-Month Text Message-Delivered Diabetes Support Intervention u-Health and JMIR Mhealth. At http://mhealth.jmir.org accessed on June 2023\u003c/li\u003e\n \u003cli\u003eS. Muralidharan et al \u0026quot;Mobile health technology in the prevention and management of Type 2 diabetes,\u0026quot;., Indian Doi: 10.4103/ijem.IJEM_407_16. J. Endocrinol. Metab., vol. 21, no. 2, p334-340,2017.\u003c/li\u003e\n \u003cli\u003eY. Ni et al., \u0026quot;A multicenter cross-sectional study of patient-perceived service needs and health care utilization in individuals with type 2 diabetes,\u0026quot; Medicine, vol. 99, no. 21, p. e20322, 2020. doi:10.1097/MD.0000000000020322.\u003c/li\u003e\n \u003cli\u003eR. Jeddi, \u0026quot;Patients with type II diabetes and their intention to use mobile phones for personal use.\u0026quot; BMC Med. Inform. Decis. Mak., vol. 24, published in 2020; doi:10.1186/s12911-020-1038.\u003c/li\u003e\n \u003cli\u003eR. Mishra, Indian Foods: An AAPI\u0026apos;s Guide to Diet, Health, and Diabetes, AAPI Publications, 2011.\u003c/li\u003e\n \u003cli\u003eC. Sahin and P. J. Naylor, A scoping review of mixed-methods research in diabetes treatment using mobile health technologies was conducted in 2017 JMIR Diabetes, vol. 2, no. 1, p. e3. doi:10.1189/66677-diabetes.\u003c/li\u003e\n \u003cli\u003eSauro, J., \u0026quot;Quantifying usability,\u0026quot; Interactions, vol. 13, no. 6, 2006, pp. 20-21. 10.1145/1167948.11677970.\u003c/li\u003e\n \u003cli\u003eM. Serrano-Gil and S. Jacob] \u0026quot;Engaging and empowering patients to manage their type 2 diabetes, Part I: a knowledge, attitude, and practice gap?\u0026quot; by 2010, vol. 27, no. 6, pp. 321-333; doi:10.1007/s12325-010-0034-5. Adv. Ther.\u003c/li\u003e\n \u003cli\u003eT. H. Song Lipman, \u0026quot;Concept analysis: Self- monitoring in type 2 diabetes mellitus.\u0026quot; Int. Nurse Study.45(11):1700-1710, 2008.\u003c/li\u003e\n \u003cli\u003eY. Yang et al. The impact of a mobile phone-based glucose-monitoring and feedback system for managing Type 2 diabetes in various primary care clinic settings was studied in a cluster randomized JMIR Mhealth Uhealth, vol. 8, no. 2, e16266, 2020; doi:10.2196/16266; accessible at http://mhealth.jmir.org.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Selfcare management, chronic care management, Swayam diabetes, diabetes management, type 2 diabetes, mobile health, m-health, human centered, user centered","lastPublishedDoi":"10.21203/rs.3.rs-4276812/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4276812/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eType 2 diabetes mellitus (T2DM) prevalence is alarmingly rising in India, one of the nations most affected by this epidemic. Mobile health (mHealth) interventions offer a promising approach to improving diabetes management by providing tools for self-monitoring, education, and support. This article explores the development and utility of mHealth interventions, focusing on Swayam Diabetes mHealth research in the Indian context. Drawing upon existing literature and empirical evidence, the article discusses the effectiveness, challenges, and future directions of m-Health interventions in T2DM management.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e \u003cp\u003eA mixed research study qualitative n\u0026thinsp;=\u0026thinsp;18 for testing of deigned interventions and quantitative n\u0026thinsp;=\u0026thinsp;278 people conducted a DBMS questionnaire survey SUS global testing tool was needed for m-Health interventions on diabetes self-care management applications, with n\u0026thinsp;=\u0026thinsp;55 participants evaluated using the System Usability Score and DBMS a using globally tested tool\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003e78% of participants preferred using an app to monitor their self-care routine, including food intake, nutrition, physical activity, medication usage, and diabetes-related details. The study found a 5.1% improvement in self-care administration, with gender having little influence. Over 55% of participants used a daily diary and found self-management with m-health interventions beneficial. The study found three key themes: a user-centered tool, an interactive interface, and learning from other users.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe results of this study significantly support the alternative hypothesis of the research study and demonstrate a relationship between m-health and improved at-home diabetic self-care management.\u003c/p\u003e","manuscriptTitle":"Research article on development study and utility of Swayam Diabetes m- health application, nutrition informatics platform for self-care management of Type 2 Diabetes in home settings","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-09 18:44:26","doi":"10.21203/rs.3.rs-4276812/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3da2ace1-9c58-4565-a984-97549b955d22","owner":[],"postedDate":"May 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-01T09:09:02+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-09 18:44:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4276812","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4276812","identity":"rs-4276812","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}