Development and evaluation of a nurse-led telehealth intervention for diabetes management

Thesis Abstract

The rising prevalence of diabetes mellitus poses significant challenges to healthcare systems worldwide, necessitating innovative management strategies to improve patient outcomes and reduce associated complications. This study addresses the critical gap in accessible, cost-effective, and patient-centered diabetes care by developing and evaluating a nurse-led telehealth intervention designed to enhance self-management, glycemic control, and patient engagement. The primary aim is to assess the effectiveness, feasibility, and acceptability of this intervention within a structured healthcare framework, focusing on adult patients with type 2 diabetes. Specific objectives include designing a comprehensive telehealth program led by specialized nurses, measuring its impact on glycemic levels, medication adherence, lifestyle modifications, and patient satisfaction, and exploring the experiences of both patients and healthcare providers. Employing a mixed-methods research design, the study integrates a quasi-experimental quantitative component with pre- and post-intervention measurements and a qualitative process evaluation. The quantitative phase involves recruiting a sample of 150 adult type 2 diabetic patients from outpatient clinics within a metropolitan healthcare region, with participants randomly assigned to intervention and control groups. The intervention group receives bi-weekly nurse-led teleconsultations, remote monitoring of blood glucose levels via Bluetooth-enabled glucometers, personalized educational messages, and behavior reinforcement strategies over a six-month period. Data collection instruments include validated questionnaires such as the Diabetes Self-Management Questionnaire (DSMQ), the Morisky Medication Adherence Scale, and patient satisfaction surveys, alongside clinical measures of glycated hemoglobin (HbA1c), fasting blood glucose, and body mass index (BMI). The qualitative component employs semi-structured interviews with 20 purposively selected patients and 10 nurses involved in the intervention to explore experiences, acceptability, and perceived barriers. Data analysis encompasses descriptive statistics, repeated measures ANOVA to assess changes over time, and multiple regression analyses to identify predictors of glycemic improvements for quantitative data. Thematic analysis is utilized for qualitative data, following Braun and Clarke’s framework. Expected findings indicate significant reductions in HbA1c levels, improved medication adherence, healthier lifestyle behaviors, and high satisfaction scores in the intervention group compared to controls. The qualitative insights are anticipated to reveal facilitators and barriers impacting implementation, including technological literacy, communication quality, and perceived trustworthiness of remote interactions. This study aims to contribute novel evidence on the efficacy of nurse-led telehealth models in chronic disease management, specifically highlighting the role of nurses in remotely supporting self-care and fostering sustained behavioral change within diverse patient populations. It also extends theoretical understanding by integrating the Technology Acceptance Model (TAM) and Orem’s Self-Care Deficit Nursing Theory to explain technology engagement and self-management behaviors. The main conclusion underscores the potential of nurse-led telehealth interventions to augment traditional diabetes care, especially in resource-constrained settings, through improved clinical outcomes and patient empowerment. The study recommends scaling such models across different healthcare settings, incorporating ongoing training for nurses, and developing supportive policies to facilitate widespread adoption. Future research should explore long-term impacts, cost-effectiveness analyses, and the integration of artificial intelligence to personalize patient engagement further. Overall, this investigation advances knowledge on telehealth as a viable, nurse-driven approach to chronic disease management, with implications for policy, practice, and future research in digital health interventions.