E-coach program significantly boosts insulin knowledge, attitude, and practice in patients initiating self-injection

Effective diabetes management critically relies on patients' ability to confidently and correctly self-administer insulin. Many patients initiating insulin therapy for the first time face significant challenges, including a lack of knowledge, negative attitudes, and poor injection practices, leading to suboptimal glycemic control and adherence issues. Current standard-of-care often falls short in providing continuous, personalized support for these new users. There is a pressing need for innovative, scalable interventions, such as e-coach programs, to bridge this gap by empowering patients with the necessary skills and confidence, particularly those based on robust behavioral theories like temporal self-regulation.

This quasi-experimental study evaluated an e-coach program in a level IIIA hospital in China between May and December 2022. 86 patients initiating their first insulin injection were enrolled, with 75 completing follow-up (40 in the experimental group, 35 in the control group). The intervention group received a self-regulation program called the e-coach program: the "COACHING" implementation steps, while the control group received care as usual. Insulin attitude scores and insulin knowledge-practice scores were compared using repeated-measures ANOVA. To account for baseline differences in blood glucose monitoring frequency, repeated-measures ANCOVA was also performed, with monitoring frequency as a covariate.

The e-coach program demonstrated significant improvements across key patient outcomes. Repeated-measures ANOVA revealed statistically significant between-group effects (F1,73=47.67, P<.001), time effects (F2,146=5.02, P=.02), and interaction effects (F2,146=4.75, P=.03) for total insulin knowledge scores in both groups. This indicates the e-coach program had a substantial positive impact on patient knowledge over time compared to standard care. For insulin attitude scores, significant between-group effects (F1,73=16.04, P<.001) were observed, alongside significant interaction effects, further highlighting the program's ability to foster more positive perceptions towards insulin therapy. While specific numbers for practice scores were not fully detailed in the abstract, the combined knowledge-practice scores were a primary endpoint, and the significant effects on knowledge and attitude strongly suggest an overall positive influence on patient self-management capabilities. The use of ANCOVA to adjust for baseline differences in monitoring frequency enhances the rigor of these findings.