The Impact Of A Culturally Tailored Telehealth Education Programme On Glycemic Control And Self-Care Behaviours In Jordanian Adults With Type 2 Diabetes: A Randomised Controlled Trial

Abstract

BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) in Jordan is a significant public health challenge, with glycemic control frequently remaining suboptimal.

AIMS: To assess the impact of a culturally tailored telehealth education programme on glycemic control and self-care behaviours in Jordanian adults with T2DM.

METHODS: We conducted a two-arm, parallel-group, randomised controlled trial in outpatient diabetes clinics in Amman, Jordan. A total of 104 adults with uncontrolled T2DM (HbA1c 7.5-11%) were randomised (1:1) to either a 6-month intervention or standard care (control). The low-burden intervention consisted of educational content via WhatsApp broadcasts and personalised telephonic coaching for goal-setting. The primary outcome was the change in HbA1c whereas secondary included self-care behaviours, medication adherence, diabetes knowledge, and diabetes fatalism, as well as patient satisfaction with the intervention.

RESULTS AND CONCLUSIONS: A total of 92 of 104 randomised participants (88%) completed the 6-month follow-up. The intervention group demonstrated a more pronounced mean reduction in HbA1c compared to the control group (-1.1% ± 1.1% vs. -0.2% ± 1.2%; adjusted mean difference -0.9%, 95% CI -1.3 to -0.5; P < 0.001). This clinical improvement coincided with marked improvements in psychosocial and behavioural measures. Culturally grounded fatalistic beliefs were significantly reduced in the intervention group (P < 0.001), and diabetes knowledge scores increased substantially (P < 0.001). The proportion of participants with low medication adherence decreased from 64% to 20% in the intervention group, compared to a minimal change in the control group (68% to 62%) (P < 0.001). Self-care activities, particularly for general diet and blood glucose monitoring, also improved markedly (both P < 0.001). A culturally tailored telehealth education programme was successful in improving glycemic control and key psychosocial and behavioural outcomes among Jordanian adults with T2DM.