Using The ASE Model As A Framework To Develop A Staged Diet Mobile Health Management Platform For People With Diabetes

Background:The prevalence of diabetes has increased dramatically,and dietary intervention is the basis for the comprehensive treatment of diabetes.The traditional face-to-face intervention is difficult to meet the needs of individualized dietary management for many patients.Therefore,more and more researchers are exploring the use of mobile apps and other mobile devices to conduct remote behavior intervention for patients.However,due to the lack of behavioral change theory,the effectiveness and compliance of mobile intervention is not ideal.Therefore,it is necessary to further explore the behavior theory for remote behavior intervention,identify the main factors that affect the rational diet of patients,and build a diabetes mobile intervention mode to effectively promote the rational dietary behaviors of patients.Objective:(1)Through literature review,we discuss the behavior change theory suitable for mobile interventions of type 2 diabetes mellitus patients' diet behavior,and preliminarily analyze the feasibility of the ASE model(Attitude-Social influence-Efficacy model)as its theoretical basis;(2)to verify the predictive power and explanatory power of ASE model for rational diet behaviors in patients with type 2 diabetes,and clarify the influencing factors of different stages of behavior intention;(3)the theoretical framework of mobile intervention mode is revised and formed.Different behavioral intervention technologies are applied to different behavioral intention stages,and intervention measures are developed to build a diabetes mobile management platform.Methods:This study is divided into three parts:(1)the first part mainly through literature research,review and summarize the theory of the current commonly used remote mobile behavior intervention,from the theoretical level,preliminary analysis of feasibility of the ASE model as the intervention theory for dietary behavior in patients with diabetes mellitus.(2)in the second part,a cross-sectional study method was adopted to facilitate the selection of 430 patients with type 2 diabetes in Department of endocrinology in two major hospitals in Nanjing.AMOS 23 software was used to establish structural equation model to judge the fitting degree between theoretical model and survey data.SPSS 23 software was used to do single factor and multiple factor analysis to infer main factors influencing the change of behavior intention stage.(3)the third part,based on the first two parts,revised and perfected the theoretical framework of behavioral intervention,formulated intervention technologies and interventions at each stage,and worked with information technology staff to build mobile intervention platform.Results:(1)The first part of the study finds that the theoretical basis of the ASE model is derived from the three most commonly used guidance theories of behavioral mobile intervention,and the ASE model is widely used in dietary behavior.ASE model can be used as a guiding theory for mobile intervention of diabetic patients' dietary behaviors,but it still needs further validation of its predictive power and interpretation for patients with type 2 diabetes mellitus in China;(2)the second part of the study showed that the theoretical model and structural equation model fitting is good,self-efficacy,attitude,social influence,and behavior intention can explain the variance of reasonable diet behavior of 84%;63.3%of the patients in the earlier stage of reasonable diet behavior;logistics regression analysis showed that the probability of being in the advanced stage for reasonable diet is significantly associated with higher score of attitude(OR=2.45),subjective norms(OR= 1.46),and self-efficacy(OR=1.63).Longer duration of diabetes(OR=2.63),lower level of HbAlc(OR=3.11),fasting plasma glucose(OR=2.08),received health education(OR=2.78),and non-smoking(OR=2.08)increased the odds of patients in the advanced stage for reasonable diet.Attitude,social influence plays an important role in the earlier stage of reasonable diet,self-efficacy plays an important role in the action stage;(3)The third part,based on the above research results,proposes behavior intervention strategies and measures according to the characteristics of each intention stage.With the support of technical staff,we constructed a diet mobile intervention platform,and implemented the stage intervention of diabetic patients' reasonable dietary behaviors through the operation of 4 modules:stage assessment,learning center,diet center and personal center.Conclusion:The diet management of most diabetic patients is not good and needs to be improved.Attitude,social influence and self-efficacy are important intervening factors that affect their rational dietary behavior intention change.They play a key role in the transformation of different intentions or behaviors.This study based on the ASE model,according to the intervention factors of rational diet behavior changes in patients with type 2 diabetes,in view of the different characteristics of each stage,the key intervening factors of the changes in the stage of behavior or intention are proposed,and the corresponding intervention strategies and interventions are proposed,and on the basis of the mobile intervention platform,the diabetic diet phase shift intervention model was constructed.It provides a theoretical reference for the future clinical intervention program,and provides a favorable support for promoting patients' diet behavior.Future research can verify and improve its intervention effect through clinical practice.