Mobile heal h in e en ion o educe HbA1c in
ype 2 diabe es: a quasi-expe imen al s udy in
Indonesian p ima y ca e
As i Rinda wa i1, Lia Amalia1, Hikma Pe mana2
1 Ins i u Teknologi Bandung, Bandung, Indonesia
2 Uni e si as Padjadja an, Sumedang, Indonesia
Co esponding au ho s:
As i Rinda wa i ([email p o ec ed]); Lia Amalia (lia_amalia@i b.ac.id)
Recei ed
24 May 2025♦
Accep ed
7 Sep embe 2025♦
Published
10 Oc obe 2025
Ci a ion:
Rinda wa i A, Amalia L, Pe mana H (2025) Mobile heal h in e en ion o educe HbA1c in ype 2 diabe es: a quasi-expe -
imen al s udy in Indonesian p ima y ca e. Pha macia 72: 1–9. h ps://doi.o g/10.3897/pha macia.72.e160083
Abs ac
Backg ound: The global bu den o ype 2 diabe es melli us (T2DM) con inues o ise, wi h Indonesia p ojec ed o each o e 28
million cases by 2045. Limi ed access o con inuous educa ion and ollow-up ca e in low- esou ce p ima y ca e se ings necessi a es
scalable digi al heal h solu ions o suppo sel -managemen .
Objec i e: This s udy aimed o e alua e he e ec i eness o a mobile heal h (mHeal h) applica ion in educing HbA1c le els among
T2DM pa ien s in Indonesian p ima y ca e.
Me hods: A quasi-expe imen al, wo-a m s udy was conduc ed o e 24 weeks ac oss 10 public heal h cen e s (Puskesmas) in Band-
ung. One hund ed pa ien s wi h T2DM (HbA1c >8%) we e assigned o ei he an in e en ion g oup (mHeal h applica ion suppo ed
by in eg a ed pha macis consul a ion) o a con ol g oup (s anda d ca e). The p ima y ou come was he change in HbA1c le els
measu ed a baseline, 12, and 24 weeks.
Resul s: The in e en ion g oup showed a signi ican educ ion in HbA1c om 9.31% o 8.13% (p = 0.001), while he con ol g oup
showed minimal change ( om 8.99% o 8.96%, p = 0.021). Glycemic ends in he in e en ion g oup we e consis en and p og es-
si e, indica ing imp o ed adhe ence and sel -managemen . Boxplo analysis demons a ed educed a iabili y and igh e glycemic
con ol in he in e en ion g oup. High usabili y and engagemen we e obse ed among olde adul s and pa icipan s wi h low
educa ional backg ounds.
Conclusion: The mHeal h in e en ion signi ican ly imp o ed glycemic con ol and p omo ed consis en sel -ca e among Indo-
nesian T2DM pa ien s. These indings sugges ha scalable digi al solu ions may enhance diabe es managemen in p ima y ca e
sys ems in low- and middle-income coun ies.
Keywo ds
diabe es melli us, Indonesia, mobile applica ions, p ima y heal h ca e, elemedicine
Copy igh Rinda wa i A e al. This is an open access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion Li-
cense (CC-BY 4.0), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal au ho and
sou ce a e c edi ed.
Pha macia 72: 1–9
DOI 10.3897/pha macia.72.e160083
Resea ch A icle
Rinda wa i A e al.: Mobile heal h in e en ion o educe HbA1c in ype 2 diabe es2
In oduc ion
Type 2 diabe es melli us (T2DM) emains one o he
mos p essing global heal h challenges, con ibu ing sig-
ni ican ly o mo bidi y, mo ali y, and heal hca e expen-
di u es wo ldwide (In e na ional Diabe es Fede a ion
2025). As o 2021, he In e na ional Diabe es Fede a ion
(IDF) es ima ed ha 537 million adul s we e li ing wi h
diabe es globally, a igu e p ojec ed o ise o 783 million
by 2045, wi h mo e han h ee-qua e s esiding in low-
and middle-income coun ies (LMICs) (Sun e al. 2022).
The disease bu den is pa icula ly se e e in Indonesia,
whe e diabe es p e alence con inues o ise sha ply, and
he na ional heal h sys em aces subs an ial ba ie s o de-
li e ing accessible, consis en , and pa ien -cen e ed ca e
(Soewondo e al. 2013). The IDF p edic s ha Indonesia
alone may accoun o o e 28 million diabe es cases by
2045, unde sco ing he u gen need o scalable, cos -e -
ec i e in e en ions o suppo sel -managemen and im-
p o e glycemic ou comes a he p ima y ca e le el (In e -
na ional Diabe es Fede a ion 2025).
T2DM sel -managemen , encompassing medica ion
adhe ence, die a y con ol, blood glucose moni o ing, and
physical ac i i y, is undamen al o achie ing glycemic
con ol (De G oo e al. 2021). Howe e , pa ien s o en
s uggle o sus ain hese beha io s wi hin con en ional
ca e models, especially whe e pa ien s ha e limi ed access
o ongoing educa ion, moni o ing, and heal hca e-p o id-
e in e ac ion (Al-Bad i and Hamdy 2021). In his con ex ,
mobile heal h (mHeal h) echnologies o e p omising,
pa ien -cen e ed ools o b idge hese gaps (Aga wal e al.
2019). Recen e iews ha e highligh ed ha digi al in e -
en ions can signi ican ly enhance medica ion adhe ence
and sel -ca e beha io , pa icula ly among pa ien s wi h
ch onic illnesses such as T2DM (Geo gie a e al. 2023).
Sma phone-based applica ions can deli e con inuous
suppo h ough in e ac i e educa ional con en , au o-
ma ed eminde s, and communica ion wi h heal hca e
p o essionals (Al-Bad i and Hamdy 2021). Fu he mo e,
diabe es moni o ing sys ems and digi al pla o ms ha e
demons a ed he po en ial o imp o e glycemic con ol
and clinical decision-making, pa icula ly when in e-
g a ed in o heal hca e se ings (Kamushe a e al. 2021).
A g owing body o sys ema ic e iews and me a-analyses
has consis en ly demons a ed ha mHeal h in e en-
ions con ibu e o signi ican imp o emen s in glycemic
con ol among indi iduals wi h ype 2 diabe es, wi h me-
a-analy ic es ima es anging om 0.4% o 0.5% mean e-
duc ion in HbA1c compa ed o con ol condi ions (Liang
e al. 2011; Cui e al. 2016; Hou e al. 2016).
Despi e hese p omising indings, he e ec i eness o
mHeal h in e en ions a ies widely ac oss s udies and
se ings. Fo example, a mul icen e p agma ic RCT o
he BlueS a mobile app in he Uni ed S a es showed no
signi ican di e ence in HbA1c educ ion be ween in e -
en ion and con ol g oups a e 3 mon hs (Aga wal e al.
2019), la gely due o low and a iable app engagemen .
Simila ly, s udies om Sou h Ko ea and Eu ope con i m
ha con ex ual ac o s, including digi al li e acy, heal h-
ca e in as uc u e, and pa ien -p o ide in e ac ion, c i -
ically in luence ou comes (Yang e al. 2020; B e schneide
e al. 2022). Mos o hese ials ha e been conduc ed in
high-income coun ies, wi h limi ed e alua ion in LMICs,
whe e mobile heal h inno a ions may be mos impac ul.
In Indonesia, e idence ega ding he easibili y and clini-
cal e ec i eness o mHeal h in e en ions in ou ine p i-
ma y ca e se ings emains sca ce (Damayan i e al. 2021;
Kusuma e al. 2023, 2024).
To add ess his gap, we designed a quasi-expe imen al
s udy o e alua e he e ec i eness o a cul u ally adap ed
mobile heal h applica ion in imp o ing glycemic con ol
among pa ien s wi h T2DM in public heal h cen e (puskes-
mas) se ings in Bandung, Indonesia. The in e en ion in e-
g a ed mul imedia diabe es educa ion, au oma ed emind-
e s, and eal- ime pha macis consul a ions o suppo
daily sel -managemen . This s udy p o ides no el insigh s
in o he eal-wo ld u ili y o mobile app–based digi al in-
e en ions in an LMIC con ex and explo es hei po en ial
o scalabili y wi hin na ional diabe es ca e s a egies.
Me hods
E hical app o al and pe missions
E hical app o al and adminis a i e pe missions o his
s udy we e ob ained p io o da a collec ion. E hical clea -
ance was g an ed by he Heal h Resea ch E hics Commi -
ee o Uni e si as Padjadja an, Indonesia (App o al No.
635/UN6.KEP/EC/2023), issued in May 2023. In addi ion,
esea ch pe mi s we e ob ained om ele an egional au-
ho i ies o conduc he s udy in selec ed public heal h
cen e s (puskesmas) in Bandung. These included app o al
om he Na ional Uni y and Poli ical Agency (KesBang-
Pol) o Bandung (Pe mi No. PK.03.04.05/1664-BKBP/
VIII/2023, issued in Augus 2023) and om he Bandung
Ci y Heal h O ice (Pe mi No. B/PP.06.02/15934-Dinkes/
VIII/2023, also issued in Augus 2023). These p ocedu es
ensu ed ha he s udy adhe ed o all applicable e hical
and egula o y s anda ds o esea ch in ol ing human
subjec s.
S udy design
This 24-week, open-label, wo-a m quasi-expe imen al
s udy was conduc ed om Decembe 2023 o June 2024
in 10 public heal h cen e s (puskesmas) ac oss Bandung,
Indonesia. Pa icipan s we e assigned o ei he an in e -
en ion g oup, which ecei ed a mobile heal h (mHeal h)
applica ion designed o suppo diabe es sel -manage-
men , o a con ol g oup ecei ing s anda d diabe es ca e.
A o al o 100 pa icipan s we e en olled, wi h 50 indi id-
uals in each g oup. The s udy design and wo k low a e il-
lus a ed in Fig. 1.
Pha macia 72: 1–9 3
Measu emen o p ima y ou come
(HbA1c)
Glyca ed hemoglobin (HbA1c) le els we e measu ed in
pe cen age (%) using high-pe o mance liquid ch oma-
og aphy (HPLC) wi h a Bio-Rad Va ian II Tu bo Hemo-
globin Tes ing Sys em (Bio-Rad Labo a o ies, He cules,
CA, USA). This sys em is ce i ied by he Na ional Glyco-
hemoglobin S anda diza ion P og am (NGSP) and ace-
able o he In e na ional Fede a ion o Clinical Chemis y
(IFCC) e e ence me hod. All samples we e p ocessed
a ce i ied clinical labo a o ies unde s anda d ope a -
ing p ocedu es. The p ima y ou come was he change in
HbA1c om baseline o he end o he in e en ion pe i-
od, calcula ed as:
ΔHbA1c (%) = HbA1c_pos – HbA1c_p e
Educa ion deli e y and implemen a ion
The educa ional in e en ion was deli e ed h ough a
mobile heal h applica ion called Sahaba DM, which con-
ains s uc u ed educa ional ideo modules on diabe es
sel -managemen . These ma e ials we e de eloped by a
mul idisciplina y eam, including in e nal medicine spe-
cialis s, pha macis s, and academic esea che s in public
heal h and beha io al science, and we e alida ed by a
panel o expe s.
Du ing he in e en ion pe iod, he pha macis played
a cen al ole as he heal h acili a o and pa ien counsel-
o . Speci ically, he pha macis was esponsible o :
–In oducing and guiding pa ien s on how o use he
Sahaba DM app.
–Moni o ing pa ien engagemen wi h educa ional
con en .
–P o iding ein o cemen and cla i ica ion du ing
scheduled ollow-up counseling sessions (ei he
in-pe son o by phone).
–Encou aging medica ion adhe ence and li es yle
modi ica ions in acco dance wi h clinical guidelines.
These oles we e pe o med in collabo a ion wi h p i-
ma y ca e physicians as pa o in eg a ed ch onic disease
managemen a he p ima y heal hca e cen e .
Eligibili y c i e ia
Pa icipan s included adul s aged 18 o 70 yea s who had
been diagnosed wi h ype 2 diabe es melli us (T2DM), had
a baseline HbA1c alue g ea e han 8%, and had been un-
de going ea men o a leas 1 yea . All pa icipan s we e
en olled in Indonesia’s na ional ch onic disease manage-
men p og am. Addi ional inclusion c i e ia we e he
abili y o ead and w i e and access o an And oid-based
sma phone ( e sion 3.0 o highe ) wi h a minimum o 4
Figu e 1. Wo k low o he s udy.
Rinda wa i A e al.: Mobile heal h in e en ion o educe HbA1c in ype 2 diabe es4
GB RAM, ei he di ec ly o h ough a ca egi e . Exclusion
c i e ia included p egnancy o he p esence o se ious co-
mo bidi ies such as ad anced hea ailu e, end-s age e-
nal disease, o malignancy.
Sample size
The o al sample size o 100 pa icipan s (50 pe g oup)
was de e mined based on easibili y and p og am imple-
men a ion conside a ions. A o mal sample size calcula-
ion was no pe o med due o easibili y cons ain s. The
sample size was conside ed adequa e o de ec ing medi-
um e ec sizes in non- andomized designs. The s udy was
designed o p o ide p elimina y e idence o he e ec i e-
ness o mobile heal h in e en ions o diabe es manage-
men in Indonesian p ima y ca e se ings. This s udy did
no employ andom alloca ion. Pa icipan s we e assigned
o he in e en ion o con ol g oup based on heal h cen-
e loca ion and logis ical easibili y. As a non- andomized
con olled ial, s a is ical me hods we e applied du ing
analysis o add ess po en ial di e ences be ween g oups
a baseline.
In e en ion
The in e en ion g oup ecei ed access o a mobile ap-
plica ion de eloped collabo a i ely wi h use s o suppo
diabe es sel -managemen . The applica ion p o ided edu-
ca ional con en on die , physical ac i i y, medica ion, and
complica ions o diabe es in a ious o ma s, including
ideo, audio, in og aphics, and anima ions. I also included
au oma ed eminde s o blood glucose moni o ing, med-
ica ion adhe ence, and HbA1c es ing. Addi ional ea u es
enabled eal- ime communica ion wi h pha macis s ia
ex , oice, o ideo calls. Pa icipan s ecei ed pe sonal-
ized daily mo i a ional challenges ela ed o li es yle be-
ha io s, as well as a epo ing ea u e o medica ion side
e ec s. The applica ion included a dashboa d displaying
labo a o y esul s and he apy his o y. P io o he in e -
en ion pe iod, pa icipan s and ca egi e s we e ained on
app usage and p o ided a 1-week ial o ensu e usabili y.
Con ol g oup
Pa icipan s in he con ol g oup ecei ed s anda d ca e
p o ided by he public heal h cen e s (puskesmas). This
included as ing blood glucose and 2-hou pos p andial
glucose es ing e e y 4 weeks, as well as HbA1c measu e-
men s e e y 12 weeks. The apeu ic decisions we e made
based on labo a o y indings, and gene al educa ion was
deli e ed du ing scheduled clinical isi s. No mobile ap-
plica ion o digi al ools we e p o ided o his g oup.
P ima y and seconda y ou comes
The p ima y ou come o his s udy was he change in HbA1c
le els om baseline o week 24. Seconda y ou comes in-
cluded changes in as ing blood glucose le els and 2-hou
pos p andial glucose le els. Addi ional obse a ional ou -
comes included quali a i e assessmen o sel -managemen
beha io changes in he in e en ion g oup.
Measu emen s
Labo a o y measu emen s we e conduc ed a h ee ime
poin s: baseline (T0), week 12, and week 24. Blood samples
we e collec ed by ce i ied heal h p o essionals ollowing
s anda d ope a ing p ocedu es and analyzed in ce i ied
labo a o ies using s anda dized immunoassay echniques.
Pa icipan demog aphics and clinical da a we e collec ed
a baseline h ough s uc u ed in e iews and da a o ms.
S a is ical analysis
S a is ical analysis was pe o med using SPSS e sion 26
(IBM Co p.). No mali y o he da a was assessed using
he Shapi o–Wilk es . As he HbA1c da a in he in e -
en ion g oup we e no no mally dis ibu ed (W = 0.884,
p = 0.0002), nonpa ame ic es ing was applied. The
Mann–Whi ney U es was used o compa e HbA1c le els
be ween g oups a each ime poin . A p- alue <0.05 was
conside ed s a is ically signi ican . Desc ip i e s a is ics
we e also used o summa ize demog aphic cha ac e is ics
and changes in blood glucose indica o s o e ime.
Resul s
Pa icipan low and baseline cha ac-
e is ics
A o al o 100 eligible pa icipan s we e en olled om
10 communi y heal h cen e s in Bandung, Indonesia.
Fi y pa icipan s we e assigned o he in e en ion
g oup, which ecei ed he mobile applica ion, while he
emaining 50 ecei ed s anda d ca e. All pa icipan s
comple ed he 24-week in e en ion pe iod, and no
d opou s we e epo ed.
Baseline demog aphic and clinical cha ac e is ics a e
p esen ed in Table 1. The majo i y o pa icipan s we e
aged be ween 51 and 70 yea s, wi h 34% aged 51–60
and 32% aged 61–70. Mos pa icipan s we e emale
(78%), and he dominan occupa ional backg ound was
housewi e (62%). In e ms o educa ion le el, he la ges
g oup comple ed junio high school (48%), ollowed by
senio high school (36%). P ima y Ou come: Change in
HbA1c Le els.
The esul s o he seconda y ou comes ocused on
e alua ing he usabili y o he Sahaba DM applica ion.
Usabili y was measu ed using wo ools: he Single Ease
Ques ion (SEQ) and he Sys em Usabili y Scale (SUS).
Task-based usabili y es ing using SEQ was conduc ed
on 10 asks (T1–T10) pe o med wi hin he applica ion.
The a e age SEQ sco e ac oss hese asks was 5.0, which
co esponds o he “Somewha easy” ca ego y based on
he SEQ in e p e a ion scale, as shown in Table 3.
Pha macia 72: 1–9 5
The o e all SUS sco e o he Sahaba DM applica ion
was 72, which alls in o he “Accep able” ange o usabili y
acco ding o s anda d SUS benchma ks. These indings
indica e ha he applica ion was gene ally pe cei ed as
use - iendly by he pa icipan s. De ails a e p esen ed in
Table 4.
The mean HbA1c le els o bo h g oups ac oss ime
poin s a e summa ized in Table 2. A baseline, he con ol
g oup had a mean HbA1c o 8.99%, while he in e en-
ion g oup showed a sligh ly highe baseline o 9.31%. A
week 12, he con ol g oup’s HbA1c ma ginally inc eased
o 9.04%, whe eas he in e en ion g oup demons a ed a
educ ion o 8.76%. A he end o he 24 weeks, he con-
ol g oup’s HbA1c emained la gely unchanged a 8.96%,
while he in e en ion g oup showed a subs an ial de-
c ease o 8.13%.
Bo h g oups exhibi ed s a is ically signi ican changes
in HbA1c; howe e , he educ ion was no ably g ea e in
he in e en ion g oup (p = 0.001) compa ed o he con-
ol g oup (p = 0.021). A boxplo in Fig. 2 illus a es he
dis ibu ion o HbA1c alues a week 24, highligh ing a
lowe median and na owe in e qua ile ange in he in-
e en ion g oup.
Pha macis s in educa ion
In his s udy, pha macis s played a pi o al ole in bo h he
de elopmen and implemen a ion o educa ion and con-
sul a ion se ices ia he Sahaba DM mobile applica ion.
Thei con ibu ions included designing and alida ing 60
concise, 2-minu e educa ional ideos co e ing key aspec s
o diabe es sel -managemen –such as medica ion ad-
he ence, heal hy ea ing, physical ac i i y, unde s anding
HbA1c, he mechanism o me o min, and iden i ica ion
o ad e se d ug eac ions and in e ac ions. These ideos,
hos ed wi hin he app’s “Educa ion” ea u e, we e manda-
o y o pa icipan s in he in e en ion g oup o comple e
o e he 24-week s udy pe iod.
Mo eo e , pha macis s p o ided eal- ime, pa-
ien -cen e ed consul a ion h ough in eg a ed cha and
call ea u es in he applica ion. This allowed pa icipan s
o ecei e imely, e idence-based guidance on medica ion
usage, side e ec s, li es yle adjus men s, and o he ea -
men - ela ed conce ns. The con inuous in ol emen o
pha macis s ensu ed pe sonalized suppo , con ibu ing
o imp o ed pa ien engagemen and glycemic ou comes
in he in e en ion g oup.
HbA1c educ ion end analysis
As shown in Fig. 3, he in e en ion g oup expe ienced a
consis en and p og essi e decline in HbA1c om baseline
h ough week 24. In con as , he con ol g oup exhibi ed
luc ua ing and ela i ely s able alues o e he same pe-
iod. The ajec o y o HbA1c educ ion u he suppo s
he clinical bene i o he mobile heal h applica ion.
Table 1. Baseline demog aphic cha ac e is ics o pa icipan s.
Cha ac e is ic N (%)
Age (yea s)
30–40 4 (4%)
41–50 12 (12%)
51–60 34 (34%)
61–70 32 (32%)
71–80 18 (18%)
Gende
Male 22 (22%)
Female 78 (78%)
Educa ional Le el
Elemen a y School 8 (8%)
Junio High School 48 (48%)
Senio High School 36 (36%)
Bachelo ’s Deg ee 6 (6%)
Pos g adua e Deg ee 2 (2%)
Occupa ion
Me chan 8 (8%)
Housewi e 62 (62%)
Re i ed 30 (30%)
Table 2. HbA1c le els (%) o e ime in con ol and in e en ion
g oups.
G oup Baseline (T0) Week 12 Week 24 p- alue
Con ol 8.99 ± SD 9.04 ± SD 8.96 ± SD 0.021
In e en ion 9.31 ± SD 8.76 ± SD 8.13 ± SD 0.001
Figu e 2. Compa ison o week 24 HbA1c be ween con ol and
in e en ion g oups.
Table 3. SEQ in e p e a ion scale.
Sco e In e p e a ion
7 Ve y Easy
6Easy
5Somewha easy
4 Neu al
3 Fai ly di icul
2 Di icul
1 Ve y di icul
Table 4. SUS in e p e a ion scale.
Responden s’ A e age To al Sco e Le e G ade Adjec i e Ra ing
>80.3 A Excellen
68-80.3 B Accep able
68 C Ok
51-67 D Poo
<51 F Aw ul
Rinda wa i A e al.: Mobile heal h in e en ion o educe HbA1c in ype 2 diabe es6
Discussion
To he bes o ou knowledge, his is he i s quasi-ex-
pe imen al s udy in Indonesia o e alua e he e ec i e-
ness o a mobile heal h (mHeal h) applica ion ha in e-
g a es pha macis consul a ion, mul imedia educa ion,
and pe sonalized blood glucose moni o ing eminde s
in he managemen o ype 2 diabe es melli us (T2DM)
in a p ima y ca e se ing. O e 24 weeks, pa icipan s in
he in e en ion g oup expe ienced a subs an ial and s a-
is ically signi ican educ ion in HbA1c om 9.31% o
8.13%. In con as , he con ol g oup, which con inued
ecei ing ou ine ca e, showed negligible change ( om
8.99% o 8.96%). These indings align wi h exis ing clini-
cal e idence sugges ing ha a educ ion o ≥1% in HbA1c
is associa ed wi h a 21% educ ion in diabe es- ela ed
mo ali y, a 14% educ ion in myoca dial in a c ion, and
a 37% educ ion in mic o ascula complica ions (Bukhsh
e al. 2018). These igu es, de i ed om UKPDS and
ADA guidelines, ein o ce he clinical impo ance o ou
obse ed ou comes and suppo he ole o digi al in e -
en ions in achie ing meaning ul he apeu ic bene i s in
glycemic con ol (Eikenho s e al. 2017).
The pa e n o HbA1c decline was bo h p og essi e and
sus ained. Imp o emen s we e obse ed as ea ly as week
12 and main ained h ough week 24, sugges ing long- e m
beha io al change and adhe ence o he apy a he han
sho -li ed no el y e ec s (Be ge e al. 2020). In con-
as , he con ol g oup exhibi ed sligh a iabili y wi h no
meaning ul end, indica i e o he inhe en limi a ions
o con en ional ca e models (A nold e al. 2023). These
ypically o e educa ion in s a ic, in equen o ma s,
o en lacking in e ac i i y o pa ien -cen e ed ollow-up
(Alba and Tunsi 2016). The digi al in e en ion, by con-
as , p o ided daily cues, weekly con en e eshes, and
indi idualized suppo (Takenouchi e al. 2016). This ype
o s uc u ed and pe sis en ein o cemen is c i ical o
ch onic disease managemen , as emphasized by Ma den
e al. (2017), who a gue ha sus ainable heal h ou comes
depend on sys ems ha ein o ce beha io in eal ime
and ac oss di e se con ex s.
The supe io ou comes in he in e en ion g oup can
be a ibu ed o he mul i ace ed beha io al mechanisms
embedded wi hin he app (Azel on e al. 2021). Func ion-
ing as a “digi al heal h coach,” he pla o m inco po a ed
e idence-based ea u es such as medica ion eminde s,
glucose moni o ing p omp s, pha macis consul a ion
h ough cha o ideo calls, and adap i e educa ional mod-
ules (Azel on e al. 2021). These componen s align wi h
he In o ma ion–Mo i a ion–Beha io al Skills (IMB)
model, which posi s ha sus ainable heal h beha io
change occu s when indi iduals a e adequa ely in o med,
in e nally mo i a ed, and p o ided wi h he beha io al
skills needed o ac (Camacho e al. 2023; Co en y e al.
2019). Fo ins ance, eminde s and p omp s ac ed as en i-
onmen al cues, educing eliance on memo y and os e -
ing habi o ma ion, while mo i a ional con en inc eased
pe cei ed bene i s and sel -e icacy (A alos e al. 2024).
Sel - egula ion heo y u he suppo s he idea ha e-
quen eedback–especially when pe sonalized–closes he
gap be ween in en ion and beha io , enabling pa ien s o
sus ain complex egimens such as blood glucose moni o -
ing and die a y adjus men (Cas o e al. 2022).
In line wi h Social Cogni i e Theo y, he in e en ion’s
eal- ime bidi ec ional eedback mechanisms, pa icula ly
pha macis in e ac ion, likely enhanced pa ien s’ sel -e -
icacy and capaci y o au onomous disease managemen
(Kooij e al. 2017). Se e al ecen me a-analyses ha e con-
i med ha digi al in e en ions inco po a ing eal- ime
p o ide in e ac ion a e mo e e ec i e in educing HbA1c
compa ed o s a ic educa ional ools (Benne e al. 2017).
Michie e al. (2017), o ins ance, epo ed ha mHeal h
apps wi h in e ac i e ea u es achie ed up o 0.8% g ea e
HbA1c educ ion compa ed o con ol condi ions. This
sugges s ha immediacy and pe sonaliza ion in eedback
no only main ain pa ien engagemen bu also empowe
use s o adjus beha io in a imely and con ex -sensi i e
manne (Knigh e al. 2016).
Impo an ly, ou esul s demons a ed no only a e-
duc ion in a e age HbA1c bu also imp o emen s in
glycemic s abili y (Ga cia e al. 2017). As illus a ed in
Fig. 2, he in e en ion g oup displayed a lowe median
HbA1c, na owe in e qua ile ange, and ewe ou li-
e s a week 24, indica ing educed a iabili y in glucose
con ol (Seok e al. 2015). This is clinically impo an be-
cause glycemic a iabili y, independen o mean HbA1c,
is linked o inc eased oxida i e s ess, in lamma ion,
and ascula complica ions (Liu e al. 2020). Huang e
al. (2024) demons a ed ha luc ua ions in glucose
le els con ibu e mo e o endo helial dys unc ion han
sus ained hype glycemia alone. The enhanced glycemic
s abili y obse ed in ou s udy may e lec he imely, dy-
namic na u e o he app’s in e en ion, allowing pa ien s
o an icipa e and mi iga e dis up ions in hei diabe es
managemen (Okumu a e al. 2016).
The easibili y and usabili y o he in e en ion we e
u he suppo ed by i s success ul implemen a ion ac oss
a demog aphically di e se sample (Chew e al. 2025). The
majo i y o pa icipan s we e aged 51–70 yea s, and many
had only seconda y-le el educa ion, ye hey engaged
meaning ully wi h he app (Rod íguez e al. 2019). This
is no able because olde adul s and indi iduals wi h lim-
i ed educa ional backg ounds o en exhibi lowe digi al
Figu e 3. Compa ison o he educ ion in HbA1c le els in he
con ol and in e en ion g oups.
0
5
10
15
20
25
30
35
40
45
Baseline week 12 week 24
HbA1C
T ea men
con ol g oup in e en ion g oup
Pha macia 72: 1–9 7
li e acy, posing a ba ie o echnology adop ion (Chew e
al. 2025). Ou in e en ion o e came his h ough in ui-
i e in e ace design, ca egi e in eg a ion, and he use o
amilia communica ion ools like Wha sApp (Rod íguez
e al. 2019; Kim e al. 2021). These design elemen s align
wi h he Technology Accep ance Model (TAM), which
emphasizes ha pe cei ed ease o use and pe cei ed use-
ulness a e key p edic o s o echnology up ake (Tsai e al.
2017). The app’s success ac oss a ied use g oups sugges s
s ong po en ial o scalabili y wi hin Indonesia’s pub-
lic heal h in as uc u e and o he low- esou ce se ings
(Chou e al. 2024).
The cumula i e impac o educed HbA1c, imp o ed
glycemic consis ency, high use engagemen , and wide
demog aphic applicabili y unde sco es he in e en ion’s
po en ial as a ans o ma i e ool o T2DM sel -man-
agemen (Bone e al. 2023). The s udy was conduc ed
in a eal-wo ld p ima y ca e se ing in ol ing 10 public
clinics, wi h ull e en ion ac oss he 24 weeks, enhanc-
ing he ecological alidi y o ou indings (Ben ley e al.
2016). The app i sel was de eloped using use -cen e ed
design p inciples and unde wen p e-deploymen usabil-
i y es ing, ensu ing cul u al and echnological i (Bone
e al. 2023). Addi ionally, HbA1c, used as ou p ima y
ou come, ep esen s a alida ed and objec i e measu e o
long- e m glycemic con ol, enhancing he scien i ic igo
o ou e alua ion (Te auchi e al. 2017).
Despi e hese s eng hs, his s udy has se e al limi a-
ions. The quasi-expe imen al design wi hou andomiza-
ion in oduces he possibili y o selec ion bias, al hough
baseline compa abili y be ween g oups was main ained.
HbA1c was he sole clinical endpoin ; we did no assess
complemen a y heal h indica o s such as BMI, blood
p essu e, o lipid p o iles, which limi s he scope o in-
e p e a ion. The 24-week du a ion, while su icien o
obse e in e media e ou comes, does no allow o an as-
sessmen o he long- e m sus ainabili y o he in e en-
ion’s e ec s. Addi ionally, ex e nal con ounde s such as
concu en use o o he digi al heal h ools o in o mal
suppo om amily membe s we e no con olled o and
may ha e in luenced esul s.
Conclusion
This quasi-expe imen al s udy p o ides s ong p elimi-
na y e idence ha a cul u ally ailo ed mobile heal h ap-
plica ion, in eg a ed wi h pha macis suppo , beha io al
ein o cemen , and mul imedia educa ion, can signi i-
can ly imp o e glycemic con ol and suppo sus ained
sel -managemen in pa ien s wi h ype 2 diabe es melli us
in Indonesian p ima y ca e se ings. The signi ican e-
duc ions in HbA1c, enhanced glycemic s abili y, and high
engagemen ac oss di e se use g oups unde sco e he in-
e en ion’s easibili y, usabili y, and po en ial o b oade
implemen a ion. Fu u e andomized con olled ials a e
needed o alida e long- e m e ec i eness, cos -e iciency,
and scalabili y.
Acknowledgmen s
The au ho s would like o exp ess hei since e g a i ude
o he Cen e o Highe Educa ion Funding and Assess-
men (PPAT), Minis y o Highe Educa ion, Science, and
Technology o he Republic o Indonesia, and he Indo-
nesia Endowmen Fund o Educa ion Agency (LPDP)
o he Republic o Indonesia, o hei in aluable suppo
and gene ous unding o his esea ch. Thei con ibu ions
we e ins umen al in acili a ing he success ul comple ion
o his s udy. The au ho s also ex end hei app ecia ion
o all indi iduals and ins i u ions who p o ided insigh s,
echnical assis ance, and encou agemen h oughou he
esea ch p ocess.
Addi ional in o ma ion
Con lic o in e es
The au ho s ha e decla ed ha no compe ing in e es s exis .
E hical s a emen s
The au ho s decla ed ha no clinical ials we e used in he p es-
en s udy.
The au ho s decla ed ha expe imen s on humans o human
issues we e pe o med o he p esen s udy.
In o med consen om he humans, dono s o dono s’ ep e-
sen a i es: The s udy p o ocol ecei ed app o al om he Facul-
y o Medicine E hics Commi ee a Padjadja an Uni e si y, wi h
e hical clea ance numbe 635/UN6/KEP/EC/2023, da ed May
19, 2023. All pa icipan s p o ided w i en in o med consen a -
e being in o med abou he objec i es, p ocedu es, isks, and
bene i s o he s udy. Pa icipa ion was olun a y, and pa ici-
pan s e ained he igh o wi hd aw om he s udy a any ime
wi hou penal y.
The au ho s decla ed ha no expe imen s on animals we e
pe o med o he p esen s udy.
The au ho s decla ed ha no comme cially a ailable immo -
alised human and animal cell lines we e used in he p esen s udy.
Use o AI
No use o AI was epo ed.
Funding
This esea ch was suppo ed by he Indonesian Educa ion
Schola ship P og am (BPI) g an no 202209091648, Educa ion
Financing Se ice Cen e (Puslapdik), Minis y o Educa ion
and Cul u e, Republic o Indonesia (Kemendikbud), Cen e o
Highe Educa ion Funding and Assessmen (PPAPT), and Indo-
nesia Endowmen Fund o Educa ion Agency (LPDP).
Au ho con ibu ions
Concep ualiza ion, AYR, HP, LA; me hodology, AYR, HP, LA;
in es iga ion, AYR, HP, LA; da a cu a ion, AYR, LA; w i ing –
o iginal d a p epa a ion, AYR; w i ing – e iew and edi ing,
AYR, HP, LA; supe ision, HP, LA; unding acquisi ion, AYR.
All au ho s ha e ead and ag eed o he published e sion o
he manusc ip .
Rinda wa i A e al.: Mobile heal h in e en ion o educe HbA1c in ype 2 diabe es8
Au ho ORCIDs
As i Rinda wa i h ps://o cid.o g/0000-0001-8741-3112
Lia Amalia h ps://o cid.o g/0000-0002-0011-1558
Hikma Pe mana h ps://o cid.o g/0000-0002-1337-1770
Da a a ailabili y
All o he da a ha suppo he indings o his s udy a e a ailable
in he main ex .
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