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Feasibility and Preliminary Impacts of a Diabetes Education Chatbot Simulation on Glycemic Targets, Loneliness, and Health Beliefs in Indonesia: An Explanatory Mixed-methods Study
Yohanes Andy Rias, Wildan Akasyah, Tri Ana Mulyati, Harwina Widya Astuti, Herminio Noronha, Fakhrudin Nasrul Sani, Hsiu-Ting Tsai
J Prev Med Public Health. 2026;59(1):56-65.   Published online December 3, 2025
DOI: https://doi.org/10.3961/jpmph.25.334
  • 1,691 View
  • 198 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Chatbot technology improves access to and engagement with diabetes education. However, few studies have evaluated the feasibility and rigorously assessed the impact of chatbots among individuals with type 2 diabetes (T2DM) using theory-based approaches. This pilot study assessed the feasibility and preliminary impact of a chatbot on glycemic targets, loneliness, and perceived health beliefs among adults with T2DM.
Methods
An explanatory mixed-methods approach, comprising a one-group experimental design and qualitative interviews, was used. The chatbot simulation, named “TakonGendhis,” was developed based on conceptual models derived from the technology acceptance model and the health belief model. Feasibility included usefulness, ease of use, and intention to use. Preliminary impact was evaluated based on changes in glycemic targets, loneliness, and health beliefs from baseline to 12 weeks post-intervention. Qualitative data were gathered through individual interviews and focus group discussions and were analyzed thematically. Narrative synthesis was employed to integrate findings from the quantitative and qualitative phases of the study.
Results
The scores for usefulness, ease of use, and intention to use were 26.55, 27.32, and 34.03, respectively. Quantitative analysis revealed reduced loneliness, improved health beliefs, and lower glycemic scores after the 12-week intervention. The qualitative study identified 4 themes: feasibility, beliefs, emotional support, and areas for improvement.
Conclusions
The intervention was feasible and had beneficial preliminary impacts on glycemic targets, loneliness, and health beliefs. Addressing feasibility, beliefs, emotional support, and identified areas for improvement may increase patients’ willingness to use the chatbot.
Summary
Key Message
This mixed-methods study highlights that a diabetes education chatbot simulation is both feasible and beneficial in its preliminary impact for individuals with diabetes in Indonesia. The preliminary results indicate possible enhancements in glycemic targets, reduced feelings of loneliness, and more encouraging health beliefs, confirmed by qualitative insights about user feasibility, beliefs, emotional support, and areas for improvement.
Cardiovascular Disease–related Health Beliefs and Lifestyle Issues Among Karen Refugees Resettled in the United States From the Thai-Myanmar (Burma) Border
Akiko Kamimura, Kai Sin, Mu Pye, Hsien-Wen Meng
J Prev Med Public Health. 2017;50(6):386-392.   Published online November 2, 2017
DOI: https://doi.org/10.3961/jpmph.17.098
  • 16,281 View
  • 237 Download
  • 6 Crossref
AbstractAbstract PDF
Objectives
Refugees resettled in the US may be at risk for cardiovascular disease (CVD). However, little is known about CVD-related issues among Karen refugees who have migrated to the US from the Thai-Myanmar border. The purpose of this study was to examine CVD-related health beliefs and lifestyle issues among Karen refugees resettled in the US.
Methods
Karen refugees resettled in the US from the Thai-Myanmar border (n=195) participated in a survey study on health beliefs related to CVD, salt intake, physical activity (PA), and smoking in the fall of 2016.
Results
A high-salt diet, physical inactivity, and smoking were major lifestyle problems. Participants who adhered to a low-salt diet considered themselves to be susceptible to CVD. Most participants did not engage in regular PA. Regular PA was associated with less perceived susceptibility to CVD and greater perceived benefits of a healthy lifestyle for decreasing the likelihood of CVD.
Conclusions
Each refugee population may require individualized strategies to promote PA and a healthy diet. Future studies should develop health education programs that are specifically designed for Karen refugees and evaluate such programs. In addition to health education programs on healthy lifestyle choices, tobacco cessation programs seem to be necessary for Karen refugees. At the same time, it is important to foster strategies to increase the utilization of preventive care among this population by promoting free or reduced-fee resources in the community to further promote their health.
Summary

Citations

Citations to this article as recorded by  
  • Burmese Refugees’ Beliefs and Experiences of Diabetes Self-management in Texas
    So Hyeon Bang, Bora Kim, Jung Kwak, Julie A. Zuñiga, Lauren E. Gulbas, Ya-Ching Huang, Nicholas H. Travers, Alexandra A. García
    Advances in Nursing Science.2025;[Epub]     CrossRef
  • Health status and Healthcare Access of Southeast Asian refugees in the United States: An integrative review
    So Hyeon Bang, Ya‐Ching Huang, Hsuan‐Ju Kuo, Emma S. Cho, Alexandra A. García
    Public Health Nursing.2023; 40(2): 324.     CrossRef
  • Breaking the barriers: The impact of health information and cultural factors on immigrant health in the Nordic countries
    Hamed Ahmadinia
    Library & Information Science Research.2023; 45(3): 101253.     CrossRef
  • Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review
    Gayathri S. Kumar, Jenna A. Beeler, Emma E. Seagle, Emily S. Jentes
    Journal of Immigrant and Minority Health.2021; 23(4): 813.     CrossRef
  • BeWell: quality assurance health promotion pilot
    Linda A. Piwowarczyk, Fernando Ona
    International Journal of Health Care Quality Assurance.2019; 32(2): 321.     CrossRef
  • Bibliometric analysis of global migration health research in peer-reviewed literature (2000–2016)
    Waleed M. Sweileh, Kolitha Wickramage, Kevin Pottie, Charles Hui, Bayard Roberts, Ansam F. Sawalha, Saed H. Zyoud
    BMC Public Health.2018;[Epub]     CrossRef

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