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Visualizations of illness and treatment processes are promising interventions for changing unhelpful perceptions and improving health outcomes. However, these are yet to be tested in patients with type 2 diabetes mellitus (T2DM).
This study assesses the cross-cultural acceptability and potential effectiveness of a brief visual animation of T2DM at changing unhelpful illness and treatment perceptions and self-efficacy among patients and family members in 2 countries, New Zealand and Saudi Arabia. Health care professionals’ views on visualization are also explored.
A total of 52 participants (n=39, 75% patients and family members and n=13, 25% health care professionals) were shown a 7-minute T2DM visual animation. Patients and family members completed a questionnaire on illness and treatment perceptions and self-efficacy before and immediately after the intervention and completed semistructured interviews. Health care professionals completed written open-ended questions. Means and 95% CIs are reported to estimate potential effectiveness. Inductive thematic analysis was conducted on qualitative data.
All participants rated the visual animation as acceptable and engaging. Four main themes were identified: animation-related factors, impact of the animation, animation as an effective format for delivering information, and management-related factors. Effect sizes (ranged from 0.10 to 0.56) suggested potential effectiveness for changing illness and treatment perceptions and self-efficacy among patients and family members.
Visualizations are acceptable and may improve the perceptions of patients’ with diabetes in a short time frame. This brief visual animation has the potential to improve current T2DM education. A subsequent randomized controlled trial to investigate the effects on illness and treatment perceptions, adherence, glycemic control, and unplanned hospital admission is being prepared.
Type 2 diabetes mellitus (T2DM) is a metabolic condition characterized by high blood sugar levels owing to a loss of pancreatic beta cell function [
T2DM requires ongoing self-management and lifestyle changes to achieve glycemic control and minimize the risk of complications [
However, research has shown that low adherence to diabetes self-care behaviors is common [
There is a growing awareness of the importance of psychosocial factors in the management of diabetes, as highlighted by recommendations to integrate psychosocial support into routine diabetes care [
Related to CSM is the necessity-concerns framework, which proposes that patients also have beliefs about medicine and that these beliefs influence adherence to treatment [
In diabetes, systematic reviews have established that patients’ perceptions of personal control over their illness are associated with better glycemic control, whereas greater illness identity perceptions (attributing more symptoms to diabetes), greater consequences perceptions (perceiving diabetes to have severe consequences), higher emotional distress, and concern perceptions about diabetes were associated with suboptimal glycemic control [
Illness perceptions of family members can also influence patients’ health behaviors, as many self-care behaviors in diabetes occur within patients’ social contexts. Patients with chronic conditions tend to have better health outcomes when their perceptions align with those of their family members [
Research suggests that addressing unhelpful illnesses and treatment perceptions can result in better coping behaviors and improved health outcomes [
Robust theoretical models (eg, cognitive theory of multimedia learning) and published empirical studies support the use of visuals to improve learning [
Research on the effects of visualization on illness and treatment perceptions of T2DM is lacking. Therefore, this pilot study aimed to explore the cross-cultural acceptability of a brief visual animation of T2DM among patients and family members across 2 countries and collect feedback from health care professionals (HCPs) to highlight ways in which the visual animation could be improved. The study also assessed potential effects of the visual animation on illness and treatment perceptions and self-efficacy to inform a future trial on adherence to medication, diet and exercise behaviors, and health outcomes (eg, glycemic control and unplanned hospital admissions).
The authors followed the Standards for Reporting Qualitative Research [
This pilot study used a mixed methods design, involving pre-post assessment and semistructured interviews with patients with T2DM and family members across 2 countries (New Zealand and Saudi Arabia). This study also explored views about the visual animation among HCPs in New Zealand using open-ended questions. Given its exploratory nature, this study was not powered to detect statistical significance; however, it assessed potential effects on illness and treatment perceptions and self-efficacy by looking at changes in mean scores from before to after the intervention. The effect sizes were calculated from the means and SDs, which may be useful for a power calculation for a future trial. A previous study using visual animation found small effect sizes for illness identity perceptions and return to normal activities in patients with acute coronary syndrome [
Primary participants were patients with T2DM. Patients were eligible to participate if they were aged ≥18 years, had a formal diagnosis of T2DM for ≥1 year, were prescribed diabetes medications, lived in New Zealand (for the New Zealand participant group) or Saudi Arabia (for the Saudi Arabia participant group), and had access to the internet and a smartphone or computer. Eligible participants were encouraged to invite their family members to participate in the study. A family member was defined as a relative in regular contact with a person with T2DM. Participating family members had to be aged ≥18 years, living in New Zealand or Saudi Arabia, and with access to the internet and a smartphone or computer. Patients were allowed to participate by themselves if they did not want to invite a family member. Family members were also allowed to participate by themselves if they found it more convenient for them.
HCPs were consulted for feedback on the visual animation. In addition to working at an outpatient diabetes clinic, there were no other inclusion or exclusion criteria for this group. All participants were recruited between March and July 2021.
The brief visual animation was developed by a multidisciplinary team including health psychologists, endocrinologists, and developers. The developmental process involved iterative feedback from the multidisciplinary team to refine the visual content. Māori and Pacific HCPs were consulted to ensure cultural appropriateness.
The visual animation is a 7-minute video that begins with introductory statements explaining the focus and purpose of the visual animation. The visual animation shows the production of glucose in the body after food consumption, glucose levels in the blood, and how glucose and insulin interact to allow glucose to enter body cells using the lock-and-key analogy. The visual animation then depicts what happens when patients have T2DM (eg, glucose cannot enter body cells because of inadequate insulin or insulin resistance, which leads to increased glucose levels in the blood). Symptoms and long-term complications associated with T2DM are visually depicted. The visual animation shows how treatment (with a particular focus on metformin, healthy eating, and regular exercise) can help control blood glucose levels. The visual animation concludes with an emphasis on the importance of family and significant others as a source of support and motivation. We developed 2 versions of the visual animation, one in English suited for the New Zealand context and one in Arabic suited for the Saudi context. Differences included the appearance and dress of the characters, food depicted, and pictures of the environment when the character was exercising outside (Figures S1-S11,
Participants were recruited from an outpatient diabetes clinic at the Greenlane Clinical Centre in Auckland, New Zealand, a specialized diabetes clinic at a tertiary hospital in Riyadh, and Facebook diabetes support groups and community groups. Patients and their family members were approached in the waiting rooms by a student researcher (New Zealand sample) or a medical intern (Saudi sample) who introduced the study and invited them to participate. A study flyer was posted on community and diabetes support pages on Facebook outlining brief information about the study and the research team contact details. Interested participants were provided with a link to the study on Qualtrics (web-based software for data collection; [
On Qualtrics, participants confirmed their eligibility, viewed and downloaded participant information sheets, provided web-based consent, completed baseline questionnaires, and chose a time for the interview. At the beginning of each semistructured interview, participants were shown the brief visual animation either on web using Zoom software (New Zealand sample) or face-to-face at a clinic in an office room (Saudi sample). The participants then completed a web-based questionnaire immediately after the intervention. Participants were then interviewed, and only the participants and interviewers were present. All interviews were audio recorded and lasted for up to 60 minutes (
The interviews were conducted by the first author (MA), a male PhD health psychology student originally from Saudi Arabia but studying or residing in New Zealand, and a female medical intern living in Riyadh, Saudi Arabia. The interviewers had no relationships with the participants before the commencement of the study.
HCPs working at an outpatient diabetes clinic at the Greenlane Clinical Centre in Auckland, New Zealand, were asked to provide feedback about the visual animation. The first author (MA) gave a presentation during the clinic staff meeting and showed the brief visual animation of T2DM. HCPs responded to 7 written open-ended questions related to the visual animation (
Patients with T2DM provided their age, sex, ethnicity, marital status, educational level, partnership status, employment status, type of prescribed diabetes medications, and duration of T2DM. Family members also provided information on age, sex, ethnicity, educational level, and relationship with the patient.
At baseline, patients’ perceptions of T2DM were assessed using 4 items of the Brief Illness Perception Questionnaire (B-IPQ; [
Patients’ perceptions regarding the effectiveness of treatment (medication, healthy eating, and regular exercise) in controlling T2DM were assessed using 3 items adapted from previous research ([
Immediately after watching the visual animation, patients completed the same questionnaire administered at baseline. Participants further completed 3 yes or no questions related to their perceptions of T2DM (eg
Family members completed similar questionnaires at baseline and immediately after viewing the visual animation; however, the questions were slightly modified to ask about their perceptions of their family members’ T2DM (eg,
Interviews with Saudi patients were translated and transcribed into English by an independent researcher from Saudi Arabia who held a bachelor’s degree in English literature. The transcriptions were then checked against the original recordings for accuracy by the first author (MA), who was fluent in Arabic and English. Interviews with patients from New Zealand and family members were transcribed by the first author (MA). Transcriptions were emailed to participants who wished to review their interview transcriptions and were instructed to return any comments within 2 weeks. All qualitative data from interviews and responses to open-ended questions provided by HCPs were coded and analyzed using an inductive thematic analysis approach [
First, data familiarization was achieved through manually transcribing, reading, and rereading the data. During this phase, a list of initial ideas regarding the data set was generated. Second, the entire data set was coded and each code was matched to the data extracts. Third, the generated codes were sorted and combined to form the initial themes and subthemes, and all relevant coded data extracts were collated within each initial theme and subtheme. All coded data extracts were reviewed to ensure coherence and meaningfulness. Themes were then further refined in relation to the entire data set to ensure that each theme was distinct. Themes and subthemes were assigned labels that captured their essence. Discussions between the researchers ensued until a consensus was reached on the themes and the strongest quotes to support each theme and subtheme.
Descriptive statistics were used to analyze the data. Frequencies and percentages were calculated for dichotomous data. Continuous data were summarized using the mean and 95% CI at baseline and immediately after the intervention. Effect size (
This study was reviewed and approved by the Auckland Health Research Ethics Committee (reference number AH3217) and the General Directorate of Health Affairs, Najran Institutional Review Board, Saudi Arabia (IRB 20‐040E).
There were 52 participants (n=15, 29% New Zealand patients; n=17 (33%) Saudi patients; n=7, 13% New Zealand family members; and n=13, 25% HCPs).
Participant flowchart. NZ: New Zealand; SA: Saudi Arabia.
Demographic and clinical characteristics of the sample.
Characteristics | NZa patients (n=15) | SAb patients (n=17) | NZ family members (n=7) | |
Age (years), mean (SD) | 55.5 (11.1) | 52.7 (11.4) | 44.1 (11.0) | |
Female, n (%) | 10 (67) | 9 (53) | 6 (86) | |
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NZ European | 7 (47) | 0 (0) | 3 (43) |
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Māori | 3 (20) | 0 (0) | 0 (0) |
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Cook Island | 1 (7) | 0 (0) | 0 (0) |
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Niuean | 0 (0) | 0 (0) | 1 (14) |
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Indian | 1 (7) | 0 (0) | 2 (29) |
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Saudi | 0 (0) | 15 (88) | 0 (0) |
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Other | 2 (13; Palestinians) and 1 (7; Filipino) | 1 (6; Egyptian) and 1 (6; Yemeni) | 1 (14; South Asian) |
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No formal education | 2 (13) | 2 (12) | 0 (0) |
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Secondary education | 3 (20) | 2 (12) | 0 (0) |
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High school | 4 (27) | 4 (23) | 1 (14) |
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University education | 6 (40) | 9 (53) | 6 (86) |
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Single | 4 (27) | 0 (0) | —c |
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Married or civil union | 9 (60) | 15 (88) | — |
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Couple or de facto | 1 (7) | 0 (0) | — |
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Widowed | 1 (7) | 2 (12) | — |
Working (yes), n (%) | 8 (53) | 6 (35) | — | |
Taking metformin (yes), n (%) | 13 (87) | 14 (82) | — | |
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Oral medications only | 9 (60) | 11 (65) | — |
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Insulin therapy only | 1 (7) | 2 (12) | — |
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Oral and insulin | 5 (33) | 4 (23) | — |
aNZ: New Zealand.
bSA: Saudi Arabia.
cNot available.
Four main themes were identified from the patients’ and family members’ combined data set: (1) animation-related factors, (2) impact of the animation, (3) animation as an effective format, and (4) diabetes management–related factors. Subthemes have been presented in the text using
This theme covered participants’ perceptions and views of the visual animation. Participants viewed the visual animation as
Participants reported that a longer visual animation would have probably made them lose interest. A few participants from New Zealand noted that the visual animation was slow with some unnecessary pauses, whereas some family members and participants from Saudi Arabia reported that it was too fast for them.
The use of simple nonmedical language and creative visuals were identified as important elements that made the visual animation
I felt I can be more in control now by doing the simple three stuff, take my medication every day, eat healthy and watch my portions and exercise daily.
I suppose we know it’s manageable, what it made me think was I’ve got to make it more manageable.
Participants identified with the
Participants highlighted the importance of making the characters context-specific, where characters reflect culture. This made the visual animation feel inclusive of minority groups such as the Māori and Pacific groups in New Zealand who are at higher risk of developing T2DM. Participants from Saudi Arabia also appreciated that the visual animation was custom-made to suit their cultural context.
Some participants felt that they would relate more to the animated characters if they were personalized to match participants’ demographics. However, others acknowledged that diabetes can affect anyone regardless of ethnicity or gender and said that personalizing the animated characters was unnecessary.
This theme was related to the perceived impact of the visual animation, in which
It is sort of a bit of a wakeup call now that I can understand it better. Sort of how important it is to follow that [lifestyle changes].
For others, the visual animation reinforced what they had been told in the past about the importance of self-care behaviors and reassured them that diabetes medications work to control their blood glucose levels. Other participants who managed their T2DM well felt reassured that they were on the right track. A few participants reflected on their low adherence to diabetes self-care behaviors and reported feelings of guilt.
Of note, participants from Saudi Arabia reported that the visual animation specifically made them think about the potential complications of T2DM and the need to improve their adherence to delay or avoid these events, whereas participants from New Zealand did not. Participants from New Zealand reported general concerns about T2DM-related complications, but this was not related to the visual animation itself:
I thought about the consequences of diabetes, especially on the body organs. I felt that if I really do not control my diabetes, I will suffer more, and I will have more serious complications than I have so far.
For family members, the visual animation made them reflect on what they were already doing and what they could do to better support the patient, including preparing healthier meals and reminding them to take their medications. For those who lived apart from the patient, there was some uncertainty about whether the patients were, in fact, adherent to self-care behaviors:
That worked well for him, cutting down his portions yeah. It gives you a sense of control. That’s what you should be eating and aiming for.
Family members reported a sense of pride about their relatives with T2DM who were making significant lifestyle changes to control their T2DM. They were seen as role models who could influence other family members to have a better lifestyle, including improving physical activity and watching the type and portions of their food:
I was thinking about how he’s doing all that like every day, whether it rains or shines, he gets up and goes for his exercise. And even the food, even if he likes certain food, he restricts the amount that he eats, which also makes other people in the family realize OK you have to control your portion of food that you’re eating even if you really love it.
This theme covered the participants’ perceived reasons for why the visual animation was an effective format. Information that participants had come by or received in the past (either written or verbal) was often described as confusing and medical. Many participants reported not reading diabetes pamphlets available at clinics and pharmacies, and those who read them thought they were often limited and primarily diet based. The visual animation was regarded as superior to written information as
We have seen pamphlets, but we often throw them out. They are hard to understand and too many words...I think the video is much better because you can see inside the body. I knew things before, but in my mind, I never pictured it. Now, I know how insulin works.
It is powerful, you know, seeing how food is broken down into sugar, going through the bloodstream, and used for energy. How insulin is essential for this process and without it, like in type 1 diabetes, you can die.
It is culturally responsive to a whole section of society that might find it valuable, because it’s not just written literature, that it is very medical with medical speak. I think that the visual aspect is very good.
Despite having been living with T2DM for years, the animation presented
It is more than what I have been told by anybody else basically...I had no clue about that, testing your sugar levels daily!
I got to know more about diabetes, most of which I hadn’t known previous to watching the video.
This theme covered general issues around diabetes management (knowing and doing are 2 different things), which were not related to the visual animation itself. Participants identified main
Participants expressed
I’ve actually had an aversion to the idea of insulin, but before this meeting, I was saying to myself if I go on insulin, then it’s over for me basically.
Participants expressed frustration about the cost and funding for new diabetes medications such as empagliflozin (Jardiance). This medication is funded in New Zealand only for people with T2DM if they fulfill various eligibility criteria such as being at high risk of heart and kidney complications. Patients who wanted to go onto this new medication but did not meet the eligibility criteria chose to pay the cost themselves, creating financial strain and additional concerns. Another frustration patients and family members experienced was the dismissal by HCPs in instances where patients came to their appointments having done some research on the internet and prepared their questions.
Other participants were concerned about long-term complications if they did not control their T2DM. For some participants, understanding the chronicity and progressive nature of T2DM, in addition to being fearful of potential complications, pushed them to improve their adherence and make serious lifestyle changes.
Problems can arise when patients do not want help or live alone, or when family members are not supportive for any reason, including low health literacy. Participants expressed frustration when, for example, family members cooked unhealthy meals or perceived T2DM as something that is easily fixed and not chronic.
Inductive thematic analysis of the HCPs’ data set resulted in a single theme consistent with the first theme identified from the patients’ and family members’ data set, “animation-related factors.” HCPs perceived the visual animation as
Participants from all groups provided suggestions for improvement, including using a less formal and female voiceover, changing medical terms to lay terms (eg, chronic to long-term, glucose to sugar), personalizing the animated characters based on the patient’s demographics, and adding subtitles to accommodate those with hearing difficulties. The participants also suggested adding greetings in Te Reo Māori and other Pacific languages.
Furthermore, the participants expressed a need for more visual content that covered other important issues in diabetes such as how insulin therapy works, daily self-monitoring of blood glucose, HbA1c testing, and foot care. Brief, simple, and accessible educational digital content in the form of animated videos could be developed for each topic.
Data support the potential effectiveness of the brief visual animation on patients’ perceptions and self-efficacy (
All patients and family members (100%) believed that it was necessary to take diabetes medication every day at baseline and after the intervention. The cited reasons included controlling blood glucose levels, avoiding and delaying complications, and having a better quality of life. After the intervention, most patients and family members reported that the brief visual animation made them actively think about the potential consequences of T2DM, things they could do to control their T2DM, and diabetes medications.
Illness and treatment perceptions and self-efficacy scores at baseline and immediately after the intervention.
Variable | Baseline, mean (95% CI) | Immediately after intervention, mean (95% CI) | Effect size ( |
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Personal control | 5.40 (4.11-6.69) | 8.07 (7.03-9.10) | 0.52 | |||
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Coherence | 6.67 (5.35-7.98) | 9.07 (8.42-9.71) | 0.56 | |||
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Consequences | 7.53 (6.47-8.60) | 9.27 (8.69-9.84) | 0.43 | |||
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Concerns | 7.87 (6.61-9.12) | 8.67 (7.98-9.35) | 0.27 | |||
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Medication | 7.67 (6.55-8.79) | 9.33 (8.88-9.79) | 0.48 | |||
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Eating healthy food | 8.53 (7.58-9.49) | 9.07 (8.42-9.71) | 0.19 | |||
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Regular exercise | 7.87 (6.46-9.27) | 8.93 (8.17-9.70) | 0.27 | |||
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Self-efficacy | 6.13 (4.73-7.54) | 8.40 (7.78-9.02) | 0.52 | |||
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Personal control | 7.18 (5.53-8.82) | 8.59 (7.77-9.40) | 0.36 | |||
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Coherence | 7.65 (6.05-9.24) | 9.00 (8.19-9.81) | 0.41 | |||
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Consequences | 8.00 (6.33-9.67) | 9.18 (8.57-9.79) | 0.23 | |||
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Concerns | 6.88 (5.15-8.62) | 5.59 (4.06-7.12) | 0.24 | |||
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Medication | 8.12 (6.89-9.35) | 9.29 (8.67-9.92) | 0.47 | |||
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Eating healthy food | 8.18 (6.89-9.46) | 9.18 (8.69-9.67) | 0.38 | |||
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Regular exercise | 8.71 (7.52-9.89) | 9.41 (9.09-9.73) | 0.24 | |||
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Self-efficacy | 7.71 (6.22-9.19) | 9.06 (8.47-9.65) | 0.34 | |||
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Personal control | 6.71 (3.57-9.86) | 8.43 (6.93-9.93) | 0.44 | |||
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Coherence | 7.14 (5.90-8.39) | 8.57 (6.98-10.16) | 0.37 | |||
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Consequences | 8.86 (7.40-10.31) | 9.00 (7.81-10.19) | 0.10 | |||
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Concerns | 8.00 (5.38-10.62) | 6.71 (4.23-9.20) | 0.39 | |||
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Medication | 6.71 (4.11-9.31) | 9.43 (8.03-10.83) | 0.51 | |||
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Eating healthy food | 7.86 (5.44-10.27) | 9.29 (8.59-9.98) | 0.40 | |||
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Regular exercise | 8.57 (7.39-9.75) | 9.57 (8.84-10.30) | 0.55 | |||
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Self-efficacy | 6.14 (3.56-8.73) | 7.57 (5.66-9.49) | 0.23 |
aNZ: New Zealand.
bSA: Saudi Arabia.
This pilot study showed that a brief animation was acceptable and engaging for patients with T2DM and their families. Inductive thematic analysis revealed 4 main themes related to the brief animation, the impact of animation, animation as an effective format for delivering information, and diabetes management–related factors. Preliminary analysis showed potential cross-cultural effectiveness for improving illness and treatment perceptions and self-efficacy in all patients and family members, with larger effect sizes observed in the New Zealand patient group than in the Saudi patient group. Room for change in the New Zealand patient group may have been larger given the lower baseline means for many of the perception dimensions. Given the explanatory nature of this study, baseline characteristics were not used in the analysis but could be used in a subsequent trial.
The visual animation was well received. Nearly all patients and their family members reported that the visual animation was informative and understandable. This is consistent with previous studies that have shown that visual interventions (eg, animations covering general information about diabetes, symptoms, risk factors, and management) improved diabetes health literacy [
Visualizing both the illness and its treatment are important [
Many of the reported barriers to adherence to self-care behaviors (eg, poor understanding, forgetfulness, and concerns about medication side effects and costs) are similar to previous findings [
Some participants reported avoiding going onto insulin therapy despite the necessity as going onto insulin was seen as a sign of personal failure for not being able to control their T2DM through oral medications and other self-care behaviors. This phenomenon is not uncommon in the literature [
Although it has been established that illness perception interventions, often delivered over multiple sessions, can change perceptions and improve outcomes in T2DM [
This evidence is consistent with the findings from previous randomized controlled trials using different patient samples [
Family members’ perceptions have been shown to mediate relationships between patients’ perceptions and outcomes [
A key strength of this study was the inclusion of 2 culturally specific versions of the visual animation and the cross-cultural patient samples. A second strength is the mixed methods design, which allowed us to gather both quantitative and qualitative data regarding the utility and acceptability of the visual animation. However, this study has a few limitations. First, patients and family members were not involved in co-designing the initial storyboards, scripts, or the visual animation assessed in this study; therefore, valuable input may have been missed. Second, because of convenience sampling, pre-post pilot design, and lack of a control group, our findings on changes in perceptions and self-efficacy must be interpreted with caution, and the study was not sufficiently powered to analyze scores by ethnicity (Māori, Pacific groups). Third, all patients perceived diabetes medications as necessary, and therefore it would be interesting to find out what a less receptive audience thinks about the visual animation and how it may influence their illness and treatment perceptions. Finally, data collection for this study was handled differently for the New Zealand and Saudi samples. Although extensive efforts were made to conduct the study completely on web, face-to-face recruitment from diabetes clinics was more successful in both countries. The New Zealand sample was comfortable using technology and therefore interviews were conducted over Zoom. Patients in the Saudi sample opted to perform the study in person at the clinic, either while waiting to be seen by the clinician or immediately afterward. In doing so, the opportunity for family members to participate was severely limited. Nonetheless, this study did help demonstrate the cross-cultural applicability of the visual animation. This also informs the practical aspects of recruitment for planning a future trial.
The brief visual animation will be adapted in light of the participants’ suggestions and feedback. This will include adding greetings in Te Reo Māori (for the New Zealand version), using a female Māori narrator voice, simplifying the language to overcome health literacy barriers, personalizing the animated characters to match the viewer’s gender and ethnicity, and adding subtitles to accommodate patients with hearing difficulties. The next step is to conduct a cross-cultural randomized controlled trial to investigate the effects on illness perceptions, adherence to medication, diet and exercise behaviors, glycemic control, and unplanned hospital admissions. The effect sizes found from this preliminary analysis will inform the sample size; therefore, the study will be sufficiently powered to conduct subgroup analyses by ethnicity. This future trial will ensure the recruitment of Saudi family members by offering incentives and allowing web-based participation for convenience. The inclusion of family members in the intervention is likely to have a larger impact on families and community health and improve the quality of life. This future trial could use the visual animation intervention as a stand-alone or as a component of a larger illness perception intervention. This future research would also look at how such an intervention could reduce or eliminate ethnic disparities and contribute to health equity.
Visual animation of type 2 diabetes mellitus.
Interview schedule and open-ended questions.
Patients’ and family members’ themes.
Health care professional’s themes.
Brief Illness Perception Questionnaire
Consolidated Standards of Reporting Trials
common sense model
health care professional
type 2 diabetes mellitus
This work was supported by the University of Auckland School of Medicine Performance-Based Research Fund under grant number (71603). MA is receiving financial support to complete his PhD from the Saudi Ministry of Higher Education (King Salman Scholarship Program) and the University of Auckland Student Funds. Funding agencies were not involved in the design of the study. the collection, analysis and interpretation of data, writing the report, or the decision to submit the report for publication.
The authors would like to acknowledge and thank Jane Wilkinson, Stephanie Duckworth, and Roxanne Henare from Auckland District Health Board (Greenlane Clinical Centre) for facilitating data collection. The authors would also like to acknowledge and thank the New Zealand and Saudi participants for their participation in this study.
None declared.