Adherence-based experiences with a personalized self-care program for type 2 diabetes in South Korea: a mixed-methods study

Purpose: This study aimed to explore the experiences of patients with type 2 diabetes (T2D) according to their adherence to a personalized self-care (PSC) program and to evaluate its effects on self-care activities and hemoglobin A1c (HbA1c) levels 18 months after baseline.Methods: A convergent mixed-methods design was employed. Qualitative interviews were conducted with 33 participants who demonstrated high adherence (adherence group, AG) and 17 participants who demonstrated low adherence (non-adherence group, NAG). Data were analyzed using Elo and Kyngäs’s content analysis approach. The program’s effects were evaluated by comparing the mean differences between pre-test and 18-month follow-up data using SPSS version 23.0.Results: Participants in the AG used the app for self-monitoring, which promoted self-reflection and improved diabetes self-care. Participants in the NAG expressed an intentions to improve but reported low motivation due to limited willpower, busy schedules, and insufficient awareness of the diabetes severity. Foot care significantly improved both within (Z = −3.98, p < .001) and between groups (t = −2.22, p = .031), with the most notable improvement observed in the AG. Significant improvements in general diet (t = −2.68, p = .012) and HbA1c levels (Z = −2.93, p = .003) were observed only in the AG.Conclusion: The finding suggested that PSC program enhanced diabetes self-care activities, particularly in the areas of general diet, foot care, and HbA1c control. To enhance self-care adherence among individuals with T2D, mobile apps should offer goal setting, progress tracking, simplified data entry, and reminders.