PENGEMBANGAN MOBILE HEALTH APPLICATION PADA SKRINING DAN INTERVENSI DINI PASIEN PREDIABETES DI FASILITAS KESEHATAN TINGKAT PRIMER

Yaltafit Abror Jeem, Prof.dr.Hari Kusnanto Josef.S.U., Dr.PH.; dr. Lutfan Lazuardi M. Kes Ph.D

2022 | Disertasi | S3 Kedokteran Umum

Latar Belakang: Skrining dan intervensi dini pasien prediabetes adalah langkah efektif dalam pencegahan diabetes melitus tipe 2 (DM tipe 2). Sampai saat ini, skrining dan intervensi dini prediabetes di fasilitas kesehatan tingkat primer masih belum optimal. Pemanfaatan teknologi menjadi salah satu peluang dalam kendali mutu dan biaya. Mobile health application yang valid, praktis dan mudah diaplikasikan oleh pasien dan tenaga kesehatan dalam upaya skrining dan intervensi dini pasien prediabetes di fasilitas kesehatan tingkat primer sangat layak untuk diteliti dan diwujudkan.

Tujuan: Mengembangkan mobile health application pada skrining dan intervensi dini pasien prediabetes yang sesuai di fasilitas kesehatan tingkat primer.

Metode: Penelitian ini adalah penelitian (mixed methods) metode campuran dengan pendekatan exploratory sequential. Penelitian diawali dengan action research untuk penggalian data mengenai kebutuhan dalam pengembangan mobile health application pada skrining dan intervensi dini prediabetes di FKTP. Kemudian diikuti dengan Randomized Control Trial (RCT) untuk mengetahui pengaruh penggunaan mobile health application pada skrining dan intervensi dini pasien prediabetes. 

Hasil: Prototipe mobile health application dibuat berdasarkan analisis data kebutuhan dan usulan pasien dan tenaga kesehatan. Prototipe dinamakan SI-GAP (Skrining dan Intervensi Dini Gencarkan Aksi pencegahan Prediabetes). Mobile health application berbasis website dan android. Total 637 responden mengikuti skrining dengan (254 mobile health application dan 383 non mobile health application) dan 182 responden bersedia melanjutkan untuk intervensi dini. Terdapat 273 (50.83%) dari 537 responden yang dianalisis terdiagnosis prediabetes. Nilai AUC kuesioner ADA dengan modifikasi adalah 62 %. Nilai diagnositik dari kuesioner tersebut adalah sensitivitas 82.42 %, spesifisitas 31.44 %, nilai duga positif 55.42 %, nilai duga negatif 63.36%,   rasio kemungkinan positif (RK +) 1.20, rasio kemungkinan negatif (RK-) 0,56, akurasi sebesar 57.36 ?n Pre-test Probability  51 %. Terdapat perbedaan kadar HbA1c dan GDP antara kelompok intervensi dengan non intervensi. Tidak terdapat perbedaan kadar TTGO, berat badan, dan lingkar perut kelompok intervensi dengan non intervensi. Terdapat pengaruh secara simultan konstruk guna (kegunaan) dan konstruk mudah (kemudahan) terhadap minat penggunaan mobile health application. 

Simpulan: Mobile health application dapat digunakan sebagai alat skrining dan intervensi dini prediabetes yang sesuai di fasilitas kesehatan tingkat primer. Diperlukan adanya pelatihan dan kolaborasi berkesinambungan antara tenaga kesehatan, pasien dan keluarga dalam proses skrining dan intervensi dini prediabetes. 

Background: Screening and early intervention of prediabetes patients is an effective step in the prevention of type 2 diabetes mellitus (DM type 2). Until now, screening and early intervention for prediabetes in primary health facilities have not been optimal. Utilization of technology is one of the opportunities for quality and cost control. It is very feasible to research and implement a mobile health application that is valid, practical, and easy to use by patients and health workers in screening and early intervention for prediabetes patients in primary health facilities is very feasible to be researched and realized.

Objective: To develop a mobile health application for the appropriate screening and early intervention of prediabetes patients in primary health facilities.

Method: This was a mixed-method study using an exploratory sequential approach. The study began with action research to collect data regarding the need for mobile health application development for screening and early intervention for prediabetes in FKTP. This was followed by a Randomized Control Trial (RCT) to determine the effect of using a mobile health application on screening and early intervention in prediabetes patients. 

Result: The prototype of the mobile health application was made based on data analysis of the needs and suggestions of patients and health workers. The prototype is called SI-GAP (Early Screening and Intervention to Intensify Prediabetes Prevention Action). Mobile health application based on a website and Android. A total of 637 respondents participated in the screening (254 mobile health applications and 383 non-mobile health applications), and 182 respondents were willing to continue for early intervention. There were 273 (50.83%) of the 537 respondents who were analyzed as having prediabetes. The AUC value of the ADA questionnaire with modifications was 62%. The diagnostic value of the questionnaire is sensitivity of 82.42%, specificity of 31.44%, positive predictive value of 55.42%, negative predictive value of 63.36%, positive likelihood ratio (RK +) 1.20, negative probability ratio (RK-) 0.56, accuracy of 57.36%, and pre-test probability of 51%. There were differences in HbA1c and GDP levels between the intervention and non-intervention groups. There was no difference in OGTT levels, body weight, o waist circumference between the intervention and non-intervention groups. There was a simultaneous effect of constructs of use (usability) and easy constructs (convenience) on interest in using mobile health applications.

Conclusion: Mobile health applications can be used as an appropriate screening tool and early intervention for prediabetes in primary health facilities. There is a need for continuous training and collaboration between health workers, patients, and families in the process of screening and early intervention for prediabetes.

Kata Kunci : Prediabetes, Skrining, Intervensi Dini, Mobile Health Application, Self care, Dokter Layanan Primer, Fasilitas Kesehatan Tingkat Primer