Effects of an e-Coach Program on the Knowledge, Attitude, and Practice of Patients Self-administering Their First Insulin Injection: Quasi-Experimental Study.

Background: The current level of insulin knowledge, attitudes, and practices of patients self-administering their first insulin injection needs to be improved. There is an emerging need to develop a program for patients self-administering their first insulin injection based on the e-coach model derived from the temporal self-regulation theory. Objective: This study aimed to examine the effectiveness of a temporal self-regulation theory-based e-coach program on the knowledge, attitude, and practice of patients self-administering their first insulin injection. Methods: A quasi-experimental research design was used, and the study adhered to the Transparent Reporting of Evaluations with Nonrandomized Designs statement. The study was developed and evaluated in a level IIIA hospital between May 1 and December 1, 2022, in Suzhou, Jiangsu Province, China. The control group received care as usual. The intervention group received a self-regulation program called the e-coach program: the "COACHING" implementation steps. The insulin attitude scores and insulin knowledge-practice scores were compared using repeated-measures ANOVA. In particular, given that baseline blood glucose monitoring frequency differed significantly between the 2 groups, thereby compromising their comparability, a repeated-measures analysis of covariance (ANCOVA) was performed, with monitoring frequency entered as a covariate. This approach was adopted to enhance the scientific rigor of the findings and reduce potential bias. Results: In total, 86 patients were enrolled; of these, 75 patients were followed up, 40 in the experimental group and 35 in the control group. Repeated-measures ANOVA results revealed statistically significant between-group effects (F1,73=47.67, P<.001), time effects (F2,146=5.02, P=.02), and interaction effects (F2,146=4.75, P=.03) for total insulin knowledge scores in both groups. In both groups, statistically significant between-group effects (F1,73=16.04, P<.001) and interaction effects (F2,146=12.52, P<.001) were observed for total insulin attitude scores, but time effects (F2,146=2.47, P=.11) were not statistically significant. In both groups, statistically significant between-group effects (F1,73=0.66, P=.004) were observed for total insulin practice scores, but time effects (F2,146=1.05, P=.35) and interaction effects (F2,146=2.82, P=.08) were not statistically significant. Conclusions: The e-coach program based on the TST was effective in improving insulin knowledge and insulin attitude but was not proven effective for insulin practice. A longer follow-up study is needed to uncover its long-term benefits on clinical outcomes.