Journal of medical Internet research
Evaluation of a Clinical Protocol-Guided Chatbot to Support Telecarers in Diabetes Management: Embedded Mixed Methods Study
By Ong RHS, Oh HC, Choo BP and 22 others.
Abstract
Background
Type 2 diabetes mellitus (T2DM) is a chronic condition that requires ongoing self-management. While chatbots offer scalable monitoring and management, evidence on their integration into structured hospital tele-support workflows, where patient engagement and digital readiness may differ from those in standalone digital interventions, remains limited.
Objective
This study aimed to describe the design of a clinical protocol-guided chatbot, Sharing Information with Users on Diabetes Actions and Interventions (Siu Dai), and evaluate its feasibility, usability, and acceptability among patients and telecarers within a hospital tele-support program.
Methods
We used an embedded mixed methods design (QUAL [quan]) guided by the World Health Organization (WHO) monitoring and evaluating digital health interventions and the theoretical framework of acceptability. Through a co-design process involving clinicians, researchers, telecarers, and developers, the chatbot was aligned with established clinical protocols. It featured 7 precall sessions designed to collect patient data, generate summary reports for staff, and deliver targeted educational content. Patients (≥21-year-old individuals with T2DM) and telecarer nurses (with experience ≥6 mo) were recruited from an existing tele-support program. Data sources included interviews, online surveys (5-point Likert scale), and chatbot usage logs. Qualitative data were analyzed thematically; quantitative data were summarized descriptively to supplement and contextualize the qualitative findings.