e-Health for Diabetes Self Management in Saudi Arabia: Barriers and Solutions (Preprint)

Abstract

<sec> <title>BACKGROUND</title> U.S. National Centre for Health Statistics defines chronic disease as any disease which lasts long, typically over three months or more (Shiel Jr, 2018). Chronic diseases long term care consisting of multiple approaches. This makes many chronic diseases amenable to self-management. One such chronic disease is diabetes. Shrivastava, Shrivastava, and Ramasamy (2013) described Diabetes or more precisely, Diabetes mellitus (DM) as “a chronic progressive metabolic disorder characterized by hyper-glycemia mainly due to absolute (Type 1 DM) or relative (Type 2 DM) deficiency of insulin hormone. “The authors prescribe seven essential components of self-management of diabetes. These include healthy eating, being physically active, monitoring of blood sugar, compliance with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviours. Clearly, all these practices may not be absolutely essential for all patients all times. Some of them may be more critical than others like closer monitoring of blood sugar when the person already has high level of blood sugar. To what extent the diabetes patients follow these seven practices and in what contexts is an important aspect. e-health is variously defined in various sources. Eysenbach (2001) defined the term as, “e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.” The relevance of self-management of diabetes in Saudi Arabia arises from the fact that it is a serious demographic threat to the country. In a recent review, Abdulaziz Al Dawish, et al. (2016) cited WHO to establish that Saudi Arabia tops Middle East and is seventh in the world regarding the population affected by diabetes. Out of 7 million population, 3 million have been affected by diabetes. The rate of increase in diabetes had also been very high reaching epidemic levels. An article by Jennifer Bell in Arab News (2019) cited Colliers International, which estimates 17.9% of Saudi population affected by diabetes. In addition, about 35.4% of Saudi population is obese, which is a predisposing factor for diabetes. Translated into numbers, Saudi population in 2019 is 34.1 million and 17.9% of this will be about 6 million diabetic population and 12 million obese. Thus, Saudi Arabia needs to focus on about 20 million of its population. The Saudi Vision 2030 has targets to achieve fitness and sports participation of youth by 25%. This strategy will reduce diabetes problem also. Clearly, apart from hospital visits, these patients need to be trained to manage their diabetes problem themselves. The seven elements of diabetes self-management prescribed by Srivastava et al (2013) listed above are relevant here. The usefulness of self-management in producing positive outcomes for diabetic patients in Saudi Arabia was demonstrated by AlShareef, AlMaarik, AlGarni, AlGhamdi, and AlMutairi (2017) through a survey. However, another survey by Saad, et al. (2018) showed that only foot care and medication self-management were practised by the majority of diabetic patients. Diet control, exercise and blood glucose monitoring were not being done as a part of self-management by most of them. Since these were the factors which enhanced self-efficacy, it was low in the surveyed population. Low level of self-management practices except medication was also reported by Al Johani, Kendall, and Snider (2015) from their survey. In a review of research on self-management of diabetes in GCC countries, Al Slamah, Nicholl, Alslail, and Melville (2017) menti