Peunajoh.id as a Media for Strengthening Knowledge of Type 2 Diabetes Mellitus Diet Based on Embodied Conversational Agents

Authors

  • Rizki Andriani STIKes, Medika Seramoe Barat, Indonesia
  • Aghnia Kamila RSUD Dr. Zainoel Abidin Aceh, Indonesia
  • Yulfa Aulia STIKes, Medika Seramoe Barat, Indonesia
  • Harwalis Harwalis STIKes, Medika Seramoe Barat, Indonesia
  • Novi Afrianti Departemen Keperawatan Medikal Bedah, Fakultas Keperawatan, Universitas Syiah Kuala, Indonesia

DOI:

https://doi.org/10.58774/jourkep.v4i1.109

Keywords:

Diabetes Mellitus, Diet, Dietary Knowledge, Embodied Conversational Agent, T2DM

Abstract

Background: Adherence to the recommended dietary patterns for individuals with Type 2 Diabetes Mellitus (T2DM) is a major challenge in effectively managing the disease. One reason is the varying levels of knowledge among T2DM patients regarding appropriate dietary patterns. Limited knowledge makes it difficult for patients to understand appropriate eating patterns, impacting the effectiveness of diet management. As an educational digital media, the Embodied Conversational Agent (ECA) has proven effective in improving patient knowledge and adherence to T2DM management.

Purpose: Developing and evaluating the feasibility of peunajoh.id as an ECA-based application designed to strengthen knowledge of the DMT2 diet.

Methods: This study used a Research and Development (R&D) design with the Borg & Gall development model. Validation was conducted by 3 material experts and 3 media experts, followed by an initial trial on 15 T2DM patients in the prolanis community to assess the content's understandability and ease of use of the application, and an operational test on 45 T2DM outpatients to test the effectiveness of the widespread use of ECA media in a regional hospital. Data were analyzed using the Content Validity Index (CVI) to assess the appropriateness of the content and the percentage of user satisfaction with the use of ECA media in dietary education for T2DM patients.

Results: Expert validation yielded an average I-CVI of 0.88 (material) and 0.83 (media). The results exceeded the ideal feasibility limit of ≥ 0.78, indicating that the material and media display had high relevance. Operational test results showed an average user satisfaction of 92%, with aspects of ease of navigation at 33.7%, ease of application use at 33.3%, and interaction with virtual agents at 33%.

Conclusion: Peunajoh.id is an interesting application and is suitable for use as a diet education digital media for T2DM patients through the results of an average user satisfaction level reaching 92%.

Downloads

Download data is not yet available.

References

Abate, T. W., Tareke, M., Abate, S., Tegenaw, A., Birhanu, M., Yirga, A., Tirfie, M., Genanew, A., Gedamu, H. & Ayalew, E. (2022) “Level of dietary adherence and determinants among type 2 diabetes population in Ethiopian: A systemic review with meta-analysis”, PLoS ONE, 17(10). https://doi.org/10.1371/JOURNAL.PONE.0271378

American Diabetes Association. (2024) “Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024”, Diabetes Care, 47(1), pp. 111–125. https://doi.org/10.2337/DC24-S006

Arikunto, S. (2018) “Dasar-Dasar Evaluasi Pendidikan Edisi 3. In Restu Damayanti (Ed.), Dasar-Dasar Evaluasi Pendidikan” Jakarta: PT. Bumi Aksara. https://books.google.com/books/about/Dasar_Dasar_Evaluasi_Pendidikan_Edisi_3.html?id=j5EmEAAAQBAJ

Badan Kebijakan Pembangunan Kesehatan Republik Indonesia. (2023). Survei Kesehatan Indonesia (2023) Dalam Angka: Data Akurat Kebijakan Tepat. https://layanandata.kemkes.go.id/katalog-data/ski/ketersediaan-data/ski-2023

Balsa, J., Félix, I., Cláudio, A. P., Carmo, M. B., Silva, I. C. e., Guerreiro, A., Guedes, M., Henriques, A. & Guerreiro, M. P. (2020) “Usability of an Intelligent Virtual Assistant for Promoting Behavior Change and Self-Care in Older People with Type 2 Diabetes”, Journal of Medical Systems, 44(7), pp. 1–12. https://doi.org/10.1007/S10916-020-01583-W/TABLES/4

Bano, A., Afzal, M., Sarwar, H., Waqas, A., Kousar, S., & Gulzar, S. (2017) “Dietary knowledge, Attitude and Practices of Diabetes Patients at Services Hospital Lahore”, International Journal of Applied Sciences and Biotechnology, 5(2), pp. 227–236. https://doi.org/10.3126/IJASBT.V5I2.17625

Baptista, S., Trawley, S., Pouwer, F., Oldenburg, B., Wadley, G. & Speight, J. (2019) “What Do Adults with Type 2 Diabetes Want from the “Perfect” App? Results from the Second Diabetes MILES: Australia (MILES-2) Study”, Diabetes Technology & Therapeutics, 21(7), pp. 393–399. https://doi.org/10.1089/DIA.2019.0086

Baptista, S., Wadley, G., Bird, D., Oldenburg, B., & Speight, J. (2020) “Acceptability of an Embodied Conversational Agent for Type 2 Diabetes Self-Management Education and Support via a Smartphone App: Mixed Methods Study”, JMIR MHealth and UHealth, 8(7). https://doi.org/10.2196/17038

Bickmore, T., Gruber, A., & Picard, R. (2005) “Establishing the computer-patient working alliance in automated health behavior change interventions”, Patient Education and Counseling, 59(1), pp. 21–30. https://doi.org/10.1016/J.PEC.2004.09.008

Borg, W. R., & Gall, M. D. (1983). Educational research : an introduction / Walter R. Borg, Meredith Damien Gall. 936. https://books.google.com/books/about/Educational_Research.html?hl=id&id=KcE0AAAAMAAJ

Bross, R., Genter, P., Lu, Y., Serpas, L., Campa, D. & Ipp, E. (2021) “Barriers to Healthy Eating and Diabetes Diet Education: Divergent Perspectives of Patients and Their Providers”, Health Educ Behav, 49(4), pp. 658–666. https://doi.org/10.1177/10901981211052241

Chatterjee, S., Davies, M. J., Heller, S., Speight, J., Snoek, F. J. & Khunti, K. (2018). Diabetes structured self-management education programmes: a narrative review and current innovations”, The Lancet. Diabetes & Endocrinology, 6(2), pp. 130–142. https://doi.org/10.1016/S2213-8587(17)30239-5

Cradock, K. A., ÓLaighin, G., Finucane, F. M., Gainforth, H. L., Quinlan, L. R. & Ginis, K. A. M. (2017) “Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: A systematic review and meta-analysis”, The International Journal of Behavioral Nutrition and Physical Activity, 14(1). https://doi.org/10.1186/S12966-016-0436-0

Doupis, J., Festas, G., Tsilivigos, C., Efthymiou, V. & Kokkinos, A. (2020) “Smartphone-Based Technology in Diabetes Management”, Diabetes Therapy, 11(3), pp. 607. https://doi.org/10.1007/S13300-020-00768-3

Effendi, H., & Hendriyani, Y. (2020) “The Conceptual and Hypothetical Model of Interactive Blended Problem Based Learning”, JPI (Jurnal Pendidikan Indonesia), 8(2), pp. 285. https://doi.org/10.23887/JPI-UNDIKSHA.V8I2.24162

Fan, W. (2017) “Epidemiology in diabetes mellitus and cardiovascular disease”, Cardiovascular Endocrinology, 6(1), pp. 8–16. https://doi.org/10.1097/XCE.0000000000000116

Fleming, G. A., Petrie, J. R., Bergenstal, R. M., Holl, R. W., Peters, A. L. & Heinemann, L. (2020) “Diabetes digital app technology: benefits, challenges, and recommendations. A consensus report by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) Diabetes Technology Working Group”, Diabetologia, 63(2), pp. 229–241. https://doi.org/10.1007/S00125-019-05034-1/TABLES/1

Gaffney, H., Mansell, W. & Tai, S. (2019) “Conversational Agents in the Treatment of Mental Health Problems: Mixed-Method Systematic Review”, JMIR Ment Health 6(10). https://doi.org/10.2196/14166

Goni, M. D., Naing, N. N., Hasan, H., Wan-Arfah, N., Deris, Z. Z., Arifin, W. N., Baaba, A. A., Adam, B. M. & Arshad, M. R. (2021) “Effectiveness of a Novel Smartphone Health Education Intervention in Enhancing Knowledge, Attitudes, and Practices for the Prevention of Respiratory Tract Infections Among Private Hajj Pilgrims From Malaysia”, Frontiers in Public Health, 9(1). https://doi.org/10.3389/FPUBH.2021.594204/BIBTEX

Greenwood, D. A., Gee, P. M., Fatkin, K. J.,& Peeples, M. (2017) “A Systematic Review of Reviews Evaluating Technology-Enabled Diabetes Self-Management Education and Support”, Journal of Diabetes Science and Technology, 11(5), pp. 1015–1027. https://doi.org/10.1177/1932296817713506

Grekin, E. R., Beatty, J. R. & Ondersma, S. J. (2019) “Mobile Health Interventions: Exploring the Use of Common Relationship Factors”, JMIR MHealth and UHealth, 7(4), https://doi.org/10.2196/11245

Guilford, J. Paul., & Fruchter, Benjamin. (1986) “Fundamental statistics in psychology and education”,https://books.google.com/books/about/Fundamental_Statistics_in_Psychology_and.html?hl=id&id=wTOCAAAAIAAJ

International Diabetes Federation. (2021). IDF Diabetes Atlas 10th edition. In IDF. https://doi.org/10.1016/j.diabres.2013.10.013

König, L. M., Attig, C., Franke, T., & Renner, B. (2021) “Barriers to and Facilitators for Using Nutrition Apps: Systematic Review and Conceptual Framework”, JMIR Mhealth Uhealth, 9(6), Https://Mhealth.Jmir.Org/2021/6/E20037, 9(6), e20037. https://doi.org/10.2196/20037

Laranjo, L., Dunn, A. G., Tong, H. L., Kocaballi, A. B., Chen, J., Bashir, R., Surian, D., Gallego, B., Magrabi, F., Lau, A. Y. S. & Coiera, E. (2018) “Conversational agents in healthcare: a systematic review”, Journal of the American Medical Informatics Association : JAMIA, 25(9), pp. 1248–1258. https://doi.org/10.1093/JAMIA/OCY072

Lustria, M. L. A., Smith, S. A. & Hinnant, C. C. (2011) “Exploring digital divides: an examination of eHealth technology use in health information seeking, communication and personal health information management in the USA”, Health Informatics Journal, 17(3), pp. 224–243. https://doi.org/10.1177/1460458211414843

Lynn, M. R. (1986) “Determination and quantification of content validity”, Nursing Research, 35(6), pp. 382–386. https://doi.org/10.1097/00006199-198611000-00017

Martínez, M, J. (2017) “Embodied Conversational Agents for the Detection and Prevention of Suicidal Behaviour: Current Applications and Open Challenges”, Journal of Medical Systems, 41(9). https://doi.org/10.1007/S10916-017-0784-6

Nabovati, E., Rangraz Jeddi, F., Tabatabaeizadeh, S. M., Hamidi, R., & Sharif, R. (2022) “Design, development, and usability evaluation of a smartphone-based application for nutrition management in patients with type II diabetes”, Journal of Diabetes and Metabolic Disorders, 22(1), pp. 315. https://doi.org/10.1007/S40200-022-01140-X

Nguyen, T.-T., Sim, K., To, A., Kuen, Y., O’donnell, R. R., Lim, S. T., Wang, W. & Nguyen, H. D. (2021) “Designing AI-based Conversational Agent for Diabetes Care in a Multilingual Context”, https://arxiv.org/abs/2105.09490v1

Nkhom, D., Soko, C. J., Bowrin, P. & Iqbal, U. (2020) “Digital Health Interventions for Diabetes Self-Management Education/Support in Type 1 & 2 Diabetes Mellitus”, Studies in Health Technology and Informatics, 270, pp. 1263–1264. https://doi.org/10.3233/SHTI200393

Peraturan Menteri Kesehatan No. 41 Tahun 2014 Tentang Pedoman Gizi Seimbang, Pub. L. No. 41 (2014). https://peraturan.bpk.go.id/Details/119080/permenkes-no-41-tahun-2014

Perkumpulan Endokrinologi Indonesia (PERKENI). (2021) “Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia” , Jakarta: Perkeni.

Polit, D. F., & Beck, C. T. (2008) “Nursing Research: Generating and Assessing Evidence for Nursing Practice - Denise F. Polit, Cheryl Tatano Beck - Google Buku (8th ed.)”, Lippincott Williams & Wilkins. https://books.google.co.id/books?id=Ej3wstotgkQC&printsec=frontcover#v=onepage&q&f=false

Polit, D. F., Beck, C. T. & Owen, S. V. (2007) “Is the CVI an acceptable indicator of content validity? Appraisal and recommendations”, Research in Nursing & Health, 30(4), pp. 459–467. https://doi.org/10.1002/NUR.20199

Poonoosamy, J., Lopes, P., Huret, P., Dardari, R., Penfornis, A., Thomas, C. & Dardari, D. (2023) “Impact of Intensive Glycemic Treatment on Diabetes Complications—A Systematic Review”, Pharmaceutics,, 15(7), pp. 1791. https://doi.org/10.3390/PHARMACEUTICS15071791

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Hess Fischl, A., Maryniuk, M. D., Siminerio, L. & Vivian, E. (2015) “Diabetes Self-Management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics”, Journal of the Academy of Nutrition and Dietetics, 115(8), pp. 1323–1334. https://doi.org/10.1016/J.JAND.2015.05.012

Provoost, S., Lau, H. M., Ruwaard, J., & Riper, H. (2017) “Embodied Conversational Agents in Clinical Psychology: A Scoping Review”, J Med Internet Res, 19(5), https://doi.org/10.2196/JMIR.6553

Raaijmakers, L. G. M., Hamers, F. J. M., Martens, M. K., Bagchus, C., De Vries, N. K. & Kremers, S. P. J. (2013) “Perceived facilitators and barriers in diabetes care: A qualitative study among health care professionals in the Netherlands. BMC Family Practice”, 14(1), pp. 1–9. https://doi.org/10.1186/1471-2296-14-114/FIGURES/1

Rahmadani, S. (2020) “Pengembangan Aplikasi Diabetes Care Sebagai Self Care Management Dalam [Fakultas Kedokteran Universitas Sriwijaya]”. https://repository.unsri.ac.id/38018/1/RAMA_14201_04021381621059.pdf

Sami, W., Ansari, T., Butt, N. S., & Hamid, M. R. A. (2017) “Effect of diet on type 2 diabetes mellitus: A review Introduction”, International of Journal Health Sciences, 11(2), pp. 65–71. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426415/

Sari, V. R. (2019) “Pengembangan Booklet Sebagai Media Dalam Membantu Pengaturan Diet Bagi Penderita Diabetes Melitus Tipe 2” [Politeknik Negeri Jember]. https://sipora.polije.ac.id/14986/4/G42150140_Laporan%20Lengkap.pdf?utm_source=chatgpt.com

Sillice, M. A., Morokoff, P. J., Ferszt, G., Bickmore, T., Bock, B. C., Lantini, R. & Velicer, W. F. (2018) “Using Relational Agents to Promote Exercise and Sun Protection: Assessment of Participants’ Experiences With Two Interventions”., J Med Internet Res 2018;20(2):E48 https://Www.Jmir.Org/2018/2/E48, 20(2), e7640. https://doi.org/10.2196/JMIR.7640

Spronk, I., Kullen, C., Burdon, C., & O’Connor, H. (2014) “Relationship between nutrition knowledge and dietary intake”, The British Journal of Nutrition, 111(10), pp. 1713–1726. https://doi.org/10.1017/S0007114514000087

Sue Kirkman, M., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Huang, E. S., Korytkowski, M. T., Munshi, M. N., Odegard, P. S., Pratley, R. E. & Swift, C. S. (2012) “Diabetes in older adults: a consensus report”, Journal of the American Geriatrics Society, 60(12), pp. 2342–2356. https://doi.org/10.1111/JGS.12035

Ulrich, K. T., & Eppinger, S. D. (2004) “Product Design and Development, 3rd ed. Product Design and Development, 365. https://books.google.com/books/about/Product_Design_and_Development.html?id=Qju5AAAAIAAJ

Wu, Y., Zhang, J., Ge, P., Duan, T., Zhou, J., Wu, Y., Zhang, Y., Liu, S., Liu, X., Wan, E., & Sun, X. (2024) “Application of Chatbots to Help Patients Self-Manage Diabetes: Systematic Review and Meta-Analysis”, Journal of Medical Internet Research, 26, e60380. https://doi.org/10.2196/60380

Zheng, Y., Ley, S. H., & Hu, F. B. (2018) “Global aetiology and epidemiology of type 2 diabetes mellitus and its complications”, Nature Reviews. Endocrinology, 14(2), pp. 88–98. https://doi.org/10.1038/NRENDO.2017.151

Downloads

Published

2025-07-18

How to Cite

Andriani, R., Kamila, A., Aulia, Y., Harwalis, H., & Afrianti, N. (2025). Peunajoh.id as a Media for Strengthening Knowledge of Type 2 Diabetes Mellitus Diet Based on Embodied Conversational Agents. Journal Keperawatan, 4(1), 62–79. https://doi.org/10.58774/jourkep.v4i1.109

Issue

Section

Original Research