Android application for type 2 diabetes mellitus

Abstract

The purpose of this study is to develop an interactive service for people with DM and design a product specifically for the Android operating system. This study employs a research and development (R&D) design. The research phase consisted of a situation analysis, data collection, product design, expert validation, product revision, product tryout, and final revision. The research instrument was a questionnaire. Data analysis involved descriptive quantitative in percentage form. The results of the validation from the Android application experts, which focused on display quality, technical concerns, audio, and video quality, were found at 93.75% (very acceptable). In addition, the results of the validity assessment from the material experts, including general health experts and nutritionists, reached 98.08% (very acceptable) and 86.54% (very feasible), respectively. Based on the results of expert validation, the application design is categorized as very acceptable for development as a DM interactive service product.

Introduction

The prevalence rate of diabetes mellitus (DM) has increased every year. Based on data from the International Diabetes Federation (IDF), it appeared that in 2013 there were 382 million people living with a DM diagnosis and it was predicted that it would increase to 592 million residents by 2035.¹ The increase was also evidenced by the results of Basic Health Research (RISKESDAS), indicating that DM patients had doubled since 2007.² The Ministry of Health predicts that DM patients in Indonesia will reach 21.3 million people by 2030. The increasing prevalence rate creates a burden on the health sector in Indonesia because it is feared that it will result in complications and cause other diseases such as cardiovascular and cerebral vascular disease, neuropathy and nephropathy.³ However, when it is diagnosed, the disease has already transformed into complications.⁴ In 2013, a total of 175 million people of the 382 million people with DM in the world were not diagnosed beforehand.⁵ In Indonesia in the same year, there were around 1 million people over 15 years of age, 0.6% of the population, who felt the symptoms of DM, but had no confirmation of whether or not they suffered from DM.¹

Currently, early detection technology suitable for the Android operating system on cellular phones has been developed and is expected to help the public to identify the risk of DM.⁶ The application still has limitations, which include a non-interactive interface and the absence of feedback from health consultants in IT management. Therefore, it is necessary to increase the application of Android products for DM disease services to further the measures made in previous research. The purpose of this study is to develop an interactive service product designed for people with DM suitable for the Android operating system.

Method

Design

This study applied research and development design. This method was divided into two major parts, namely product design and tryout of the android operating system. The procedure of this study adapted the development model of Sugiyono with modifications.⁷

Population and study setting

Product try-out was carried out at Janti Health Center in Malang City in June 2019 and took 10 people for small group try-out and 30 people were involved for large group try-out. The inclusion criteria for determining subjects were visitors who did not suffer from type 2 DM, aged 45–55 years old, male or female, and willing to become part of a research sample by signing an informed consent document. The exclusion criteria were suffering from all types of DM (small group), patients diagnosed with type 2 DM accompanied by other diseases (large group), and not able to read and/or write.

Data collection

Questionnaire were used to collecting data on validation process and product testing. The measurement scale used on validation process was the Likert scale.

Data analysis

Assessment by experts was adjusted to the numbers considered appropriate (4 = very appropriate; 3 = appropriate; 2 = hardly appropriate; 1 = inappropriate). The results of the subsequent assessment were analyzed using a simple quantitative descriptive analysis, which is the percentage calculation (76–100% = very appropriate; 51–75% = appropriate; 26–50% = fairly appropriate; 0–25% = inappropriate)

The technique of analyzing product try-out data employed simple descriptive data analysis involving percentage. The value obtained from each indicator, namely the sum of the values of each indicator, was divided by the maximum number and multiplied by 100%. The formula applied in the analysis can be seen in Fig. 1.

Figure 1.

Simple descriptive data analysis formula.

Furthermore, indicated in the form of percentage, the user response results are classified into the following levels (85% ≥ response very positive; 70% ≤ response < 85% = positive; 50% ≤ response < 70% = hardly positive; Response < 50% = negative).

Ethical aspects

The study was approved by Local Ethics Committees at Universitas Brawijaya Malang, Indonesia.

Results

Validation results by media experts

The percentage of media experts’ assessments on product design was found to be 93.75%, which was categorized as very acceptable to be developed as an interactive service product based on the Android operating system for DM patients. The results of the media expert's assessment can be seen in Table 1.

Table 1.

The validation by media experts.

No	Aspects	Indicators	Score
1	Interface Quality	Use of buttons	4
2		Application interface	4
3		Choice of fonts	4
4		Choice of colors	4
5		Conformity between font design and media	4
6		Image selection	3
7		Practical menu choices	4
8	Technical Quality	The ease of menu operation	4
9		Menu clarity	4
10		The clarity of menu hierarchy	4
11		The Ease of operating the menu	4
12		The clarity of menu information	4
13	Audio quality	Sound quality	3
14		Voice reception speed	3
15	Video quality	Image quality in video	4
16		Video reception speed	4

Validation results by material experts

The percentage of general health experts’ assessments of product design was 98.08%, categorized as very acceptable to be developed as an interactive service product based on the Android operating system for DM patients. The assessment results can be seen in Table 2.

Table 2.

The validation by general health experts.

No	Aspects	Indicators	Score
1	Material presentation	Suitability of information for users	4
2		Language compatibility	4
3		Material organization	4
4		Linkages between materials	4
5		Data storage	4
6		Confidentiality of user's data	4
7		Appropriate expert data with menus	4
8	Usage	The ease of use for experts	4
9		The ease of registration for experts	4
10		The practicality of the conditions proposed for experts	4
11		The practicality of chat menus for experts	4
12		The practicality of the video menu for experts	3
13		The Ease of operating menus for experts	4

The percentage of nutritionists’ assessment reached 86.54%. This was categorized as very acceptable to be developed as an Android application with an interactive service product for DM patients. Assessment performed by the nutritionists can be seen in Table 3.

Table 3.

The Validation by Nutritionists.

No	Aspects	Indicators	Score
1	Material presentation	Suitability of information for users	4
2		Language compatibility	4
3		Material organization	3
4		Linkages between materials	4
5		Data storage	3
6		Confidentiality of user's data	3
7		Appropriate expert data with menus	3
8	Usage	The ease of use for experts	4
9		The ease of registration for experts	4
10		The practicality of the conditions proposed for experts	4
11		The practicality of chat menus for experts	3
12		The practicality of the video menu for experts	3
13		The ease of operating menus for experts	3

Discussion

The current concept of digital health is beginning to evolve.⁸ About 50,000 health-related applications are available on mobile devices.⁹ One of them is digital innovation for early detection of DM which can be done using several different methods and various tests of risk factors, such as Android-based early detection.¹⁰ Before the development of an Android-based application, the American Diabetes Association (ADA) developed an online calculator to find out how much risk someone has, where DM risk calculation is measured through a few simple questions, investigating the risk seen from accumulated points generated by the user's answers.¹¹

This study developing an interactive service based on an Android operating system has gone through fairly lengthy stages ranging from product design, validation, and product revision. This is because high standard validations are needed to ensure product quality. As such, the quality of the application can satisfy expected usage and accuracy and provide the right information to users.¹² In addition, the validation process aims to ensure that the products developed can meet the intended use of the product.⁸

This application is proven to reach a validity score of 93.75% from media experts. A person's interest in the media can be seen from the design, color, letters, and content or message of the information contained.¹³ Fijacko et al. also argues that health application developers must pay special attention to application design such as visualization, font size, and button size.¹⁰ The application's interface is an important point that is closely related to the concept of delivering messages to users, according to Arsyad, a combination of elements that function together can facilitate the delivery of messages to users.⁶

By contrast, on the technical quality aspect, media experts were asked to assess the product based on the ease of use of the menu, menu clarity in use, ease of understanding the menu hierarchy, ease of menu operation, and clarity of information in the menu. The study conducted by Teo et al. reports that users of the health screening application want applications that are easy to use, operational, and offer social connectivity.¹⁴

Audio indicators assessed by media experts are sound quality and speed of sound reception, while the image quality in video and video reception speed are indicators of assessment in the video aspect. In addition to text, the application should present images and videos so that health messages are easily conveyed to users.¹⁴ Videos facilitate the reception of information through the involvement of the user's sense of sight and hearing to receive and process information so that it will be more easily stored in their memory.⁷

A health product must involve experts to carry out validation, inasmuch as it aims to compare products with health care standards germane to prevention, detection, and management.⁸ The development of this product received a general health expert's assessment of 98.08% and a nutritionist's assessment at 86.54%. Moreover, the material expert assessed the product from two aspects, namely the presentation of material and use. The material presentation aspect consists of several indicators, namely the suitability of information, the suitability of language, material organization, the interrelationship between the material, data storage, the confidentiality of user data, and the suitability of expert data with the menu. Applications on smartphones provide an opportunity for someone to assess the risk of the DM disease and learn how to reduce the risks.¹⁰ A health application must be reliable and can store personal information, as well as the user's medical history safely.¹⁴ Language is one that must be considered in developing health products, because language is a significant predictor in delivering health messages.¹⁵ Therefore, the application should offer choices of language as desired by the user.¹⁴

The Android application has many advantages, including an attractive appearance and user-friendly features. The purpose of developing the application is to provide accessible public health facilities.⁹ Today's smartphone development is very fast and its use has spread rapidly.¹⁶ This application is developed for the Android operating system because the system is considered to have more significant results than the iOS system, particularly due to the number of users.¹⁷ The application must contain up-to-date information from credible sources such as government or professional agencies.¹⁴ Therefore, the application for early detection of DM is equipped with a consultation menu where users can conduct two-way communication with experts through the chat feature. The chat feature in the mobile health application, can also support the prevention of type 2 DM through healthier lifestyles and more attention to the prevention of DM complications.¹⁸ Developing such an application is deemed substantially helpful in maintaining health and also training someone to live independently, especially for people who live in rural areas who have limited costs for conducting health screening.⁹

Conclusion

As a conclusion from this stage-1 study, the design of an interactive service product based on the Android operating system for DM patients is proven highly acceptable to develop as a product. Stage-2 research can be carried out, namely product testing, on targeted subjects with a wider scope.

Conflict of interest

The authors declare no conflict of interest.