Background Intervention based on family support and risk perception can enhance type 2 diabetes mellitus (T2DM) patients’ self-care activities. In addition, eHealth education is considered to improve family members’ support for patients with T2DM. However, there is little evidence from rigorously designed studies on the effectiveness of an intervention combining these approaches. Objective This randomized controlled trial (RCT) aimed to assess the effectiveness of an eHealth family-based health education intervention for patients with T2DM to improve their glucose control, risk perception, and self-care behaviors. Methods This single-center, 2-parallel-group RCT was conducted between 2019 and 2020. Overall, 228 patients were recruited from Jiading District, Shanghai, and randomly divided into intervention and control groups. The intervention group received an eHealth family intervention based on community management via WeChat, whereas the control group received usual care. The primary outcome was the glycated hemoglobin (HbA1c) level of the patients with T2DM, and the secondary outcomes were self-management behavior (general and specific diet, exercise, blood sugar testing, foot care, and smoking), risk perception (risk knowledge, personal control, worry, optimism bias, and personal risk), and family support (supportive and nonsupportive behaviors). A 2-tailed paired-sample t test was used to compare the participants at baseline and follow-up within the control and intervention groups. An analysis of covariance was used to measure the intervention effect. Results In total, 225 patients with T2DM were followed up for 1 year. After intervention, they had significantly lower HbA1c values (β=–.69, 95% CI –0.99 to –0.39; P<.001). They also had improved general diet (β=.60, 95% CI 0.20 to 1.00; P=.003), special diet (β=.71, 95% CI 0.34 to 1.09; P<.001), blood sugar testing (β=.50, 95% CI 0.02 to 0.98; P=.04), foot care (β=1.82, 95% CI 1.23 to 2.42; P<.001), risk knowledge (β=.89, 95% CI 0.55 to 1.24; P<.001), personal control (β=.22, 95% CI 0.12 to 0.32; P<.001), worry (β=.24, 95% CI 0.10 to 0.39; P=.001), optimism bias (β=.26, 95% CI 0.09 to 0.43; P=.003), and supportive behaviors (β=5.52, 95% CI 4.03 to 7.01; P<.001). Conclusions The eHealth family-based intervention improved glucose control and self-care activities among patients with T2DM by aiding the implementation of interventions to improve T2DM risk perceptions among family members. The intervention is generalizable for patients with T2DM using health management systems in community health centers. Trial Registration Chinese Clinical Trial Registry ChiCTR1900020736; https://www.chictr.org.cn/showprojen.aspx?proj=31214

Aims and objectivesTo examine the combined effects of the patient’s and family members’ knowledge, attitudes and perceived family support on self-monitoring of blood glucose (SMBG) behaviour of patients with type 2 diabetes.DesignA cross-sectional design using the framework of knowledge–attitude–behaviour (KAB) combined with family support.SettingShanghai, China.ParticipantsSeventy type 2 diabetes patient–family member dyads recruited from 26 residential committees in Shanghai were investigated. Twenty-three health providers were interviewed.Primary outcome measuresThe knowledge, attitudes and perceived family support of patients’ and their family members’ data were measured through scales. Combined effects were analysed by a fuzzy-set qualitative comparative analysis (fsQCA) using fsQCA V.3.0. Other analyses and calculations were performed by STATA V.14.0.ResultsSMBG was very poor (20%), and behaviour was characterised by ‘multiple complications,’ and ‘all paths lead to the same destination’ for patients. There were two solution paths toward patients’ SMBG (solution coverage=0.4239, solution consistency=0.7604). One path was the combination of ‘patients with low risk perception, the patients’ and family members’ perceived negative support’, the other was the combination of ‘patients with high risk perception, the patients’ perceived negative support’. In both paths, basic knowledge serves as an auxiliary condition.ConclusionThe study revealed that for patients with high and low risk perceptions that are relatively difficult to change, we could strengthen family support to achieve the desired SMBG behaviour. Knowledge is not a prerequisite to achieving SMBG. Moreover, negative family support plays a crucial role. Perceived family support by patients is more important than perceived family support by family members, which suggests that family members should improve support for patients so that the patients can perceive more family support.

BACKGROUND Intervention based on family support and risk perception can enhance type 2 diabetes mellitus (T2DM) patients’ self-care activities. In addition, eHealth education is considered to improve family members’ support for patients with T2DM. However, there is little evidence from rigorously designed studies on the effectiveness of an intervention combining these approaches. OBJECTIVE This randomized controlled trial (RCT) aimed to assess the effectiveness of an eHealth family-based health education intervention for patients with T2DM to improve their glucose control, risk perception, and self-care behaviors. METHODS This single-center, 2-parallel-group RCT was conducted between 2019 and 2020. Overall, 228 patients were recruited from Jiading District, Shanghai, and randomly divided into intervention and control groups. The intervention group received an eHealth family intervention based on community management via WeChat, whereas the control group received usual care. The primary outcome was the glycated hemoglobin (HbA_1c) level of the patients with T2DM, and the secondary outcomes were self-management behavior (general and specific diet, exercise, blood sugar testing, foot care, and smoking), risk perception (risk knowledge, personal control, worry, optimism bias, and personal risk), and family support (supportive and nonsupportive behaviors). A 2-tailed paired-sample <i>t</i> test was used to compare the participants at baseline and follow-up within the control and intervention groups. An analysis of covariance was used to measure the intervention effect. RESULTS In total, 225 patients with T2DM were followed up for 1 year. After intervention, they had significantly lower HbA_1c values (β=–.69, 95% CI –0.99 to –0.39; <i>P</i>&lt;.001). They also had improved general diet (β=.60, 95% CI 0.20 to 1.00; <i>P</i>=.003), special diet (β=.71, 95% CI 0.34 to 1.09; <i>P</i>&lt;.001), blood sugar testing (β=.50, 95% CI 0.02 to 0.98; <i>P</i>=.04), foot care (β=1.82, 95% CI 1.23 to 2.42; <i>P</i>&lt;.001), risk knowledge (β=.89, 95% CI 0.55 to 1.24; <i>P</i>&lt;.001), personal control (β=.22, 95% CI 0.12 to 0.32; <i>P</i>&lt;.001), worry (β=.24, 95% CI 0.10 to 0.39; <i>P</i>=.001), optimism bias (β=.26, 95% CI 0.09 to 0.43; <i>P</i>=.003), and supportive behaviors (β=5.52, 95% CI 4.03 to 7.01; <i>P</i>&lt;.001). CONCLUSIONS The eHealth family-based intervention improved glucose control and self-care activities among patients with T2DM by aiding the implementation of interventions to improve T2DM risk perceptions among family members. The intervention is generalizable for patients with T2DM using health management systems in community health centers. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR1900020736; https://www.chictr.org.cn/showprojen.aspx?proj=31214