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Table of contents


ABBREVIATION AND ACRONYMS………………………………………………………………4


1.1 Background of Study…………………………………………………………………………….5

1.4 Research Questions………………………………………………………………………………8

1.5 Research Objectives………………………………………………………………………………9

1.6 Scope of Study ….……………………………………………………………………………….9

1.7 Significance of Study……………………………………………………………………………10

1.7.1 Theoretical Contribution…………………………………….………………………………..10

1.7.2 Practical Contribution………………………………………………………………………….11

LITRATURE REVIEW …………………………………………………………………………….11

Research Gaps……………………………………………………………………………………………………………..……18

3.0 BUSINESS CASE……………………………………………………………………………….19


3.2 Experimental Design and Area of study…………………………………………………………………………, 29

3.3 Study participants and study population………………………………………………………………………….29

3.4 Sampling size and methods……………………………………………………………………………………………29

3.5 Research Variables………………………………………………………………….…………..29

3.6 Data Collection…………………………………………………………………….……………29



4.2 Management Theories…………………………………………………………………………..33

4.2.1 Social Learning Theory………………………………………………………………………. 33

4.2.2 Self-Regulation Theory……………………………………………………………………….34








Diabetes is a metabolic disorder that raises blood glucose levels, leading to long-term health issues and expensive medical care. Diabetes complications are severe, result in significant human misery and disability, and have significant socio-economic implications due to early morbidity and mortality. This investigation was researched to explore the impact of the improvement of the My Sugar diabetes app in Offering Personalized Healthcare for patients with diabetes in the National Health Service in the United Kingdom. The objectives of the study were; to ascertain the influence of improvement of the My Sugar diabetes app on patients’ parental care, to investigate the influence of improvement of My Sugar diabetes app on patients’ Quality of life, and to investigate the influence of improvement of My Sugar diabetes app on diabetes patients Self-Management. The study was conducted at National Health Service in the Unit Kingdom. The study was directed by the emotional intelligence Theory, the human capital Theory, and the principal-agent leadership Theory. A descriptive research design was adopted in the study. The research utilized a stratified random sampling technique to select 36 participants. The questionnaire was used as the data collection method from the selected respondents. The information collected was analyzed descriptively through content analysis. The study concluded that Diabetes management is a full-time job for many diabetic patients. The clinicians and the app developers need to equip easily understandable and available proper tools and timely information on the My Sugar diabetic app to enable the whole process to be streamlined, thus reducing patient frustration









UK– United Kingdom

NHS– National Health Service

AI– Artificial Intelligence

FDA– Food and Drugs Administration

PCPs– Primary Care Professionals

WHO– World Health Organization

HCPs- Healthcare Personnel

APNs-Advanced Practice Nurse

CGM– Continuous Glucose Monitoring












1.1 Background of the Study


Diabetes is a chronic condition that develops with insufficient insulin. Diabetes treatment and care are becoming increasingly digitalized in the United Kingdom (UK), partly due to the National Health Service (NHS) giving diabetes higher priority. Agencies have poured billions of dollars into the study and creation of cutting-edge technology like artificial intelligence (AI) and mobile applications for people with diabetes, which have trickled into diabetic services (Anderson et al., 2016). People with diabetes rapidly benefit from technology like non-invasive blood glucose monitoring and smartphone apps (Albertson et al., 2015)

Technological advances, such as the creation of diabetic applications, are facilitating a change in diabetes management from the traditional model, which relied on a small number of current clinical measurements, to one in which people with diabetes, medical practitioners, and research scholars have direct exposure to and can exchange information at thousands of time points through the apps (Arsand et al., 2010). This has opened the way to remote diabetes control by healthcare providers and to greater self-management by persons with diabetes. Numerous functions are available in diabetes applications, including tracking blood glucose levels, activity and carb consumption, weight, and physical activity, sharing information with others or healthcare experts, social safety, messaging, and alerts. Adopting these components may improve patient adherence to dietary, exercise, and medication management regimens, leading to better outcomes for people with diabetes (Baker, 2019)

The fast expansion of healthcare technology applications presents potential benefits and challenges for primary care practitioners (PCPs), who must be familiar with regularly used diabetes apps such as the MySugar app to advise diabetic patients on using these services  (Baranyi et al., 2018) . However, there are benefits to using the application for diabetes management. The MySugar app allows Practitioners to confer about glycemic data in a way that was previously not possible, improving the standard of treatment and health results for their diabetic patients.

1.2 Artefact Improvement for Service Improvement

Despite years of reform, the health industry still remains an opaque landscape for most patients. This is due to factors like a lack of transparency and professional bodies prioritizing the welfare of their members over that of the patients. Information technology can radically change the status quo (Beck et al., 2017). In this project, the idea has been to develop a rating system that will help patients make health related decisions.

Furthermore, patients can leave comments and suggestions that institutions and health practitioners can use to serve their clients better (Chomutare et al., 2011). Not only does the system help patients in decision-making, but it will also collect information that will be invaluable to policymakers. Such information can be used in data-driven decision-making at the national level. As part of the initiative, the data will be available over an API for software developers and anyone needing such data.

The system will be a cloud-based web app for ease of development, deployment, and management. This will not only help ease the time needed to develop and deploy it but also greatly reduce the overall system’s costs. By leveraging existing computing infrastructure, those in the health industry will not have to invest in expensive computing hardware (Chlebowy et al., 2006). The cloud platform will be the google compute platform, with the front being developed in angular. The choice of the platform and tech stack is driven by a large number of software developers able to use both technologies. The system requirements are listed below:

  • As a user, I can sign up and login to the system
  • As a user, I can add, edit and delete health institutions and practitioners
  • As a user, I can add, edit and delete comments and recommendations
  • As a user, I can rate health institutions and health practitioners
  • As a user, I can view the rating of health institutions and practitioners made by other users
  • As a software developer or data analyst, I can access the data available on the system over an API
  • As a moderator, I can edit and delete users, ratings, recommendations and comment.


1.3 Problem of Statement

Since a sizeable portion of diabetes app users stop using the app regularly, the effectiveness of the sugar diabetes app as a self-management tool is constrained. This problem is exacerbated by the fact that there are still few apps that are ideal for managing diabetes. Regarding veterinary microbiology and disease, used a mobile app intervention with people with diabetes and saw a 12.0-month attrition rate of 23.4% (Ciemins et al., 2010). According to a study conducted by Chomutare regarding features of mobile diabetes applications, only 20% of apps offered personalized feedback (Chomutare, 2011). This shows much-untapped potential for using mobile devices to give real-time feedback and diabetes education. According to Bickmore & Schulman a health tool is at risk of being abandoned if it cannot satisfy patients’ basic needs (Bickmore & Schulman, 2010). This can factor in the high attrition and low engagement levels associated with using MySugar diabetes app. Therefore, more research was needed to examine the primary causes of the low engagement levels and high attrition rates and identify potential remedies.

1.4 Research Questions


  • What is the importance of improvement of MySugar app on patients at National Health Service in United Kingdom?
  • What strategies can be put in place to ascertain fully management of MySugar app at National Health Service in United Kingdom?



1.5 Research Objectives

  • To explain the importance of improvement of MySugar app on patients at National Health Service in United Kingdom.
  • To explain the strategies that can be put in place to ascertain fully management of MySugar app at National Health Service in United Kingdom.

1.6 Scope of the Study


The general purpose of the study was to investigate the influence of improvement of My Sugar diabetes log-in apps in the National Health Service in the United Kingdom. The sample size for the study was 36 respondents. The study was further restricted to clinicians, app managers, and diabetes patients from a broad range of backgrounds in the United Kingdom. The study’s independent variable is the improvement of MySugar diabetes app in National Health Service on proposed strategies while the dependent variable is better performance and management of diabetic patients in the United Kingdom. Interview method and the filling of questionnaires were the most preferred methods of collecting data because they made it possible to gather both subjective and objective data from a sizable sample of the research population to produce statistically significant results. The study was conducted at National Health Service in the United Kingdom. This was due to the high number of diabetic patients, which was thought to be the best location to conduct the study. The study was guided by both leadership and management theories. The leadership theories included; the emotional intelligence theory, the human capital theory, and the principal-agent leadership theory. The management theories were; social learning, self-regulation, and dual process theories. Lastly, the sample size of the engaged population, time limits, phone abilities, the patient aspect of self-reporting, and the data processing procedure could be considered limitations of this research.

1.7 Significance of the Study

1.7.1 Theoretical Contributions

The difficulties preventing the documentation and application of developmental aspects in designing mobile apps for diabetes management require much work. This study is important in educating patients on the importance of using mobile phone treatments like the use of MySugar to better management of their body sugar levels. The study also provides insights that supports future works to support the creation of evidence-based apps for research and clinical use like MySugar app for delivering self-management education and integrating features into fundamental diabetes self-management activities. Future mobile app creators should consider integrating theories of health behavior modification, consumers, and clinical experts’ involvement while maintaining data privacy and security.

1.7.2 Practical Contributions

The findings of this study were helpful to the United Kingdom Ministry of Health because they gave it the knowledge it needed to reduce the problem of unfavorable diabetic health outcomes among patients by continuing to promote the usage of diabetes applications like MySugar app. In addition to using the MySugar diabetes apps to raise awareness of the warning signs and symptoms to ensure timely diagnosis and treatment, this study was beneficial to nurses in their field towards offering insightful dietary and lifestyle guidance to individuals developing diabetes to assist lower their risk (Clark et al., 1999).

MySugar app will help patients improve their understanding of the condition, particularly their awareness of complications and their capacity for self-management. Additionally, Patients with diabetes can monitor their blood glucose levels, diet, and physical activity with smartphone diabetes apps (24–27). Then again patients with diabetes can track their development toward meeting individual glycemic and behavioral objectives using MySugar application (Clark et al., 1999).

The introduction of MySugar application was important for society as a whole since they helped people better their diabetes self-management status by inputting data into the My Sugar application, which sends data directly to their selected hospitals’ medical staff (El-Gayar et al., 2013). The My Sugar apps give members of the society feedback from medical specialists or automated algorithms. Through improved communication between members of the society and healthcare professionals, this individual exercise hopes to improve individuals’ diabetes care.


A systematic medical and behavioral treatment strategy for diabetes control via the MySugar app enhances diabetic patient’s quality of life and may reduce complications and early mortality. There is a strong interest in patients’ education as a strategy for self-empowerment to enhance patients’ general quality of life in light of the increasing incidence of diabetes combined with an ever-increasing population (Hou et al., 2016). In order to avoid difficulties and promote a healthy future, diabetes patients must have the skills and knowledge needed to improve metabolic control while using the MySugar diabetes app, according to the Royal College of Nursing in CYP. Technology alone is not the solution and that obstacles will avert its widespread use (Eng et al., 2013).

Healthcare professionals must be determined to bring about change that will improve care and encourage the use of digital technologies to raise the standard of living for patients (El-Gayar et al., 2013). According to a review by Hunt, technology can support by serving as an instructive and motivating tool in addition to the care provided by healthcare professionals. Despite technology’s success in helping patients control their treatment and adjust to their unique time restrictions (Eysenbach, 2005). To serve the requirements of diabetic patients and improve their quality of life, healthcare professionals must strike a balance in educating patients between in-person instruction and using technology via the MySugar diabetes app.

People with diabetes need to maintain their blood sugar levels with medication and lead healthy lives with complex lifestyle modifications. Affected people may experience severe psychological effects from this circumstance, making them perceive their Quality of Life as lower. Numerous research from developing nations have reported on the quality of life in managing diabetes and recommend further improvement of the tactics and methods.

High Quality of Life was made possible by patients’ dedication to self-monitoring as instructed by their doctors. They have been able to help diabetic patients control and avoid complications by regularly checking their blood glucose levels and sharing that information with their doctor. An article examined the difficulties people encounter due to the demanding daily schedules required for managing their diabetes. Using smartphone technology in the form of app-based platforms like Freestyle Libre and Xdript is one way to enhance the number of encounters that encourage patient care adherence (Dadgar et al., 2018)

Over the past few years, more individuals have had access to smartphone technology and are using it more frequently for daily tasks. This has produced a robust platform that can assist decision-making, provide education and personalize care to the requirements of people with diabetes (El-Gayar., 2013). Due to the many interconnected elements, such as nutrition, blood sugar monitoring, physical exercise, adherence to medicine, coping and problem-solving skills, and dangerous behaviors, using MySugar applications in daily diabetic self-care has become more practical and significant (Faridi et al., 2008). The MySugar app has the potential to boost patients’ self-care and raise patient involvement with their health if it is correctly developed.

However, it has been discovered that patient-centered care improves Quality of Life, patient satisfaction, treatment compliance, the integration of preventive and promote care, and providers’ work satisfaction (Funnel et al., 2008). Patient-centeredness denotes a more team-oriented strategy and comprehensive comprehension of the patient that aims to comprehend, acknowledge, and address the many ways, dismantling the hurdles in the control management of the disease. For many patients, managing their diabetes independently seems like a full-time job. Technology can be used to assist people with diabetes in self-managing their condition while also allowing them to communicate information, communicate, and receive assistance from healthcare professionals regarding the most suitable tool based on the patient’s context and self-care requirements (Gallant., 2003).

Effective diabetic self-management includes regular exercise, monitoring blood sugar levels according to medication instructions, and eating a balanced diet. Diabetes self-management is critical in efficient and affordable diabetes care that significantly lowers complications and hospital admissions. Furthermore, managing diabetes on one’s own is a demanding duty that necessitates ongoing support and instruction to help patients improve their health literacy and continue to practice the necessary self-care behaviors (Gerstein et al., 2019). There is evidence that diabetes applications (apps) such as MySugar help people improve their understanding of the condition, especially their awareness of complications and individual self-management skills. Diabetic patients can monitor their physical activity, diet, and blood glucose levels with the help of MySugar diabetes applications.

Self-management entails thoughtful planning of diet and physical activities, coping with low and high glucose levels, and routine glucose monitoring and treatment adherence. Efficient diabetes self-management lowers the likelihood of diabetic complications by preserving tight glucose control (Guevara, 2020). Nevertheless, integrating diabetic self-management practices into daily life can be complex and demanding, which can demoralize and depress people (Hood et al., 2016). Diabetes-related distress has been linked to poor diabetes self-care, lower quality of life in terms of health, and poor glycemic control. Elevated diabetic distress affects about one-third of people with diabetes. This emphasizes the need for techniques and treatments to help persons with diabetes manage their condition independently. Tools to promote diabetes self-management must always be available to patients since persons with diabetes frequently deal with constantly shifting internal and environmental stimuli that affect their glucose levels. Consequently, the use of digital applications such as Dexcom for treating diabetes is growing (Holtz et al., 2012).

The mySugar application is one digital health tool for individuals with diabetes. It has been demonstrated that it is positively connected with higher self-care behavior and was created in compliance with the specifications for quality management systems for medical devices (Hou et al., 2016). The app may automatically upload information from monitoring devices to analyze current glucose levels, medication, and insulin intake information, diet, weight, blood pressure, and exercise entries. Patient information can be shared between various medical institutions based on diabetes self-management utilizing diabetic apps like mySugar, which can cut the cost of unnecessary tests. On the app, patients and the medical staff can communicate directly to address issues with blood glucose monitoring, medication, nutrition, or exercise, which can also help patients save time and money by reducing the frequency of hospital visits and hospitalizations (Huckvale et al., 2015).

The solicitation of individual-management using diabetes apps is one feature that plays an essential role in managing diabetes, comprising diet regulation, bodily activities, blood sugar nursing, acquiescence with medication intake, and self-care (Hur et al., 2021). Actual self-management using the MySugar app in patients is essential to improve the achievement of goals in diabetes supervision. Non-adherence to diabetes medication hinders the regulation of blood sugar levels, leading to poor glucose control (Kaku et al., 2017). Therefore, patients’ compliance with diabetes self-management is needed to improve their life quality. Successful diabetes self-management depends on individual self-care activities to control the symptoms. Furthermore, regular self-management activities prevent complications (Verma et al., 2018). Numerous apps with different blood glucose monitoring and sharing functionalities are available locally. Some apps, like the diabetic tracker app, enable users to schedule visits, share data with their healthcare providers, and receive instructional SMS messages. This software also focuses on diet and contains glucose trackers, activity recorders, calorie calculators, and a restaurant (Martinez-Millana et al., 2018). Users may examine the nutritious composition of their meals at their convenience. Currently, many internet services are emerging as platforms designed to help people with diabetes make tailored and educated decisions about their health (Mazze et al., 1984)

Moreover, research indicates that many patients are not regulating their routines to regulate blood glucose effectively. According to the research, there are several obstacles in managing diabetes, including a lack of awareness about the condition. The use of self-management programs, particularly those that emphasize education, is one technique to assist in overcoming obstacles. According to research, people who actively participate in these activities have improved health. Alternative methods for offering these programs could help people in remote areas stick to their medication regimen more consistently.

However, the challenges of treating diabetes must be taken into account with the demands on health professionals to adopt evidence-based practices and ensure effective person-centered care strategies. According to (Panagioti et al., 2014), there are various obstacles to how clinicians provide concrete proof advice in the real world, including a limited amount of time, understanding, and accessibility to supported technical opportunities for education. According to research by (Perrin et al., 2017), practitioners frequently remain ignorant of and unacquainted with the most recent evidence-based recommendations for a transformational approach to diabetes care. This requirement can be satisfied by making it easier for health care personal (HCP) to access frequent, planned diabetes education programs, leading to better care for diabetic patients (Persell et al, 2004). This is an action call for National Health Service (NHS) England and Health Education England to acknowledge that diabetes training, conveyed through various methods to satisfy the various needs of both HCPs, is an essential tool for successful, reliable, and effective person-centered care in clinical settings.

Generally, the evidence points to a significant investment return in pharmacy diabetic initiatives in terms of more excellent persona with disabilities (PWDs) self-care and enhanced diabetes treatment success. The bedrock of replicating such outstanding practice is enhanced access to training and greater IT accessibility to medical information to guarantee continuity of care throughout fields of diabetes care provision. Dietitians are recognized medical practitioners with a profession who are qualified to convert the science of nutrients into precise, helpful data about food, empowering individuals to make sensible lifestyle and dietary decisions. Dietetic intervention can improve HbA1c by an extra eight mmol/mol (0.7%) in patients with newly diagnosed diabetes (Persell et al, 2004)

Comprehensive dietary interventions for type 2 diabetes have been linked to improved glycemic control (Coppell et al., 2010), with reductions of up to 21mmol/mol observed. Additionally, dietetic interventions are economical, reduce the requirement for insulin therapy, and result in fewer trips to the doctor and other healthcare providers. Diabetes UK has made suggestions that might make it easier for better individual guidance to PWD, boost the responsibility of nutrition experts by increasing the number of those educated in medicating, undertake more audits of the effectiveness of dietitian’s solutions and give MDT participants more period for schooling and mentorships. (Yuan et al., 2018) used a mobile app rating system to examine various applications and concluded that the ratings the applications obtained did not always correctly represent their influence on behavior modification and clinical outcomes. (Bryan et al., 2016) highlighted the variance in the number of features included in the applications they assessed in their review. Research of 35 mobile applications for diabetes by (Yuan et al., 2018) revealed that the structure of these apps was more “centered on monitoring and setting alarms, rather than offering tailored instruction or therapy assistance.” “In the future, application layout can be enhanced to incorporate patients’ demands, usefulness for illness management and lifestyle modifications,” they said in their conclusion (Persell et al, 2004). Diabetes prevention and management programs and materials like X-PERT, DESMOND, and DAFNE have been found to enhance glycemia regulation, self-care, and clinical results, in addition to the psychological adjustment of patients to their diabetes (Polonsky et al., 2005)

Various digital applications and tools have also gained NHS Digital and QISMET certifications (Milanova et al., 2009). They are now accessible through the NHS England app library, despite the difficulties in locating theory-driven, concrete-proof, and clinically applicable digitization and applications in app stores. A quality management system must indicate high standards because several apps are currently available. However, fewer have been thoroughly evaluated and certified regarding their therapeutic effectiveness. However, to determine the effect of mobile app use on blood glucose control in the self-care of diabetes, carried out a systematic evaluation of 10 relevant experimental studies. The author drew attention to the differences in app functionality and emphasized the necessity for app performance to be standardized (Milanova et al., 2009)


2.1 Research Gaps


Yuan and colleagues conducted a study regarding app features for diabetes support and patient empowerment, the available apps focused on disease management aspects such as data records and appointments. However, their study did not explain the importance of improvement of mobile apps like MySugar app on patients at National Health Service in United Kingdom to encompass a variety of important app features, such as personalized and tailored empowerment features (Yuan et al., 2018) . Therefore, this study aims at filling that gap where such features should be included in diabetes apps for Large-scale assessment of potential in the self-management of diabetes.

Yap and colleagues in their findings concerning reinforcement learning application in diabetes blood glucose control for self-care established that Data record and Personalization as the most prevalent features in mHealth diabetes apps for patient health care (Yap et al., 2021). Hence their study did not explain the strategies that can be put in place to ascertain fully management of MySugar app at National Health Service in United Kingdom thus, this research study aimed at filling that existing gap.

Finally, to enhance diabetic patient’s quality of life in a study conducted by Dadgar and colleagues, they only investigated the number of app features in enhancing patient’s quality of life rather than also investigating the challenges facing the improvement of mobile apps like MySugar app on patients at National Health Service in United Kingdom for future improvements (Tatara et al., 2009) .Therefore, this study focused on filling the gap by identifying current challenges on features such as gamification and coaching techniques valuable for diabetic patients to equip their quality of life and future improvements.


Executive Summary

MySugar is a diabetes mobile app for diabetes support and management. The MySugar app provides free in-app coaching sessions which are affordable to low-income and underprivileged patients. The coaching service includes the use of gamification and incentives, such as reward points and vouchers, to encourage self-management. Our MySugar app is set to help the UK National Health Service (NHS) make the most of cutting edge technology to improve patient quality of life and treatment successes.


There are over 3 million people in the UK with diabetes and most of them have to manage their condition on a day-to-day basis, with little or no support, which can be physically, mentally and socially draining (Oser & Oser, 2020). The MySugar app’s on-going coaching sessions will allow them to achieve better control of their condition, improve their wellbeing and quality of life, and reduce visits to the doctor.

Current Provision

Within the NHS, diabetic patients are often given guidelines to help them manage their condition and learn how to count their carbohydrates and monitor their glucose levels, but there is no ongoing follow-up. In addition, the UK has been lagging behind other countries in terms of implementing digital technology for patient engagement, which has been shown to improve compliance with lifestyle recommendations (Oser & Oser, 2020).


The MySugar app will provide coaching sessions, accessible to patients over the Internet using apps or computers. The sessions will be provided by experienced and qualified clinicians who are specialists in diabetes. Sessions will be booked by the patient using a website and can be completed using either their smartphone or computer. Each session lasts approximately 20 minutes, and there are six coaching sessions available within the app. Patients can choose which topics they wish to cover, and use a progression chart within the subject to help them monitor progress (American Diabetes Association Professional Practice Committee, 2022). The patient’s progress is tracked using data collected during coaching sessions, and is stored securely within the app. The coaching sessions will include personalised top-up discussions to support the patient, along with a series of online resources available at any time. These resources will be available on a website, which patients can access using their mobile devices.


The MySugar app will provide a valuable service to NHS patients, helping them manage their condition and improving the chances of getting better. There will be significant benefits for both the patient and the NHS. The patient will be able to engage with qualified health professionals on a regular basis, allowing them to monitor their condition and improve it over time (Sherr, 2022). An improvement in health outcomes will also allow patients to take on less appointments with GP’s, as well as reducing hospital admissions related to diabetes.


The costs of the app are low, and there will be no additional cost to the NHS. The app will employ a small team to manage patient data, which will be provided on an as-needed basis. These staff would work from a central location, with patients able to access their data remotely using online tools. It is anticipated that the app will cost approximately £25,000 over a two-year trial period. The project will use this funding to develop a prototype and finalise its business case.


As with any new product implementation, there is a small risk that the app may not be as successful as anticipated. However, potential risks can be mitigated by developing the app in partnership with an experienced digital agency that has experience in healthcare products (Eiland et al., 2019).


The MySugar app will be developed using agile and iterative approaches, which involve developing a prototype for review, then further development based on the feedback received, to iterate until a stable version is achieved (Al-Saqqa et al., 2020). This approach will allow the NHS to gain valuable insight from users early on in the process. Possible improvements can also be made once the app is implemented in NHS settings by evaluating its impact against other healthcare products from digital agencies that have experience with diabetes management.


3.2 Experimental Design and Area of Study

The investigation embraced simple random technique. The simple random approach was chosen because it sought to gain insight into a phenomenon to provide basic information in an area of study. The simple random technique was adopted in this study based on the conceptual relationship between the independent and dependent variables. The design enables the collection of qualitative data through in-depth research. The chosen study area of this study was the National Health Service in the United Kingdom.



3.3 Study Participants and the Study Population

The study population was picked from consenting adults (18 years and above) diagnosed with diabetes on clinic care for one or more months. The study was conducted at National Health Service in the United Kingdom. The study participants included patients diagnosed with diabetes, clinicians, and nurses of the institution. A sample size of 36 was randomly selected from the register of patients booked on appointment days. On clinic day, sample participants were randomly approached to participate in the study.

3.4 Sampling Size and Methods

A sample of 36 participants was selected using the randomized technique to represent the entire population. Randomized sampling method under stratified technique was used because it less biased and costly effective.

3.5 Research Variables

The study’s independent variable is the improvement of MySugar diabetes app in National Health Service on proposed strategies while the dependent variable is better performance and management of diabetic patients in the United Kingdom.

3.6 Data Collection

The investigation made use of interviews and questionnaires. The interviews were preferred to collect qualitative data because of a better response rate than mailed questions and aid in collecting data on time. Questionnaires were also deployed in the collection of qualitative data because they are less complicated since every appropriate response is recorded and given to the investigator for analysis.


3.6.1 Questionnaires

As they are incorporated into the paper design, the survey was conducted using questionnaires. Prejudice was shown toward the volunteers. The questions were prepared straightforwardly and reasonably to promote a high response rate. On a Likert Scale, the participants indicated how much they agreed or disagreed with each item in the questionnaire regarding the enhancement of the diabetes tracker log in-app.

3.6.2 Interviews

The researcher conducted face-to-face and virtual interviews to engage every respondent in handling challenges faced by respondents who were not within reach. A Likert scale was utilized to rate the respondents’ opinions based on the questions. This method was appropriate as it could get extensive information within a short period.

3.7 Data Analysis

Before starting the fieldwork, the data was strategically analyzed using a data analysis tool, the Qualtrics as data collected was qualitative. The main reason for using the Qualtrics software is because it guarantees reliable analysis and is accessible in diverse world linguistics. The data was coded after tabulation to make statistical analysis easier.


4.1 Leadership Theories

Many ideas from various disciplines have been developed to build a theory of leadership that clarifies the elements that generate exceptional leaders. In the field of nursing, Advanced Practice Nurses (APNs) are expected to exercise increased leadership in the areas of administration, instruction, and clinical practice. In order to satisfy the expected demands of healthcare professionals and patients, Advanced Practice Nurses (APNs) are currently required to incorporate leadership theories across clinical departments. Nursing, however, has incorporated leadership theory and practice from other academic disciplines.

4.1.1 Emotional intelligence theory

Emotional intelligence theory is described as the capacity to recognize emotions, promote thinking, and assess or comprehend how one’s emotions relate to others (Sarkar et al., 2006). According to a study by Sarkar, a nurse leader who possesses emotional intelligence is someone who can manage stress in the clinical setting by working in accordance with their ideas and feelings (Sarkar et al., 2006). High-performing nurse leaders have also scored highly on emotional intelligence tests (Sauder et al., 2021). Mobile health apps to facilitate self-care: a qualitative study of user experiences. The clinical leader should be aware of the various leadership theories and how they apply to clinical practice because the role of the Advanced Practice Nurse (APN) is constantly evolving. The ultimate goal of leadership is to enhance patient care outcomes, notwithstanding the wide range of clinical practice settings and the Advanced Practice Nurses (APNs) varied tasks (Sauder et al., 2021).

Advanced Practice Nurses (APNs’) responsibilities and level of leadership skills will develop as they participate in various leadership activities. As a result, Advanced Practice Nurses (APNs) must stay conscious of their constraints and remain ready to advocate for patients powerfully. Theoretically, the statistics indicate that emotional intelligence may be a crucial protective factor for both psychological and bodily adjustment in diabetes patients by providing them with virtually accessible methods for coping with the condition in daily life through created diabetic apps (Schroeder et al., 2007). The preliminary results suggest that using the emotional intelligence theory could be a useful supplemental tool for managing diabetes patients, while more research is required.

4.1.2 The human capital theory

Human capital theory acknowledges the necessity for people and businesses to invest in their personnel to gain future benefits. The combined education, knowledge, skills, and capacities of an entire group are human capital (Stopford et al., 2013). According to the human capital hypothesis, these advantages might be increased, or productivity could be improved. Longevity at work so becomes the desired result for cherished employees.

Advanced Practice Nurses (APNs) conversant with applying human capital leadership theory can use these ideas in a clinical setting. The application of human capital theory brought to light how important it is for nursing personnel to treat newly diagnosed diabetics with care and compassion. Watson’s theory of human caring gave clinic nurses the theoretical grounding they needed to learn about the transpersonal component of the caring human conscience (Stopford et al., 2013). Furthermore, healthcare professionals must provide newly diagnosed patients with more in-depth information on diabetes tracker applications than just the standard verbal and written materials. For example, healthcare professionals must also concentrate on comprehending the patient’s entire life, including environment, culture, and traditions, on delivering effective holistic care that produces positive outcomes, rather than just focusing on hemoglobin levels in recently diagnosed diabetics.

4.1.3 The principal-agent leadership theory

Principal-agent leadership theory was characterized as another interactive theory and descended from an economic model in the 1960s. This model’s defining feature is that not all followers (also known as agents) are compelled to act in the employer’s or leaders’ best interests by nature (principal). This presupposes that sufficient incentives must be offered in order for the followers to execute. If this leadership paradigm is used, Advanced Practice Nurses (APNs) may need to create incentives for medical staff, such as monetary prizes, promotions, employee recognition programs, or social recognition (Stopford et al., 2013).

Advanced Practice Nurses (APNs) may also impact management improvements by developing innovative techniques for rewarding patients who adhere to incentives or health compliance. Clinicians and pharmacists are increasingly taking on the leadership role by urging individuals to start using mHealth, or “mobile and wireless technology to support the attainment of health objectives,” to help them manage their diabetes (Zinman et al., 2015). Mobile health is frequently patient-focused and accessible through personal mobile devices.

4.1.4 The Democratic Leadership Theory

Democratic leadership theory was initially proposed by Robert Axelrod as an effort to analyze how leaders of democratic organizations can create effective groups. The theory is based on the notion that people may not always agree in all their opinions about where the party should be headed, but they can nevertheless engage with other members of their political party (Barr & Dowding, 2022). Democratic leadership theory suggests that when leaders don’t have a monopoly on leadership abilities, it is sometimes beneficial for everyone to work together to achieve a common goal (Barr & Dowding, 2022 ). Advanced Practice Nurses (APNs) can use this leadership model to interact with other nurses and doctors to determine strategies for management improvement in their clinical setting.

Advanced Practice Nurses (APNs) could inform others on the benefits of using a mobile health application, such as scheduling reminders to monitors medication, taking medication at the correct time, and other diabetes-related self-help processes (Barr & Dowding, 2022). The positive outcome of this collaborative approach is that it lowers stress and improves patients’ satisfaction with their healthcare providers.

  • 2 Management Theories
    • 2.1 Social Learning Theory

Social learning theory concentrates on how individuals believe they can carry out actions and carry out plans of action (Tejedor et al., 2020). This is known as self-efficacy psychologically, although the idea of self-confidence is extremely similar. Most health psychology models include self-efficacy since it has been found to be one of the most reliable indicators of successful self-care behavior (Tejedor et al., 2020). It was noted in the recently released book, social media and Mobile Technologies for Healthcare that while mobile social presence has recently been described as an augmentation of virtual social presence with collaborative technologies like conveying photos, videos and local-based statuses, there have been relatively few models incorporating social network components into MySugar diabetes app.

In the United Kingdom (UK), this effort for workshops is still very new. The only other model that is now in operation offers patient education at the time of diagnosis in a specialized diabetes facility, and it is located in Bournemouth, United Kingdom. The Portsmouth seminars’ intended purpose of educating persons with newly diagnosed with diabetes about self-management has been substantially accomplished.

  • 2.2 Self-Regulation Theory

According to Keenan and colleagues’ self-regulation theory focuses on how people perceive their condition or have a personal model of diabetes as a major factor in how they behave and feel when they are ill (UKPDS, 1998). A crucial feature of diabetes apps is the ability for users to conveniently self-monitor their blood glucose levels. After doing finger stick blood tests, the patient can adjust the blood glucose level using the input circle’s scrollbar. The time and date of the record will be automatically recorded, and you can change them further by dragging the time picker around. Before and after meals, different persons have varied blood glucose target ranges (Wang et al., 2020). As a result, the design enables users to choose their own target ranges for both the before-meal and after-meal glucose levels. Therefore, using the support tab in the apps, clinicians urge diabetes patients to heavily utilize the app platform to continuously improve their health state.

Five fundamental components that shape our representations of sickness across cultures have been found by this field’s research:

  • Identification (What is diabetes? What signs and symptoms are present? What exactly is a problem?
  • Origin (What led to my diabetes?
  • Calendar How long is this going to last?
  • Repercussions (How will diabetes impact me today and in the future?
  • Effectiveness of the treatment (How well does my medicine control or reverse my diabetes?

Diabetes research in adults and adolescents has repeatedly shown that people have a wide range of illness beliefs that do not align with the medical understanding of the disease and that these beliefs are strong and immediate predictors of patients’ emotional well-being and self-care activity (Yuan et al., 2018). Persons frequently know or have relatives who have diabetes. They have also seen media depictions of individuals who have diabetes and heard about some of its problems.


4.2.3 Dual Process Theory

Dual process theory serves as a roadmap for educating people about diabetes and addressed their present understanding of the disease (Wangberg et al., 2006). Heuristic processing and systematic processing are distinguished by dual process theory (Zinman et al., 2015) . Heuristic processing is the primary method used in patient education, in which patients play a largely passive role by listening to medical personnel explain their illnesses to them. To log their diet, patients only need to do a few simple actions. By selecting “Capture Meal” on the main page, you can start by taking a picture of the meal. The type of food must be entered in the second stage so that the App can determine how many carbohydrates are there to control diabetes.

The amount of completed food must be specified as the final stage. These phases could even be expedited with the use of social support capabilities. The period of the diet record that the patient would wish to review may also be chosen. The date picker located at the top of the “Diet Record” screen can be used to alter both the beginning and end dates. The program includes process goal-setting features that divide significant goals into concrete, doable tasks that may be completed in a predetermined amount of time.

Dual process theory strongly emphasizes the necessity of involving people actively in the learning process to address these problems. This entails giving people as little information as possible to learn from. For instance, the workshops mention that insulin resistance is a diabetes issue (Whitehead et al., 2016). The mediators’ then assist people in determining how this knowledge relates to what is happening in their bodies now and in the future by asking thoughtful questions and using analogies (the workshops use the analogy that having insulin resistance is somewhat like having a rusty lock on your front door). Adjustments in beliefs that result from this more active learning are more resilient to the effects of contradicting knowledge. It gives people the tools they need to investigate and test new information (Yuan et al., 2018). Additionally, it makes it harder for people to explain away the knowledge since it enables them to tie it to what is happening in their bodies. Due to this strategy, people who participated in program evaluations up to a year after attending a workshop could provide incredibly detailed accounts of the workshop. Contrast this to people’s memories of one-on-one conversations.

4.3 Change Strategies for the new App

Diabetes is a field that is expanding in delivering behavioral interventions via the internet and mobile health (mHealth) technology. Others have created intervention strategies to be provided via technology, while in-person interventions have been modified for internet transmission and seem similarly efficient. For teenagers with Type 1 diabetes, Sauder and Ritchie created a web-based, self-guided behavioral intervention that includes multimedia vignettes, coping and problem-solving techniques, and social networking instruction. One of the most popular mHealth change techniques being developed is sending text messages with encouragement or reminders to perform diabetes-related behaviors (Wangberg et al., 2006)


Smartphone-based applications to monitor diabetes routines or communicate with clinicians and motivational video games are a few other examples of mHealth apps that are currently in development and are being evaluated. Web and mHealth initiatives are intriguing to youth, and there are developments toward advantages in diabetes consciousness, compliance, and glycemic control among those youth who participate more with the technologies. However, advancements in glycemic control are not repeatedly reported in these early studies (Whitehead et al., 2016)


A glucose and meal tracker that gives a comprehensive record in a diary format must be added to the diabetic tracker app. The data can be seen on the associated website and prepared to provide insulin doses, scheduled physical activity, carbohydrate intake, hypoglycemia, etc. The App should also offer an incremental snapshot of the median blood sugar levels from meal to meal and throughout the night. This design and the bolus calculator wizard make it easy and comfortable for the patient to modify their insulin dosage (Whitehead et al., 2016)



According to the study, the respondents stated that there is need for improvement. 10% of the respondents stated that the MySugar app is sometimes complicated during uploading information from monitoring devices to analyze current glucose levels, medication, insulin intake information, diet, weight, blood pressure, and exercise entries so there is the need to reduce to complication. 20% of them revealed that Patient information should be shared between various medical institutions based on diabetes self-management utilizing diabetic apps using MySugar, which can cut the cost of unnecessary tests. This is because on the app, patients and the medical staff should be able to communicate directly to address issues with blood glucose monitoring, medication, nutrition, or exercise, which can also help patients save time and money by reducing the frequency of hospital visits and hospitalizations

The respondents also stated that strategies should be put in place to fully ascertain management of the application. 40% stated that the app is one feature that plays an essential role in managing diabetes, comprising diet regulation, bodily activities, blood sugar nursing, acquiescence with medication intake, and self-car so the need of system configuration management. 15% of the total participants responded that the application should be responsible in improving the achievement of goals in diabetes supervision because the app includes features that allow peer interactions among users with similar medical experiences to discover new, valuable strategies for maintaining their health. 15% of the total participants concluded that they should be given sufficient information on the MySugar app on how to configure a pump to administer the proper quantity of insulin as it helps to encourage the achievement of steady blood sugar levels in them.

Part of the management measure for diabetes patients is to know the number of calories needed for a day’s activity. This helps prevent obesity, which research has shown is a risk factor for diabetes mellitus. The mobile application of the system contains a calorimeter, which helps patients to determine the number of calories needed for a day’s activity. With the knowledge of the number of calories needed by a patient, then determine the quantity of food to eat in adherence to the plate model. For example, a   patient with the   following input; age=34, Height=5.3   feet, weight=65kg, Sex=male, activity=moderate requires 1, 869kilocalories per day.




The study concluded that the high-quality features of diabetic tracker applications support diabetic patients’ well-being by encouraging regular blood glucose control. This suggests that patients are more likely to stick with diabetes tracker applications when they are effective. However, users may unintentionally and mistakenly divulge compassionate private information if the diabetic mobile apps’ privacy concerns are not thoroughly addressed. Therefore, all parties engaged in developing diabetic applications must be included from the beginning of the process to guarantee the apps’ strict adherence to data protection laws and user privacy. Sugar and applications for persistent glucose monitoring, including “Dexcom,” “Freestyle Libre,” and “Xdrip+,” were among the most widely used diabetic apps among those that were identified. Using diabetic apps for self-management was favorably linked to increased self-care behavior in both kinds of diabetes after controlling for the effects of covariates.


More extensive multicenter trials are required to demonstrate the applications’ long-term effects, and ongoing work should focus on creating the perfect smartphone-based diabetic self-management tool. Because so many patients perceive managing their diabetes as a full-time job, practitioners and app developers must provide accurate tools and timely information on the diabetic tracker app to streamline the process and lessen patient dissatisfaction. In order to enhance the patient’s role in their self-management treatment through the diabetes applications and expertise about how patients with diabetes experience, diabetes management program managers need to promote intervention strategies in their services. This should be regularly monitored in the patients’ applications. Clinicians should promote smartphone adoption in the context of the underdeveloped world since it suggests that these patients can increasingly be reached through these cutting-edge diabetes mobile apps. However, it is essential to thoroughly examine how cell phones can communicate real-time patient doctor intervention, diabetes management control education and safe data exchange between patients and medical professionals.














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