{
  "abstract": "Background\n\nType 2 diabetes mellitus (T2DM) is a chronic condition that requires ongoing self-management. While chatbots offer scalable monitoring and management, evidence on their integration into structured hospital tele-support workflows, where patient engagement and digital readiness may differ from those in standalone digital interventions, remains limited.Objective\n\nThis study aimed to describe the design of a clinical protocol-guided chatbot, Sharing Information with Users on Diabetes Actions and Interventions (Siu Dai), and evaluate its feasibility, usability, and acceptability among patients and telecarers within a hospital tele-support program.Methods\n\nWe used an embedded mixed methods design (QUAL [quan]) guided by the World Health Organization (WHO) monitoring and evaluating digital health interventions and the theoretical framework of acceptability. Through a co-design process involving clinicians, researchers, telecarers, and developers, the chatbot was aligned with established clinical protocols. It featured 7 precall sessions designed to collect patient data, generate summary reports for staff, and deliver targeted educational content. Patients (≥21-year-old individuals with T2DM) and telecarer nurses (with experience ≥6 mo) were recruited from an existing tele-support program. Data sources included interviews, online surveys (5-point Likert scale), and chatbot usage logs. Qualitative data were analyzed thematically; quantitative data were summarized descriptively to supplement and contextualize the qualitative findings.Results\n\nFourteen participants (7 patients and 7 telecarers) completed both interviews and surveys and were included in the analysis. Patients (mean age 45.3, SD 15.4 y) had a median diabetes duration of 10 (IQR 3-25; range 1-30) years, and all were digitally literate. Telecarers had a median of 5 (IQR 4-9) years of telehealth experience. Quantitatively, patients showed high engagement, completing 79% of started sessions with a median completion time of 2 minutes and 58 seconds. Patient satisfaction was high, with 86% (6/7) willing to recommend the tool; however, telecarer endorsement for universal rollout to patients in other clinical programs or outpatient clinics was more cautious (3/7, 43%). Qualitative findings revealed 5 themes: (1) perceptions of chatbot usability, (2) alignment and integration into telecarers' processes, (3) factors influencing acceptability of the chatbot, (4) perceived efficacy of the chatbot for T2DM self-management and care delivery, and (5) suggested improvements and enhancements. Integrated findings revealed that the chatbot was usable and functioned as a precall support tool that optimized the personalization of tele-support sessions. However, its perceived efficacy in self-management behavior was limited by this cohort's extensive experience with T2DM management. Key barriers to adoption included administrative burden for telecarers due to a lack of electronic medical record integration and content redundancy for patients. Suggested enhancements included multilingual support and adaptive content catering to different levels of disease-specific literacy.Conclusions\n\nA clinical protocol-guided chatbot is feasible for hospital tele-support, complementing rather than replacing human care. It automates routine assessments and reinforces education, but future iterations must prioritize workflow integration and adaptive content to sustain engagement.",
  "abstract_shown": true,
  "affiliations": [
    "Health Services Research, Changi General Hospital, 2 Simei St 3, 529889, Singapore, 65 7888833.",
    "Centre for Population Health Research and Implementation, SingHealth, Singapore.",
    "Department of Endocrinology, Changi General Hospital, Singapore.",
    "Regional Health System (Transition), Changi General Hospital, Singapore.",
    "Department of Nursing Administrator, Changi General Hospital, Singapore.",
    "Department of Care Coordination, Changi General Hospital, Singapore.",
    "Telecare Unit, Changi General Hospital, Singapore.",
    "Agency for Science, Technology and Research (A*STAR), Institute for Infocomm Research, Singapore.",
    "Department of Endocrinology, Singapore General Hospital, Singapore."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 29,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Rebecca Hui Shan Ong",
      "orcid": "0000-0001-8978-0557"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Hong Choon Oh",
      "orcid": "0000-0002-3086-7516"
    },
    {
      "affs": [
        0
      ],
      "name": "Bryan Peide Choo",
      "orcid": "0000-0001-5602-8094"
    },
    {
      "affs": [
        0
      ],
      "name": "Linette Zhi Ai Tan",
      "orcid": "0009-0001-5346-5376"
    },
    {
      "affs": [
        0
      ],
      "name": "Melissa Hui Wen Gunn",
      "orcid": "0009-0007-0647-8186"
    },
    {
      "affs": [
        0
      ],
      "name": "Jin Wee Ng",
      "orcid": "0009-0004-3933-5956"
    },
    {
      "affs": [
        2
      ],
      "name": "Anne Ching Ching Teng",
      "orcid": "0009-0009-3801-6466"
    },
    {
      "affs": [
        3
      ],
      "name": "Sharon Yu Bing Ong",
      "orcid": "0009-0006-5059-7951"
    },
    {
      "affs": [
        3
      ],
      "name": "Angela Hwee Koon Ng",
      "orcid": "0009-0009-5497-359X"
    },
    {
      "affs": [
        4
      ],
      "name": "Winnie Yi Ling Soo",
      "orcid": "0009-0007-3881-3655"
    },
    {
      "affs": [
        5
      ],
      "name": "Yian Chin Lee",
      "orcid": "0009-0006-1959-8067"
    },
    {
      "affs": [
        6
      ],
      "name": "Halimah Binte Sarim",
      "orcid": "0009-0000-3288-5622"
    },
    {
      "affs": [
        6
      ],
      "name": "Geok Choo Lee",
      "orcid": "0009-0008-3442-9688"
    },
    {
      "affs": [
        6
      ],
      "name": "Junaidah Binte Ibrahim",
      "orcid": "0009-0008-4686-2921"
    },
    {
      "affs": [
        6
      ],
      "name": "Kryslyn Mei Ying Kae",
      "orcid": "0009-0007-8199-8819"
    },
    {
      "affs": [
        7
      ],
      "name": "Jinyang Wu",
      "orcid": "0000-0001-6348-1225"
    },
    {
      "affs": [
        7
      ],
      "name": "Zhengyuan Liu",
      "orcid": "0000-0001-6864-3094"
    },
    {
      "affs": [
        7
      ],
      "name": "Mojisola Erdt",
      "orcid": "0000-0003-2371-6768"
    },
    {
      "affs": [
        7
      ],
      "name": "Siti Umairah Md Salleh",
      "orcid": "0009-0002-2029-319X"
    },
    {
      "affs": [
        7
      ],
      "name": "Siti Maryam Binte Ahmad Subaidi",
      "orcid": "0009-0006-5903-5824"
    },
    {
      "affs": [
        7
      ],
      "name": "Sakinah Binte Yusof",
      "orcid": "0009-0006-7370-4895"
    },
    {
      "affs": [
        7
      ],
      "name": "Nabilah Binte Md Johan",
      "orcid": "0009-0000-5446-0027"
    },
    {
      "affs": [
        7
      ],
      "name": "Kavineshaan Ramdas",
      "orcid": "0009-0008-6141-3075"
    },
    {
      "affs": [
        7
      ],
      "name": "Jia Shern Ang",
      "orcid": "0009-0002-1808-3599"
    },
    {
      "affs": [
        7
      ],
      "name": "Qi Yuan Tay",
      "orcid": "0009-0007-1951-9303"
    },
    {
      "affs": [
        8
      ],
      "name": "Yong Mong Bee",
      "orcid": "0000-0002-5482-2646"
    },
    {
      "affs": [
        7
      ],
      "name": "Nancy F Chen",
      "orcid": "0000-0003-0872-5877"
    },
    {
      "affs": [
        7
      ],
      "name": "Pavitra Krishnaswamy",
      "orcid": "0000-0001-5893-4306"
    },
    {
      "affs": [
        2
      ],
      "name": "Joan Joo Ching Khoo",
      "orcid": "0000-0002-3343-4580"
    }
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  "bibtex": "https://research.draconitic.com/paper/4sn8y7n4qm5hv.bib",
  "cited_by": 0,
  "doi": "10.2196/91058",
  "fulltext_url": "https://europepmc.org/articles/PMC13693827",
  "id": "4sn8y7n4qm5hv",
  "issns": [
    "1439-4456",
    "1438-8871"
  ],
  "landing_url": "https://europepmc.org/article/MED/42913398",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2739|Telemedicine and Telehealth Implementation"
    ]
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  "openalex": "W7212159988",
  "pdf_url": "https://europepmc.org/articles/PMC13693827?pdf=render",
  "pmcid": "PMC13693827",
  "pmid": "42913398",
  "published": "2026-10-23",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/4sn8y7n4qm5hv.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:03Z",
      "native_id": "MED:42913398",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42913398"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Telemedicine and Telehealth Implementation",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Evaluation of a Clinical Protocol-Guided Chatbot to Support Telecarers in Diabetes Management: Embedded Mixed Methods Study.",
  "title_text": "Evaluation of a Clinical Protocol-Guided Chatbot to Support Telecarers in Diabetes Management: Embedded Mixed Methods Study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:03Z",
  "url": "https://research.draconitic.com/paper/4sn8y7n4qm5hv",
  "venue": "Journal of medical Internet research",
  "versions": []
}