Examining how Nudge Theory-Based Interventions can Positively Affect Diabetes Patients on AKAP in Sikkim
DOI:
https://doi.org/10.37506/ccxd2a65Keywords:
Behavioural Intervention, Patient Education & Diabetes Management, Nudge Theory, Local Ambassador, SikkimAbstract
Introduction: Diabetes mellitus, a lifestyle illness, is a major public health problem around the world, and its numbers are growing in India, and Sikkim, a northeastern state, is no exception. Sikkim, often known to have a pristine environment where people come for rejuvenation, also shares the same burden when it comes to the incidence of lifestyle diseases such as diabetes mellitus. Hence, effective management is very crucial, and it largely depends on patients' awareness, knowledge, attitude, and practices (AKAP) regarding the condition.
Aim: This study aimed to examine the impact of interventions such as telephonic reminders based on nudge theory combined with ambassadors on the AKAP of diabetes patients in Sikkim.
Methods: This study selected 160 diabetes patients from Sikkim via purposive sampling (80 experimental, 80 control). Both groups were asked to complete a 5-point Likert scale questionnaire to assess the Awareness, Knowledge, Attitude, and Practices (AKAP) before any intervention. The experimental group then received an intervention in the form of whatsaap messaging, telephonic calls combined with an ambassador, while the control group did not. Both the groups re-completed the AKAP questionnaire post the intervention. Data were analysed using SPSS 25, using paired t-tests for within-group comparisons and ANCOVA to study the impact between-groups.
Results: Paired t-test results showed that there was no significant change in pre- and post-intervention AKAP scores for diabetes patients in the control group. Conversely, the treatment group showed a significant increase in their mean scores for awareness, knowledge, attitude, and practices related to diabetes from pre- to post-intervention. Aditionally, the ANCOVA results validated that the nudge theory-based intervention, combined with consultation, had a positive and significant impact on the awareness, knowledge, attitudes, and practices of diabetes patients.
Implications: This study highlights the effectiveness of using nudge theory as an approach to improve health behaviours amongst people in Sikkim, indicating that subtle cues and consultations empower patients to make better health choices. It highlights the importance of ongoing telephonic interventions combined with ambassador or consultation for improving AKAP, resulting in enhanced self-care and reduced complications. Policymakers and healthcare providers can use these nudge based results to create health initiatives that are scalable and culturally appropriate.
Conclusion: This study shows how nudge theory-based interventions, when combined with consultation, can significantly improve the awareness, knowledge, attitude, and practices of diabetes patients in Sikkim. These results indicate that such interventions can act as an effective approach to improve diabetes self-care attitude and patient’s health behaviour.
References
1. Dutta A, Dutta PK, Baruah SM, Dihingia P, Ray A,
Bhat DS, Patki SW, Tiwari P, Deshmukh M, Wagh R,
Mulchandani R. Non-autoimmune diabetes in young
people from Assam, India: the PHENOEINDY-2 study.
Diabetologia. 2025 Oct;68(10):2179-93.
2. Kharsati N, Kulkarni M. Living with diabetes in
Northeast India: An exploration of psychosocial
factors in management. Dialogues in Health. 2024 Jun
1;4:100180.
3. Muksor, A., & Parmar, D. (2023). Cultural Beliefs and
Practices in Self-Management of Diabetes Among Pnar
Women in Meghalaya, India. The Science of Diabetes
Self-Management and Care, 49(6), 462-476. https://
doi.org/10.1177/26350106231208155
4. Gogoi H, Borah L, Hussain I, Dutta SR, Kalita N,
Teron C, Saikia P, Rongpi S. A review on indigenous
medicinal plants of north eastindia used as antidiabetic.
Asian Journal of Pharmaceutical and Health Sciences.
2023;13(4).
5. Byahut A, Bag A. An update on medicinal plants
traditionally used to treat diabetes in southeast Sikkim,
India. Proceedings of the Indian National Science
Academy. 2022 Jun;88(2):186-96.
6. Perme O, Komut O, Boruah M. Knowledge, Attitude
and Practice of Diabetes among School Teachers in
Upper Siang District of Arunachal Pradesh: A Crosssectional
Study. Journal of Clinical & Diagnostic
Research. 2022 Oct 1;16(10).
7. Muksor A, Parmar D. Living with Diabetes in times of
COVID-19 pandemic: A Qualitative Study from West
Jaintia Hills, Meghalaya, India. Journal of North East
India Studies. 2022 Jan 1;12(1):8-32.
8. Rai P, Firdos S. Exploring the Trends, Patterns, and
Prevalence of Alcohol Consumption in Sikkim:
Insights from the National Family Health Survey
(NFHS). Global Social Welfare. 2025 Mar 7:1-7.
9. Ansari T, Sami W, Alsubaie N, Althaqib AA, Alenezi
AA, Almutairy AN, Alshamrani MA, Alanazi MA,
Almutairi MA. Assessment of knowledge, attitude,
and practice of dietary pattern in patients with type 2
diabetes mellitus: a locality-based perspective study.
International Journal of Medicine in Developing
Countries. 2019 Apr 4;3(7):581-5.
10. Dhakal D, Belinda N, Chanu KJ, Laishram S, Singh
AV, Ranabir.S. Hypoglycemia Awareness In Diabetes
Mellitus Patients Attending A Tertiary Care Centre In
North-East India. Int J Acad Med Pharm. 2024;6(6):241-5.
11. Malik BK, Goyal AK, Maiti S, Mohanty SK. Care
cascades of diabetes and hypertension among late
adolescents in India. Journal of Global Health. 2025
Mar 7;15:04101.
12. Satapathy J, Minj A, Chakrabarti K, Gupta P.
Knowledge, Awareness and Prevalence of Diabetic
Retinopathy among Patients of Type 2 Diabetes
Mellitus on Their First Visit to Eye Department in
a Tertiary Health Care Centre-A Hospital Based
Cross Sectional Study. J Evid Based Med Healthc.
2020;7(34):1770-5.
13. Pal R, Pal S, Barua A, Ghosh MK. Health education
intervention on diabetes in Sikkim. Indian journal of
endocrinology and metabolism. 2010 Jan 1;14(1):3-7.
14. Shriraam V, Mahadevan S, Anitharani M, Jagadeesh
NS, Kurup SB, Vidya TA, Seshadri KG. Reported
hypoglycemia in Type 2 diabetes mellitus patients:
Prevalence and practices-a hospital-based study.
Indian journal of endocrinology and metabolism. 2017
Jan 1;21(1):148-53.
15. Hood KK, Hilliard M, Piatt G, Ievers-Landis CE.
Effective strategies for encouraging behavior change in
people with diabetes. Diabetes Management (London,
England). 2015;5(6):499.
16. Anitha Rani M, Shriraam V. Are patients with type
2 diabetes not aware or are they unable to practice
self-care? A qualitative study in rural South India.
Journal of primary care & community health. 2019
Aug;10:2150132719865820.
17. Gadewar, O. B., & Kaur, J. (2023). A Study to Assess
the Effectiveness of Structured Teaching Program
on Practice and Attitude of Behavioral Risk Factors
of Diabetes and Hypertension in Adults of Selected
area of Pune City. DOI: https://dx.doi.org/10.21275/
SR231125152612
18. Shukla R, Yagnik D, Agarwal N, Gupta M, Ganguli B,
Shukla S, Bajpai A. Diabetes Educational Intervention
in Society to Improve (DESI) Quality of Life. Journal of
Diabetology. 2021 Apr 1;12(2):186-90.
19. Vaghela, J. F., Roy, M., Vaish, K., Mishra, R., & Mangal,
A. (2019). Integrated Health Unit of a Community
Health Department Creating Awareness on Nutrition,
Hypertension, Diabetes and Mental Health in a Slum
and Resettlement Colony in Delhi. Int. J. HealthCare
Edu. & Med. Inform, 6(2), 2. DOI: https://doi.or
20. Mohamed SS, Mohamed RF, Mohamed SH. Impact
of educational intervention program on diabetic
retinopathy patient’s compliance. American Journal of
Nursing. 2019;7(6):1000-8.
21. Chawla, Sumit Pal Singh1; Kaur, Sarabjot1; Bharti,
Aman1; Garg, Ravinder1,; Kaur, Manjeet1; Soin,
Divya1; Ghosh, Amrita2; Pal, Ranabir3. (2019). Impact
of health education on knowledge, attitude, practices
and glycemic control in type 2 diabetes mellitus.
Journal of Family Medicine and Primary Care 8(1):p
261-268.
22. Ramachandran, A., & Snehalatha, C. (2009). Current
scenario of diabetes in India. Journal of diabetes, 1(1),
18-28
23. Wang J, Cai C, Padhye N, Orlander P, Zare M. A
behavioral lifestyle intervention enhanced with
multiple-behavior self-monitoring using mobile and
connected tools for underserved individuals with type
2 diabetes and comorbid overweight or obesity: pilot
comparative effectiveness trial. JMIR mHealth and
uHealth. 2018 Apr 10;6(4):e4478.
24. Volpp KG, Asch DA, Galvin R, Loewenstein G.
Redesigning employee health incentives—lessons
from behavioral economics. New England Journal of
Medicine. 2011 Aug 4;365(5):388-90.
25. Agrawal S, Kritika, Pal R. Awareness on diabetes
among individuals attending Urban Health Training
Centre of a medical college of eastern Bihar, India.
26. Muthukumar A, Vasuki G, Oviya JP, Shahil VS, Bharath
RV, Bose MM. Clinical review on diabetic awareness
and knowledge among urban and rural population
in Coimbatore zone. Drug Invention Today. 2020 Jul
15;14(7).
27. Muralidharan S. Diabetes and current Indian scenario:
a narrative review. Journal of Diabetology. 2024 Jan
1;15(1):12-7.
28. Shilubane HN, Potgieter E. Patients’ and family
members’ knowledge and views regarding diabetes
mellitus and its treatment. Curationis. 2007 Sep
28;30(2):58-65.
29. Durai V, Samya V, Akila GV, Shriraam V, Jasmine A,
Muthuthandavan AR, Gayathri T, Mahadevan S. Selfcare
practices and factors influencing self-care among
type 2 diabetes mellitus patients in a rural health
center in South India. Journal of education and health
promotion. 2021 May 20;10:151.
30. Pal R, Pal S, Barua A, Ghosh MK. Health education
intervention on diabetes in Sikkim. Indian journal of
endocrinology and metabolism. 2010 Jan 1;14(1):3-7.
31. Shriraam V, Mahadevan S, Anitharani M, Jagadeesh
NS, Kurup SB, Vidya TA, Seshadri KG. Reported
hypoglycemia in Type 2 diabetes mellitus patients:
Prevalence and practices-a hospital-based study.
Indian journal of endocrinology and metabolism. 2017
Jan 1;21(1):148-53.
32. Hood KK, Hilliard M, Piatt G, Ievers-Landis CE.
Effective strategies for encouraging behavior change in
people with diabetes. Diabetes Management (London,
England). 2015;5(6):499.
33. Vlaev I, King D, Dolan P, Darzi A. The Theory and
Practice of “Nudging”: Changing Health Behaviors.
Public Adm. Rev. 2016;76(4): 550–61
34. Vande Velde F, Overgaard HJ, Bastien S. Nudge
strategies for behavior-based prevention and control
of neglected tropical diseases: A scoping review and
ethical assessment. PLOS Neglected Tropical Diseases.
2021 Nov 1;15(11):e0009239.
35. Wansink B, Just DR, Payne CR, Klinger MZ.
RETRACTED: Attractive names sustain increased
vegetable intake in schools.
36. Beaudoin, C. E., Fernandez, C., Wall, J. L., & Farley, T. A.
(2007). Promoting healthy eating and physical activity:
short-term effects of a mass media campaign. American
journal of preventive medicine, 32(3), 217-223.
37. Harrison, J. D., & Patel, M. S. (2020). Creating nudges
that work in health care. The AMA Journal of Ethics,
22(9), 796–801.
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