Precision health care strategies for older adults with diabetes in Indonesia: a Delphi consensus study

  • Satriya Pranata School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan; Faculty of Nursing and Health Sciences, Universitas Muhammadiyah Semarang, Semarang, Indonesia
  • Shu-Fang Vivienne Wu School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
  • Chun-Hua Chu Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
  • Khristophorus Heri Nugroho Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
Keywords: Delphi technique, diabetes, personal health service, precision health care, precision medicine
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BACKGROUND Studies on precision health care for older adults with diabetes in Indonesia are still limited. This study was aimed to reach the experts consensus on the suitable precision health care strategies for older adults with diabetes.

METHODS A total of 10 experts (4 physicians, 4 nurses, and 2 dietitians) agreed to participate in the 3-round interview using Delphi technique. The experts should have at least 5 years of experience in teaching or working as health professionals in a hospital.

RESULTS Consensus was reached that precision health care consisted of eight elements: self-management, interdisciplinary collaborative practice, personalized genetic or lifestyle factors, glycemic target, patient preferences, glycemic control, patient priority-directed care, and biodata- or evidence-based practice. The strategies of precision health care for diabetes were divided into seven steps: conducting brief deducting teaching; assessing self-management level and risk of cardiovascular disease; organizing a brainstorming session among patients to exchange experiences on glycemic target and specific target behavior; making a list of patients’ needs and ranking the priorities; setting a goal and writing action; doing follow-up; and reporting the goal attempts.

CONCLUSIONS The eight elements of precision health care provided the basis of precision health care strategies for diabetic older adults, which are the real and measurable strategies for precision health care implementation in clinical settings.


  1. Indonesian Ministry of Health. World diabetes day 2018. Indonesian Ministry of Health Data and Information Center; 2019. p. 1-8. Indonesian.

  2. Bradley D, Hsueh W. Type 2 diabetes in the elderly: challenges in a unique patient population. J Geriatr Med Gerontol. 2016;2(2):14.

  3. Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults. Diabetes Care. 2012;35(12):2650-64.

  4. International Diabetes Federation. IDF diabetes atlas. 9th ed. Brussels: 2019. Available from:

  5. Rachmawati U, Sahar J, Wati DNK. The association of diabetes literacy with self-management among older people with type 2 diabetes mellitus: a cross-sectional study. BMC Nurs. 2019;18(34).

  6. Badriah S, Sahar J, Gunawijaya J, Prasetyo S. Pampering older people with diabetes in Sundanese culture: a qualitative study. Enferm Clin. 2019;29 Suppl 2:733-8.

  7. Cimo A, Dewa CS. Tailoring Diabetes Education to meet the needs of adults with type 2 diabetes and mental illness: client and health-care provider perspectives from an exploratory pilot study. Can J Diabetes. 2019;43(6):421-8.

  8. Sassen B. Nursing: health education and improving patient self-management. Cham: Springer International Publishing; 2018.

  9. Bierman AS, Tinetti ME. Precision medicine to precision care: managing multimorbidity. Lancet. 2016;388(10061):2721-3.

  10. Corwin E, Redeker NS, Richmond TS, Docherty SL, Pickler RH. Ways of knowing in precision health. Nurs Outlook. 2019;67(4):293-301.

  11. Pranata S, Wu SFV, Alizargar J, Liu JH, Liang SY, Lu YY. Precision health care elements, definitions, and strategies for patients with diabetes: a literature review. Int J Environ Res Public Health. 2021;18(12):6535.

  12. Davies AK, McGale N, Humphries SE, Hirani SP, Beaney KE, Bappa DA, et al. Effectiveness of a self-management intervention with personalised genetic and lifestyle-related risk information on coronary heart disease and diabetes-related risk in type 2 diabetes (CoRDia): study protocol for a randomised controlled trial. Trials. 2015;16:547.

  13. Tinetti ME, Esterson J, Ferris R, Posner P, Blaum CS. Patient priority-directed decision making and care for older adults with multiple chronic conditions. Clin Geriatr Med. 2016;32(2):261-75.

  14. Hickey KT, Bakken S, Byrne MW, Bailey DCE, Demiris G, Docherty SL, et al. Precision health: advancing symptom and self-management science. Nurs Outlook. 2019;67(4):462-75. Erratum in: Nurs Outlook. 2020;68(2):139-40.

  15. Lai PC, Wu SV, Alizargar J, Pranata S, Tsai JM, Hsieh NC. Factors influencing self-efficacy and self-management among patients with pre-end-stage renal disease (Pre-ESRD). Healthcare (Basel). 2021;9(3):266.

  16. Grime MM, Wright G. Delphi method. In: Brandimarte P, Everitt B, Molenberghs G, Piegorsch W, Ruggeri F, editors. Wiley StatsRef: Statistics Reference Online; 2016. p. 1-6.

  17. Steurer J. The Delphi method: an efficient procedure to generate knowledge. Skeletal Radiol. 2011;40(8):959-96.

  18. Hickson L, Worrall L, Scarinci N. A randomized controlled trial evaluating the active communication education program for older people with hearing impairment. Ear Hear. 2007;28(2):212-30.

  19. Delavar F, Pashaeypoor S, Negarandeh R. The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: a randomized controlled trial. Patient Educ Couns. 2020;103(2):336-42.

  20. Qin W, Blanchette JE, Yoon M. Self-efficacy and diabetes self-management in middle-aged and older adults in the United States: a systematic review. Diabetes Spectr. 2020;33(4):315-23.

  21. Sherifali D, Bai JW, Kenny M, Warren R, Ali MU. Diabetes self-management programmes in older adults: a systematic review and meta-analysis. Diabet Med. 2015;32(11):1404-14.

  22. Chodosh J, Morton SC, Mojica W, Maglione M, Suttorp MJ, Hilton L, et al. Meta-analysis: chronic disease self-management programs for older adults. Ann Intern Med. 2005;143(6):427-38.

  23. Pariser P, Pham TT, Brown JB, Stewart M, Charles J. Connecting people with multimorbidity to interprofessional teams using telemedicine. Ann Fam Med. 2019;17(Suppl 1):S57-62.

  24. Wu SF, Lee MC, Liang SY, Lu YY, Wang TJ, Tung HH. Effectiveness of a self-efficacy program for persons with diabetes: a randomized controlled trial. Nurs Health Sci. 2011;13(3):335-43.

  25. Venkataraman K, Kannan AT, Kalra OP, Gambhir JK, Sharma AK, Sundaram KR, et al. Diabetes self-efficacy strongly influences actual control of diabetes in patients attending a tertiary hospital in India. J Community Health. 2012;37(3):653-62.

  26. Jiang X, Wang J, Lu Y, Jiang H, Li M. Self-efficacy-focused education in persons with diabetes: a systematic review and meta-analysis. Psychol Res Behav Manag. 2019;12:67-79.

  27. Barrot-de la Puente J, Mata-Cases M, Franch-Nadal J, Mundet-Tudurí X, Casellas A, Fernandez-Real JM, et al. Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database. Int J Clin Pract. 2015;69(12):1486-95.

  28. Saunders T. Type 2 diabetes self-management barriers in older adults: an integrative review of the qualitative literature. J Gerontol Nurs. 2019;45(3):43-54.

  29. Holt RIG. Personalized medicine for diabetes: a special issue. Diabet Med. 2016;33(6):711.

  30. Subramanian S, Hirsch IB. Personalized diabetes management: moving from algorithmic to individualized therapy. Diabetes Spectr. 2014;27(2):87-91.

  31. Spiegel AM, Hawkins M. 'Personalized medicine' to identify genetic risks for type 2 diabetes and focus prevention: can it fulfill its promise? Health Aff (Millwood). 2012;31(1):43-9.

  32. Mayor S. Individualising treatment and care of patients with diabetes. Prescriber. 2017;28:23-5.

  33. Horwitz RI, Charlson ME, Singer BH. Medicine based evidence and personalized care of patients. Eur J Clin Invest. 2018;48(7):e12945.

  34. Miñambres I, Mediavilla JJ, Sarroca J, Pérez A. Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain. BMC Endocr Disord. 2016;16:10.

  35. Sherifali D. Diabetes management in older adults: seeing the forest for the trees. Can J Diabetes. 2016;40(1):10-1.

  36. Sherifali D. Diabetes coaching for individuals with type 2 diabetes: a state-of-the-science review and rationale for a coaching model. J Diabetes. 2017;9(6):547-54.

  37. Sherifali D, Viscardi V, Bai JW, Ali RM. Evaluating the effect of a diabetes health coach in individuals with type 2 diabetes. Can J Diabetes. 2016;40(1):84-94.

  38. Sexton M, Baessler M. Interprofessional collaborative practice. J Contin Educ Nurs. 2016;47(4):156-7.

  39. Chen WC, Lin CC, Kuo CC, Wu CC, Liu TJ, Chen MT. A theorybased self-management training program for older adult peer leaders with diabetes: a feasibility assessment. J Multidiscip Healthc. 2021;14:33-44.

  40. Hood KK, Hilliard M, Piatt G, Ievers-Landis CE. Effective strategies for encouraging behavior change in people with diabetes. Diabetes Manag (Lond). 2015;5(6):499-510.

  41. Torabizadeh C, Jalali K, Moattari M, Moravej H. Effects of the problem solving technique in type 2 diabetic patients with cognitive impairment: a randomized clinical trial. Int J Community Based Nurs Midwifery. 2018;6(3):197-208.

How to Cite
Pranata S, Wu S-FV, Chu C-H, Nugroho KH. Precision health care strategies for older adults with diabetes in Indonesia: a Delphi consensus study. Med J Indones [Internet]. 2021Oct.7 [cited 2024Apr.21];30(3):221-7. Available from:
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