Tailoring and Co-designing Health Education Strategies for Older Adults with Comorbid Hypertension and Diabetes: A Qualitative Study

Abstract

Background: Effective chronic disease management for elderly patients with hypertension anddiabetes remains a significant challenge in community health settings. Peer education has been widely promoted as a strategy to enhance patient engagement, but its feasibility and effectiveness in specific local contexts require further examination. This study explores the development and iterative refinement of a community-based health management strategy tailored to elderly patients in Kunshan, China. Methods: A qualitative study was conducted using semi-structured interviews with elderly patients, their family members, community health workers, family physicians, and health officials. Data were analyzed using a framework informed by the Health Belief Model (HBM), focusing on perceived barriers, self-efficacy, and cues to action in chronic disease management. Results: Findings revealed significant barriers to health behavior change among elderly patients, including physical limitations, economic burdens, and competing household responsibilities. The study identified critical challenges that hindered the successful implementation of peer education strategies, such as low health literacy, limited peer leadership capacity, and preferences for professional guidance. In response, participants expressed receptiveness to technology-assisted health education tools. Voice-bot interventions were proposed as a feasible solution to enhance patient engagement and reduce healthcare provider workload. Conclusion: This study highlights the limitations of peer education models in the context of Kunshan and underscores the need for adaptable, technology-supported community health interventions. Future research should focus on patient-centered evaluations of Voice-bot interventions to assess their effectiveness in improving chronic disease management among elderly patients.