Introduction
Diabetes is currently one of the chronic diseases that Indonesians are most concerned about. Indonesia is ranked fifth, with approximately 19.5 million people suffering from diabetes in 2021 [1]. Diabetes is a chronic metabolic disorder characterized by high blood sugar levels due to insufficient insulin function [2, 3].
According to the International Diabetes Federation (IDF), 537 million adults worldwide aged 20-79 years suffer from diabetes, and this number is expected to increase to 643 million (one in nine elderly) by 2030 and 784 million (one in eight elderly) by 2045 [1]. The estimated number of people with diabetes in Central Java Province in 2021 was 618,546 people, and 91.5% had received health services according to standards. There are 11 districts/cities with a percentage of health services for people with diabetes greater than 100%, while the district/city with the lowest achievement is Pemalang [4]. 
To improve the self-management of diabetic patients, the government has five pillars: Education, nutrition, diet, physical exercise and pharmacology [5, 6]. Diabetes self-management has been developed to improve the quality of life of diabetic patients, one of which is self-management [7–9]. These efforts still focus on the patient’s perspective; however, self-management can help patients with diabetes at hospital discharge. Utilizing current electronic information technology (EIT) is one of the many ways to teach self-management [10–12]. One example is the development of EIT at an urban university hospital in Japan, Tokyo University Hospital, which treats patients with diabetes older than 20 years. The results showed that 16% of patients used information and communication technology (ICT)-based self-management tools, which made it easier and more effective for healthcare providers to disseminate such tools to patients [11]. 
Studies have shown that EIT can increase hospital productivity [11]. Android-based electronic information technologies can be developed, including diabetes care applications [13–15]. This application can be used as a reference for controlling blood glucose levels during type 2 diabetes treatment to reduce complications caused by uncontrolled blood glucose levels [16–18]. This indicates that there have been many studies and that EIT has become a trend in hospitals and various countries. However, many hospitals have not yet developed EIT as a key technology in the delivery of improved quality of care to diabetes patients. Before implementing EIT in Indonesia, there may be a need to change policymakers’ views on EIT for diabetes patients to find gaps and solutions [19]. This research is crucial for addressing the issues that occur in Indonesia, specifically regarding diabetes control programs that exist in various health facilities but have not been fully optimized. Thus, the purpose of this study was to explore perspectives on improving diabetes self-management using EIT at hospitals in Semarang, Indonesia, by conducting in-depth interviews.

Methods
Study design
This qualitative research used a phenomenological approach.

Sample and location
The participants in this study were 15 policymakers at hospitals in Semarang City, including the general director, head of nursing, head of management information system (SIM), head of hospital health promotion, nurses, specialist doctors, pharmacists, and dieticians. The inclusion criterion was heads of the health sector and nurses with a work experience of at least five years. The samples were selected using purposive sampling. The method used for qualitative analysis was inductive. This research was conducted at Roemani Semarang Hospital. The in-depth interviews lasted approximately 20 minutes. 

Data collection 
This research was conducted from November 2023 to February 2024 at hospitals in Semarang. During data collection, the researcher began by identifying the location for the interviews. Each interview lasted approximately 20 minutes, and the information was gathered through both recording and note-taking. Before conducting the in-depth interviews, the researcher met with the participants in the designated room and provided informed consent forms, which were then signed by the participants to indicate their agreement to participate in the interviews. The researcher prepared interview aids and then conducted in-depth interviews with participants using the following questions) What do you think about the patient’s perspective on the use of Android-based technology to improve the self-management of diabetic patients?; 2) What do you think about the use of Android-based technology to improve the self-management of diabetic patients, and what percentage of the recovery rate do you believe diabetic patients achieve?; 3) Is there EIT in this hospital that can improve the self-management of diabetic patients?; 4) Do you think EIT in this hospital can improve the self-management of diabetic patients?; 5) Is the use of EIT in this hospital effective for diabetic patients to improve self-management?; 6) Are there any impacts or complications for diabetic patients regarding the use of EIT in this hospital? If so, please mention and explain.; 7) Why do you think EIT has not been able to be implemented in this hospital? The interview was conducted to explore participants’ perspectives on efforts to improve self-management of diabetic patients using EIT. The interview activity concluded after all required information had been completely obtained.

Data analysis
Data analysis in this phenomenological research used the Collaizzi method, which aims to describe the meaning of an experience identified through the important themes of a phenomenon consisting of seven stages [20]: 1) Re-reading all interview data and field notes repeatedly to get a full understanding of what is contained in the interview results, without adding personal assumptions from the researcher; 2) The researcher reviewed the data and made a list of specific and significant questions about the phenomena presented by each participant; 3) The researcher articulated the meaning of each specific and significant question by selecting keywords; 4) The researcher grouped the keywords into categories and themes and also reviewed the original data to validate the groupings and noted the differences between the various groups to avoid the possibility of incompatible data or themes; 5) The researcher integrated the results into a description based on the themes that have been compiled; 6) The researcher formulated a complete description of the phenomenon under study in the form of clear statements and a basic structure; 7) The researcher validated the findings of the themes with the participants to ensure alignment with the circumstances experienced by them.
In qualitative research, saturated data are obtained when the data collected are sufficient to draw the necessary conclusions, and further data collection will not yield additional valuable insights. Data analysis in this study was manual. The interviewer was confident that the opinions expressed were authentic because they fully understood the content and what data were needed to address the questions posed to the researcher. Informed consent was provided to the researcher to ensure that no information was added or omitted. The information obtained was analyzed using open coding.

Rigor of study
The researcher obtained data through interviews with credentialed policymakers at the hospital. The participants consisted of both men and women. The participants included both men and women, with general occupations such as managing director, head of nursing, specialist, doctor, dietician, administrator, and pharmacist. They were researchers who have conducted many studies published in many journals. The participants were not related to each other. After an explanation from the researcher, the participants understood that the purpose of the study was to explore policymakers’ perspectives on EIT and self-management among diabetic patients. A potential bias in this study is that the interviewer believes the opinions expressed are authentic because they fully understand the content and what data is needed to address the questions posed to the researcher. The methodology used in this study was phenomenology, and the sampling method was purposive sampling which involved face-to-face interviews with a total of 15 participants. None of the participants refused to participate; however, some preferred not to be recorded and requested that their responses be noted by hand instead.
The data were collected at the hospital, with important characteristics of the participants being assessed through demographic data, including age, gender and education. During the data collection process, there was no one present other than the researcher and the intended participants. The questions, instructions and guidelines provided by the researcher did not require testing; instead, repeated interviews were conducted 14 times. After identifying similarities with previous interviews, the researcher would stop the interviews to avoid wasting data in the future. This data collection utilized audio recordings and field notes made during interviews, which lasted approximately 20 minutes. In qualitative research, saturated data were obtained when the collected data were sufficient to draw necessary conclusions and further data collection will not yield additional valuable insights. Transcripts were returned to the researcher and corrected by the researcher to ensure no information was added or subtracted. In this study, three codes were obtained, which included themes, sub-themes and example quotes. The themes formed were derived from descriptions based on participant quotes, and the data was processed manually. Participants were asked to confirm that what they described reflected their own findings.
The themes were derived from the sub-themes, which were short descriptions derived from the participants’ quotes. The researcher ensured that the data were consistent with the findings. Major themes were clearly presented in the findings, and four themes and minor themes derived from the descriptions of participant quotes were found.

Results
The participants in this study were heads of the health sector and nurses with a work experience of five years with an average age of 25 years and over. Characteristic of respondents presented in Table 1, further sub-theme of each theme presented in Tables 2, 3 and 4.












Understanding of the use of media to improve self-management through health information
The researcher identified the theme: Information through existing media is not effective.

Reasons for using EIT at hospitals for diabetic patients
Researchers identified a theme: The pros and cons of digital technology in hospitals. Patient understanding in recovery and the importance of providing education to diabetic patients. The researchers identified a theme: Self-management education to increase self-awareness is needed.

Discussion
Diabetic patients can obtain additional information through applications that provide monitoring and education. However, information obtained through social media is not recommended at several hospitals, as the primary source of information for patient education is video content from hospitals. Although there are no special media for diabetic patients, a need for the development of information tailored to the needs of diabetic patients in the hospital. Research supports the use of ICT in healthcare, but there is no research that demonstrates it is necessary. In Europe, only 14% of type 2 diabetes patients who used the web app consented to the study, while the rest did not consent due to lack of access to the Internet [21–23]. Therefore, it is essential to determine who is willing to use such tools for effective and low-cost diabetes management [24–27]. 
The use of technology in healthcare has both positive and negative impacts. Based on the results of this study, on the positive side, technology can improve the efficiency and accessibility of information. The effectiveness of digital technology is also evident in enhancing the self-management skills of diabetic patients, particularly in controlling their nutrition and diet. On the negative side, various constraints, including limited human resources, finances, and technological readiness, are obstacles to realizing the implementation of technology in hospitals in Semarang. There is supporting research on patients' willingness to use ICT in diabetes self-control [28–30]. With the rapid advancement of ICT, the use of the Internet and mobile devices is expected to help diabetes management. By enabling real-time and remote monitoring of data, such as blood glucose levels at home, these technologies can address time and location challenges. However, some patients are not willing to use ICT-based self-management tools for several reasons, including feelings of burden, satisfaction with their current management activities, perceptions of difficulty in using the tools, boredom, lack of time, beliefs about ineffectiveness and concerns that their health condition is too poor to utilize them [31, 32].
Self-management efforts play an important role for patients in managing their condition. Involving social media as a tool to provide health education can be a fairly effective strategy, allowing patients to get more extensive and in-depth information. In diabetes self-management efforts, self-readiness and family support also play an important role [33, 34]. The presence of family as a source of support can provide motivation and practical assistance for patients, strengthening their ability to manage their diabetes more effectively. In Japan, only 36% of hospitalized diabetic patients were able to maintain improved hemoglobin (HbA1c) levels for two years, suggesting that self-management education and family support are essential for diabetic patients [5, 35, 36]. One way that nurses can assist diabetic clients in gaining knowledge and skills for diabetes self-management to prevent long-term complications is by providing health education [10, 37]. Understanding the importance of self-understanding is crucial for diabetes patients, especially in terms of maintaining a regular schedule, type, and amount of food, particularly for those taking blood glucose-lowering drugs or insulin. The extent, to which patients are self-aware and able to perform self-care aimed at controlling their symptoms and preventing complications is key to successful diabetes treatment. Self-awareness is important for people with diabetes to improve adherence to dietary management, physical activity, consumption of anti-diabetic medications, and the prevention of disease complications. 

Conclusion 
Several hospitals have not recommended the use of EIT for diabetic patients, even though there is some video content from hospital health promotion that does not fully meet the needs of diabetes patients. While digital technology can improve collaboration between health workers and patients, its effectiveness may be reduced for those less familiar with technology. Constraints, such as human resources, finances, and technology readiness can hinder the implementation of technology in hospitals. Education is recognized as key to improving patient understanding, especially in the context of diabetes self-management among the elderly. Social media can be a fairly effective strategy f for providing broader and deeper education. Family support and self-readiness also play an important role in motivating and assisting patients in managing their diabetes.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Universitas Muhammadiyah Semarang, Semarang, Indonesia (Code: 313/KE/11/2023; dated December 11, 2023). Furthermore, during the study, the participants were in contact with the researcher by phone to solve possible problems and answer questions. To comply with ethical principles, participants were well-informed about the research.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Conceptualization and writing: All authors; Methodology, investigation, and resources: Nayandra Keysha; Validation, formal analysis, data curation and supervision: Satriya Pranata.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to express their gratitude to all participants in this study.


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