I
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t
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l J
o
urna
l o
f
I
nfo
rm
a
t
ics a
nd
Co
m
m
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n T
ec
hn
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lo
g
y
(
I
J
-
I
CT
)
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
,
p
p
.
553
~
5
6
4
I
SS
N:
2252
-
8
7
7
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DOI
:
1
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.
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.
v15
i
2
.
pp
553
-
5
6
4
553
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:
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ttp
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m
A mH
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del f
o
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pa
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Dec
3
1
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2
0
2
4
R
ev
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Ma
r
4
,
2
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Ma
r
3
0
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is
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p
s
a
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d
v
a
li
d
a
tes
a
m
o
b
il
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h
e
a
lt
h
(m
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a
lt
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)
a
d
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p
ti
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m
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to
e
n
h
a
n
c
e
d
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e
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se
lf
-
m
a
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m
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t
a
m
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p
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te
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it
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DM)
p
a
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ts
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n
UN
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p
r
ima
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h
e
a
lt
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c
a
re
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li
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a
c
ro
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P
a
les
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ian
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e
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a
m
p
s.
T
h
is
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d
y
fi
ll
s
a
g
a
p
in
re
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a
rc
h
o
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m
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a
lt
h
a
d
o
p
ti
o
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i
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w
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re
so
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rc
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g
s
b
y
c
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m
b
in
in
g
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e
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h
n
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lo
g
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a
c
c
e
p
tan
c
e
m
o
d
e
l
(TAM
),
tas
k
-
tec
h
n
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lo
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y
fit
(T
TF
),
a
n
d
se
lf
-
e
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c
y
th
e
o
ry
(S
ET
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.
A
d
e
sc
rip
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v
e
,
c
ro
ss
-
se
c
ti
o
n
a
l
d
e
sig
n
wa
s
e
m
p
lo
y
e
d
u
sin
g
a
stru
c
tu
re
d
,
v
a
li
d
a
ted
q
u
e
sti
o
n
n
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ir
e
a
d
m
in
is
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d
to
5
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2
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p
a
ti
e
n
ts.
Re
li
a
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a
n
a
ly
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iel
d
e
d
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h
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tern
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l
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o
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y
(Cro
n
b
a
c
h
’s
α
=
0
.
8
0
8
–
0
.
9
6
6
).
S
tru
c
tu
ra
l
e
q
u
a
ti
o
n
m
o
d
e
li
n
g
(S
EM
)
u
sin
g
S
P
S
S
a
n
d
AMOS
v
a
li
d
a
ted
th
e
m
o
d
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l
fit
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e
v
i
d
e
n
c
e
d
b
y
a
c
o
m
p
a
ra
ti
v
e
fit
in
d
e
x
(CF
I)
o
f
0
.
9
4
1
a
n
d
a
ro
o
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m
e
a
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a
p
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S
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o
f
0
.
0
4
8
.
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t
o
f
t
h
e
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lev
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n
fa
c
to
rs
th
a
t
we
re
e
x
a
m
in
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d
,
P
e
rc
e
iv
e
d
Us
e
fu
l
n
e
ss
h
a
d
t
h
e
m
o
st
p
o
siti
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imp
a
c
t
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se
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m
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>
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).
T
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u
sa
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,
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ss
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a
n
d
t
o
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f
u
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ti
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n
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s
c
e
n
tral
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m
o
ti
n
g
m
He
a
lt
h
u
se
.
T
h
e
v
a
li
d
a
ted
m
o
d
e
l
c
a
n
b
e
m
o
d
if
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e
d
fo
r
o
th
e
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c
h
ro
n
ic
d
ise
a
se
se
tt
in
g
s
i
n
c
o
m
p
a
ra
b
le
h
e
a
lt
h
c
a
re
e
n
v
ir
o
n
m
e
n
ts
a
n
d
p
r
o
v
i
d
e
s
p
ra
c
ti
c
a
l
a
d
v
ice
fo
r
c
re
a
ti
n
g
p
a
ti
e
n
t
-
c
e
n
tere
d
m
He
a
lt
h
in
terv
e
n
ti
o
n
s.
K
ey
w
o
r
d
s
:
Mo
b
ile
h
ea
lth
Self
-
ca
r
e
m
an
ag
em
e
n
t
Stru
ctu
r
al
eq
u
atio
n
m
o
d
elin
g
T
ec
h
n
o
lo
g
y
ad
o
p
tio
n
T
y
p
e
2
d
iab
etes m
ellitu
s
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
R
aja
R
in
a
R
a
ja
I
k
r
am
Facu
lty
o
f
I
n
f
o
r
m
atio
n
an
d
C
o
m
m
u
n
icatio
n
T
e
ch
n
o
l
o
g
y
,
Un
iv
er
s
iti
T
ek
n
ik
al
Ma
lay
s
ia
Me
lak
a
Ma
lacc
a,
Ma
lay
s
ia
E
m
ail: r
aja.
r
in
a@
u
tem
.
ed
u
.
m
y
1.
I
NT
RO
D
UCT
I
O
N
T
h
e
ch
r
o
n
ic
illn
ess
k
n
o
wn
as
d
iab
etes
m
ellitu
s
(
DM
)
is
ch
ar
ac
ter
ized
b
y
th
e
b
o
d
y
'
s
in
ca
p
ac
ity
to
p
r
o
p
er
l
y
m
eta
b
o
lize
g
l
u
co
s
e,
wh
ich
lea
d
s
to
c
o
n
tin
u
o
u
s
ly
in
cr
ea
s
ed
b
lo
o
d
g
lu
c
o
s
e
l
ev
els
[
1
]
.
I
n
s
u
lin
r
esis
tan
ce
an
d
a
p
r
o
g
r
ess
iv
e
d
ec
r
ea
s
e
in
in
s
u
lin
p
r
o
d
u
ct
io
n
ar
e
s
y
m
p
to
m
s
o
f
ty
p
e
2
d
iab
etes
m
ellitu
s
(
T
2
DM
)
,
th
e
m
o
s
t
co
m
m
o
n
t
y
p
e,
o
f
ten
ass
o
ciate
d
with
s
ed
en
tar
y
life
s
ty
les
an
d
h
ig
h
B
MI
[
1
]
.
I
n
Palest
in
e,
th
e
o
n
g
o
i
n
g
I
s
r
ae
li
-
Palest
in
ian
co
n
f
lict
h
as
in
ten
s
if
ied
p
s
y
ch
o
lo
g
ical
an
d
s
o
cial
d
is
tr
ess
,
p
ar
ticu
lar
ly
am
o
n
g
v
u
ln
er
ab
le
p
o
p
u
latio
n
s
.
T
h
ese
co
n
d
itio
n
s
h
av
e
led
to
h
ig
h
er
p
r
e
v
alen
ce
s
o
f
an
x
iety
,
d
e
p
r
ess
io
n
,
an
d
p
o
s
t
-
tr
au
m
atic
s
tr
ess
d
is
o
r
d
er
[
2
]
,
wh
ich
in
tu
r
n
c
o
m
p
licate
th
e
m
an
ag
em
en
t
a
n
d
p
r
o
g
r
ess
io
n
o
f
ch
r
o
n
ic
illn
ess
es
s
u
ch
as T
2
DM
[
3
]
.
Mo
b
ile
h
ea
lth
(
m
Hea
lth
)
s
o
lu
tio
n
s
h
av
e
d
em
o
n
s
tr
ated
g
r
ea
t
p
r
o
m
is
e
in
p
r
o
m
o
ti
n
g
d
iab
etes
m
an
ag
em
en
t
an
d
s
elf
-
ca
r
e
o
n
a
g
lo
b
al
s
ca
le.
Fo
r
ex
am
p
le,
a
Mo
r
o
cc
an
s
tu
d
y
f
o
u
n
d
th
at
m
Hea
lth
to
o
ls
ar
e
wid
ely
ac
c
ep
ted
,
wh
ich
g
o
t
8
9
.
3
%
o
f
d
o
cto
r
s
an
d
8
2
%
o
f
p
atien
ts
ac
k
n
o
wled
g
in
g
th
eir
p
o
ten
tial
to
en
h
a
n
ce
d
iab
etes
ca
r
e
[
4
]
.
Similar
ly
,
ev
en
i
n
en
v
ir
o
n
m
en
ts
with
lim
ited
r
eso
u
r
ce
s
,
a
m
o
b
ile
-
b
ased
ed
u
ca
tio
n
al
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
7
7
6
I
n
t J I
n
f
&
C
o
m
m
u
n
T
ec
h
n
o
l
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
5
5
3
-
5
6
4
554
p
r
o
g
r
a
m
in
I
n
d
o
n
esia g
r
ea
tly
i
m
p
r
o
v
e
d
th
e
s
elf
-
ca
r
e
s
k
ills
o
f
T
2
DM
p
atien
ts
[
5
]
.
No
n
eth
el
ess
,
a
f
ew
en
d
u
r
in
g
o
b
s
tacle
s
p
r
ev
en
t
th
e
s
u
cc
ess
f
u
l
d
ep
lo
y
m
e
n
t
o
f
m
Hea
lth
.
Patien
ts
'
k
n
o
wled
g
e
o
f
m
an
ag
i
n
g
th
eir
d
iab
etes
is
f
r
eq
u
e
n
tly
lim
ited
b
y
in
ad
e
q
u
ate
d
iab
etes
ed
u
ca
tio
n
,
p
ar
tic
u
lar
ly
in
co
m
m
u
n
iti
es
with
lim
ited
r
eso
u
r
ce
s
[
6
]
.
Fu
r
th
er
m
o
r
e
,
th
e
u
s
ab
ilit
y
an
d
r
elev
an
ce
o
f
m
an
y
m
Hea
lth
ap
p
licatio
n
s
ar
e
co
m
p
r
o
m
is
ed
b
y
th
eir
lack
o
f
u
s
er
-
ce
n
ter
ed
d
esig
n
.
T
h
ese
o
b
s
tacle
s
ar
e
p
ar
ticu
lar
ly
n
o
ticea
b
le
in
th
e
Palest
in
ian
co
n
tex
t,
esp
ec
ially
in
th
e
UNRW
A
-
r
u
n
Palest
in
ian
r
ef
u
g
ee
ca
m
p
s
,
w
h
er
e
th
e
r
e
a
r
e
s
ig
n
if
ica
n
t
ec
o
n
o
m
ic,
p
s
y
ch
o
lo
g
ical,
an
d
e
d
u
ca
tio
n
al
lim
itatio
n
s
.
T
h
ese
ca
m
p
s
r
ep
o
r
t th
e
h
ig
h
est p
r
ev
alen
ce
o
f
T
2
DM
in
th
e
co
u
n
tr
y
,
y
et
f
ew
s
tu
d
ies h
av
e
s
p
ec
if
ically
tar
g
eted
th
ese
p
o
p
u
latio
n
s
[
7
]
,
[
8
]
.
W
h
ile
ea
r
lier
s
tu
d
ies
h
av
e
e
x
p
l
o
r
ed
th
e
im
p
ac
t
o
f
m
Hea
lth
o
n
g
e
n
er
al
d
iab
etic
ca
r
e,
th
ey
h
av
e
n
o
t
e
x
p
licitly
ad
d
r
ess
ed
its
in
f
lu
en
ce
o
n
p
at
ien
t
b
eh
av
i
o
r
,
s
elf
-
ef
f
icac
y
,
a
n
d
tech
n
o
lo
g
ical
f
it
with
in
g
o
v
e
r
n
m
e
n
t
-
r
eg
u
lated
r
ef
u
g
ee
ca
m
p
h
ea
lth
ca
r
e
s
y
s
tem
s
.
T
h
is
s
tu
d
y
ex
am
in
e
d
h
o
w
m
Hea
lth
ad
o
p
tio
n
am
o
n
g
T
2
DM
p
atien
ts
in
Palest
in
ian
p
r
im
ar
y
h
ea
lth
ca
r
e
f
ac
ilit
ies
wa
s
af
f
ec
ted
b
y
task
-
tech
n
o
lo
g
y
f
it
(
T
T
F)
,
u
s
er
p
er
ce
p
tio
n
s
,
an
d
s
elf
-
ef
f
icac
y
.
W
h
ile
ea
r
lier
s
tu
d
ies
h
av
e
ex
p
lo
r
e
d
th
e
im
p
ac
t
o
f
m
Hea
lth
o
n
g
en
er
al
d
iab
etes
m
an
ag
em
e
n
t,
th
e
y
h
a
v
e
n
o
t
ex
p
licitly
ad
d
r
ess
ed
its
in
f
lu
en
ce
o
n
in
d
iv
id
u
al
b
eh
a
v
i
o
r
al
in
ten
tio
n
(
B
I
)
an
d
to
o
l
u
s
ag
e
in
g
o
v
er
n
m
en
t
-
r
u
n
s
ettin
g
s
s
u
ch
as UN
R
W
A
ca
m
p
s
.
T
h
e
tech
n
o
lo
g
y
ac
ce
p
tan
ce
m
o
d
el
(
T
AM
)
[
9
]
,
[
1
0
]
,
TTF
[
1
1
]
-
[
1
3
]
an
d
s
elf
-
ef
f
icac
y
th
e
o
r
y
(
SET
)
[
1
4
]
-
[
1
6
]
ar
e
th
r
ee
th
e
o
r
e
tica
l
f
r
am
ewo
r
k
s
th
at
ar
e
in
c
o
r
p
o
r
ated
in
to
th
is
s
tu
d
y
'
s
p
r
o
p
o
s
ed
an
d
v
alid
ated
in
teg
r
ated
m
Hea
lth
ad
o
p
tio
n
m
o
d
el
to
f
ill
th
is
g
ap
.
T
h
e
m
o
d
els
wer
e
d
esig
n
ed
to
lo
o
k
at
elev
en
elem
en
ts
th
at
af
f
ec
t
h
o
w
p
eo
p
le
u
s
e
m
Hea
lth
to
o
ls
.
T
h
ey
in
clu
d
e
wh
at
th
e
task
r
eq
u
ir
es,
h
o
w
well
th
e
to
o
l
f
u
n
ctio
n
s
,
h
o
w
o
f
ten
it
is
u
s
ed
,
t
h
e
in
ten
tio
n
t
o
u
s
e
it,
h
o
w
ea
s
y
an
d
u
s
ef
u
l
u
s
er
s
th
in
k
it
is
,
th
eir
b
eh
av
i
o
r
s
an
d
p
er
f
o
r
m
a
n
ce
,
as we
ll a
s
th
eir
co
n
f
id
en
ce
a
n
d
ex
p
ec
tatio
n
s
o
f
th
e
r
esu
lts
.
B
y
an
s
wer
in
g
th
e
f
o
llo
win
g
r
esear
ch
q
u
es
tio
n
s
:
(
1
)
W
h
at
a
r
e
th
e
k
e
y
f
ac
to
r
s
in
f
lu
e
n
cin
g
s
elf
-
ca
r
e
m
an
ag
em
en
t
am
o
n
g
T
2
DM
p
atien
ts
?
(
2
)
Ho
w
d
o
es
m
o
b
ile
h
ea
lth
(
m
Hea
lth
)
u
s
ag
e
af
f
ec
t
d
iab
etes
s
elf
-
ca
r
e
m
an
ag
em
en
t?
(
3
)
W
h
ich
th
e
o
r
etica
l
m
o
d
el
b
est
e
x
p
lain
s
m
Hea
lth
ad
o
p
tio
n
f
o
r
im
p
r
o
v
in
g
s
elf
-
ca
r
e
i
n
U
N
R
W
A
h
e
a
l
t
h
c
a
r
e
c
e
n
t
r
es
?
an
d
(
4
)
C
a
n
t
h
e
p
r
o
p
o
s
e
d
m
o
d
e
l
b
e
v
a
l
i
d
a
t
e
d
t
o
s
u
p
p
o
r
t
d
i
a
b
e
t
e
s
s
e
l
f
-
ca
r
e
a
m
o
n
g
T
2
D
M
p
a
t
i
e
n
ts
?
T
h
is
r
es
e
a
r
c
h
o
f
f
e
r
s
a
n
e
w
,
s
i
t
u
a
t
i
o
n
-
s
p
e
c
i
f
ic
f
r
a
m
e
w
o
r
k
.
T
h
e
v
a
l
i
d
a
t
e
d
m
o
d
e
l
i
n
t
e
n
d
s
t
o
g
u
i
d
e
f
u
t
u
r
e
d
i
g
i
t
a
l
h
e
al
t
h
s
o
l
u
t
i
o
n
im
p
l
e
m
e
n
t
a
t
i
o
n
i
n
u
n
d
e
r
s
e
r
v
e
d
a
n
d
r
e
s
o
u
r
c
e
-
c
o
n
s
t
r
ai
n
e
d
h
e
a
lt
h
c
a
r
e
s
et
t
i
n
g
s
,
l
i
k
e
U
N
R
W
A
c
l
i
n
i
c
s
i
n
P
a
le
s
t
i
n
e
,
an
d
i
n
f
o
r
m
t
h
e
d
e
s
i
g
n
o
f
u
s
e
r
-
c
en
t
r
i
c
m
H
e
al
t
h
i
n
t
e
r
v
e
n
ti
o
n
s
.
T
h
is
r
esear
ch
is
n
o
v
el
b
ec
au
s
e
it
was
in
v
esti
g
ated
in
a
h
ig
h
-
b
ar
r
ie
r
s
ce
n
ar
io
.
T
h
e
in
f
o
r
m
atio
n
was
g
ath
er
ed
f
r
o
m
T
2
DM
p
atien
ts
in
UNRW
A
r
ef
u
g
ee
ca
m
p
s
,
a
g
o
v
er
n
m
en
t
-
r
u
n
h
ea
lth
ca
r
e
s
y
s
tem
in
Palest
in
e
wh
er
e
ac
ce
s
s
an
d
r
esear
c
h
r
e
q
u
ir
e
n
e
g
o
tiatin
g
i
n
tr
icat
e
leg
al
an
d
eth
ical
p
r
o
ce
s
s
es.
Few
s
tu
d
ies
h
av
e
lo
o
k
ed
at
T
2
DM
p
atien
ts
'
ad
o
p
tio
n
o
f
m
Hea
lth
in
s
u
ch
lim
ited
,
p
o
lit
ically
s
en
s
itiv
e,
an
d
u
n
d
er
s
er
v
ed
s
ettin
g
s
.
2.
P
RO
P
O
SE
D
M
O
D
E
L
T
h
e
s
u
g
g
ested
m
o
d
el
co
m
b
in
es
th
r
ee
well
-
k
n
o
wn
m
o
d
els
,
wh
ich
ar
e
T
AM
,
T
T
F,
an
d
SET
,
in
o
r
d
er
to
b
etter
u
n
d
er
s
tan
d
an
d
im
p
r
o
v
e
m
Hea
lth
tech
n
o
lo
g
y
ad
o
p
tio
n
am
o
n
g
p
atien
ts
with
ty
p
e
2
d
iab
etes.
T
h
e
T
T
F
m
o
d
el
ass
ess
es
h
o
w
w
ell
tech
n
o
lo
g
y
f
its
task
r
eq
u
ir
em
en
ts
an
d
u
s
er
ca
p
ab
ilit
ies,
h
ig
h
lig
h
tin
g
th
e
s
ig
n
if
ican
ce
o
f
c
u
s
to
m
izin
g
m
Hea
lth
f
ea
tu
r
es
to
m
ee
t
th
e
u
n
iq
u
e
r
eq
u
ir
e
m
en
ts
o
f
p
a
tien
ts
with
ty
p
e
2
d
iab
etes,
in
clu
d
in
g
b
l
o
o
d
g
l
u
co
s
e
m
an
ag
em
en
t,
p
h
y
s
ical
ac
tiv
ity
tr
ac
k
in
g
,
an
d
ed
u
ca
tio
n
al
r
eso
u
r
ce
ac
ce
s
s
.
T
ask
r
eq
u
i
r
em
en
ts
,
wh
ic
h
ar
e
s
p
ec
if
ic
task
s
th
at
p
atien
ts
with
ty
p
e
2
d
ia
b
etes
m
u
s
t
m
an
ag
e
,
tech
n
o
l
o
g
y
ch
ar
ac
ter
is
tics
,
wh
ich
ar
e
th
e
f
ea
tu
r
es
o
f
m
Hea
lth
ap
p
licatio
n
s
,
an
d
TTF
,
as
th
e
d
eg
r
ee
to
wh
ich
m
Hea
lth
s
atis
f
ies p
atien
t n
ee
d
s
,
ar
e
im
p
o
r
tan
t m
o
d
el
co
n
s
tr
u
cts
[
1
7
]
.
Per
ce
iv
ed
u
tili
ty
(
PU)
an
d
p
er
ce
iv
ed
ea
s
e
o
f
u
s
e
(
PEOU
)
ar
e
th
e
two
m
ain
co
n
s
tr
u
cts
th
at
th
e
T
AM
u
s
es
to
ex
p
lain
u
s
er
ac
ce
p
ta
n
ce
o
f
tech
n
o
l
o
g
y
.
PEOU
r
e
f
er
s
to
th
e
ea
s
e
o
f
u
s
e
o
f
m
Hea
lth
ap
p
licatio
n
s
with
o
u
t
r
eq
u
ir
in
g
a
h
ig
h
lev
e
l
o
f
tech
n
ical
ex
p
er
tis
e,
wh
ile
PU
r
ep
r
esen
ts
p
atien
ts
'
o
p
i
n
io
n
s
r
eg
ar
d
i
n
g
th
e
tech
n
o
lo
g
y
'
s
ad
v
an
tag
es
in
i
m
p
r
o
v
i
n
g
d
iab
etes
s
elf
-
m
an
a
g
em
en
t
in
th
e
co
n
te
x
t
o
f
m
Hea
lth
f
o
r
ty
p
e
2
d
iab
etes
[
1
8
]
,
[
1
9
]
.
Fu
r
th
er
m
o
r
e,
th
e
in
te
n
tio
n
to
em
b
r
ac
e
an
d
r
eg
u
lar
ly
u
s
e
m
Hea
lth
s
o
lu
tio
n
s
is
ca
p
tu
r
ed
b
y
BI
[
2
0
]
.
Acc
o
r
d
in
g
t
o
T
AM
,
u
s
er
s
'
BI
r
eg
ar
d
in
g
th
e
ad
o
p
tio
n
o
f
n
ew
tech
n
o
l
o
g
y
is
g
r
ea
t
ly
in
f
lu
en
ce
d
b
y
PU
an
d
PEOU
[
2
1
]
.
T
h
e
SET
p
o
in
ts
o
u
t
p
e
o
p
le'
s
co
n
f
id
en
ce
in
th
eir
ca
p
ac
ity
t
o
ca
r
r
y
o
u
t
task
s
,
lik
e
u
s
in
g
m
Hea
lth
to
m
an
ag
e
ty
p
e
2
d
ia
b
etes.
I
t c
o
n
s
is
t
s
o
f
two
m
ain
co
m
p
o
n
e
n
ts
wh
ich
th
e
f
ir
s
t o
n
e
is
o
u
tco
m
e
ex
p
ec
tan
cy
,
as th
e
co
n
v
ictio
n
th
at
u
s
in
g
m
Hea
lth
will
r
esu
lt
in
f
av
o
r
ab
le
h
ea
lth
o
u
tco
m
es
,
an
d
th
e
s
ec
o
n
d
is
ef
f
icac
y
ex
p
ec
tan
cy
,
as
th
e
ass
u
r
an
ce
th
at
m
Hea
lth
will
p
r
o
d
u
ce
th
e
in
ten
d
ed
r
esu
lts
[
2
2
]
.
T
h
is
t
h
eo
r
y
s
u
p
p
o
r
ts
th
e
d
ev
elo
p
m
e
n
t
o
f
m
Hea
lth
in
ter
v
en
tio
n
s
th
at
g
iv
e
T
2
DM
p
atien
ts
m
o
r
e
co
n
tr
o
l
o
v
er
th
ei
r
s
elf
-
ca
r
e
s
k
ills
,
ev
en
wh
en
th
ey
q
u
esti
o
n
th
ei
r
ca
p
ac
ity
to
ca
r
r
y
o
u
t
n
ec
ess
ar
y
b
eh
av
io
r
s
[
2
3
]
.
Ho
wev
er
,
s
elf
-
ef
f
icac
y
i
n
lo
w
-
in
co
m
e
d
iab
etic
p
o
p
u
latio
n
s
is
p
o
o
r
ly
s
tu
d
ied
.
So
cio
d
em
o
g
r
ap
h
ic
f
ac
to
r
s
s
u
ch
as
in
co
m
e,
ed
u
ca
tio
n
,
an
d
cu
ltu
r
al
b
elief
s
m
ay
af
f
ec
t
s
elf
-
m
an
ag
em
e
n
t
p
r
ac
tices
an
d
m
ak
e
it
m
o
r
e
d
if
f
icu
lt
f
o
r
T
2
DM
p
atien
ts
in
Palest
in
e
to
ac
h
iev
e
s
u
cc
ess
f
u
l o
u
tco
m
es.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J I
n
f
&
C
o
m
m
u
n
T
ec
h
n
o
l
I
SS
N:
2252
-
8
7
7
6
A
mHe
a
lth
a
d
o
p
tio
n
m
o
d
el
fo
r
d
ia
b
etes self
-
ma
n
a
g
eme
n
t:
p
a
tien
t
-
ce
n
t
ered
… (
S
a
leem
Mo
h
a
mma
d
F
a
r
a
j
)
555
B
o
th
PU
an
d
PEOU
ar
e
im
p
ac
ted
b
y
task
r
eq
u
ir
em
e
n
ts
an
d
tech
n
o
lo
g
ical
f
ea
tu
r
es;
a
g
r
ea
ter
TTF
r
aises
o
p
in
io
n
s
ab
o
u
t
th
e
ad
v
an
tag
es
an
d
u
s
ab
ilit
y
o
f
m
He
alth
.
T
h
e
ass
o
ciatio
n
b
etwe
en
PEOU
an
d
B
I
is
m
o
d
er
ated
b
y
s
elf
-
ef
f
icac
y
b
e
lief
s
,
s
in
ce
p
atien
ts
wh
o
h
a
v
e
h
ig
h
er
lev
els
o
f
s
elf
-
e
f
f
icac
y
ar
e
m
o
r
e
lik
ely
t
o
em
b
r
ac
e
m
Hea
lth
d
esp
ite
u
s
ab
ilit
y
is
s
u
es.
F
u
r
th
er
m
o
r
e,
BI
is
d
ir
ec
tly
im
p
ac
ted
b
y
p
o
s
itiv
e
o
u
tco
m
e
ex
p
ec
tan
cy
,
wh
ich
in
cr
ea
s
es
m
o
tiv
atio
n
f
o
r
r
e
g
u
lar
m
Hea
lt
h
u
s
e.
T
T
F,
T
AM
,
an
d
SET
ar
e
c
o
m
b
in
ed
in
Fig
u
r
e
1
to
e
x
p
lain
w
h
y
T
2
DM
p
atien
ts
u
s
e
m
o
b
ile
h
ea
lth
.
I
t
d
r
aws a
tten
tio
n
to
h
o
w
task
r
e
q
u
ir
em
en
ts
,
tech
n
o
lo
g
ical
f
ea
t
u
r
es,
p
er
ce
iv
e
d
u
tili
ty
,
u
s
ab
ilit
y
,
an
d
s
elf
-
e
f
f
icac
y
all
af
f
ec
t
BI
,
r
ea
l
m
o
b
ile
u
s
e,
an
d
in
d
i
v
id
u
al
p
er
f
o
r
m
an
ce
.
T
h
e
f
o
llo
win
g
h
y
p
o
th
esis
is
u
s
ed
in
th
is
co
m
b
in
ed
m
o
d
el
to
ad
d
r
ess
p
s
y
ch
o
lo
g
ic
al
p
r
ep
ar
atio
n
,
tech
n
o
l
o
g
ical
alig
n
m
en
t,
an
d
c
o
n
f
i
d
en
ce
-
b
u
ild
in
g
elem
en
ts
th
at
ar
e
ess
en
tial f
o
r
s
u
cc
ess
f
u
l m
Hea
lth
:
H1
: T
ask
r
eq
u
ir
e
m
en
ts
will a
f
f
ec
t T
2
DM
p
atien
ts
o
n
T
ask
T
ec
h
n
o
lo
g
y
Fit
.
H2
: T
ask
T
ec
h
n
o
l
o
g
y
Fit
am
o
n
g
T
2
DM
p
atien
ts
will b
e
im
p
ac
ted
b
y
to
o
l f
u
n
ctio
n
ality
.
H3
: T
ask
T
ec
h
n
o
l
o
g
y
Fit
will
af
f
ec
t h
o
w
T
2
DM
p
atien
ts
u
s
e
th
eir
p
h
o
n
es.
H4
: T
2
DM
p
atien
ts
'
ac
tu
al
to
o
l u
s
e
f
o
r
m
o
b
ile
d
ev
ices w
ill b
e
in
f
lu
en
ce
d
b
y
t
h
eir
in
ten
tio
n
to
u
s
e
th
e
to
o
l.
H5
: Patien
ts
with
ty
p
e
2
d
iab
e
tes will u
s
e
to
o
ls
m
o
r
e
f
r
eq
u
e
n
tly
if
th
ey
i
n
ten
d
to
u
s
e
th
em
.
H6
: Patien
t
s
with
ty
p
e
2
d
iab
e
tes will b
eh
av
e
d
if
f
er
e
n
tly
d
ep
en
d
in
g
o
n
th
eir
in
ten
tio
n
t
o
u
s
e
th
e
to
o
l.
H7
: T
2
DM
p
atien
ts
'
in
ten
tio
n
to
u
s
e
th
e
to
o
l w
ill af
f
ec
t
h
o
w
well
th
ey
u
s
e
it.
H8
: A
m
o
n
g
T
2
DM
p
atien
ts
,
p
er
ce
iv
ed
u
s
ef
u
l
n
ess
will a
f
f
ec
t th
eir
in
ten
tio
n
t
o
u
s
e
th
e
to
o
l.
H9
: T
2
DM
p
atien
ts
'
in
ten
tio
n
to
u
s
e
th
e
to
o
l w
ill b
e
in
f
lu
en
c
ed
b
y
t
h
eir
p
er
ce
p
tio
n
o
f
its
ea
s
e
o
f
u
s
e.
H1
0
: A
m
o
n
g
T
2
DM
p
atien
ts
,
p
er
ce
iv
ed
u
s
ef
u
ln
ess
will b
e
in
f
lu
en
ce
d
b
y
PEOU
.
H1
1
: T
2
DM
p
atien
ts
'
ac
tu
al
to
o
l u
s
e
f
o
r
m
o
b
ile
d
e
v
ices w
ill b
e
in
f
lu
en
ce
d
b
y
th
eir
in
te
n
tio
n
to
u
s
e
th
e
to
o
l.
H1
2
: Patien
ts
with
ty
p
e
2
d
iab
etes w
ill b
eh
av
e
d
if
f
er
e
n
tly
d
e
p
en
d
in
g
o
n
t
h
eir
p
e
r
ce
iv
ed
lev
el
o
f
s
elf
-
ef
f
icac
y
.
H1
3
:
T
h
e
u
s
e
o
f
s
m
ar
tp
h
o
n
es
an
d
m
o
b
ile
h
ea
lth
b
y
T
2
DM
p
atien
ts
will
b
e
in
f
lu
en
ce
d
b
y
o
u
tco
m
e
ex
p
ec
tatio
n
s.
Fig
u
r
e
1
.
Mo
d
el
o
f
m
o
b
ile
h
ea
lth
u
s
e
f
o
r
s
elf
-
m
a
n
ag
em
e
n
t a
m
o
n
g
T
2
DM
p
atien
ts
3.
RE
S
E
ARCH
M
E
T
H
O
D
3
.
1
.
Resea
rc
h
des
ig
n
T
h
is
s
tu
d
y
ad
o
p
ts
a
q
u
an
titativ
e
r
esear
ch
d
esig
n
t
o
ex
am
i
n
e
th
e
f
ac
to
r
s
in
f
lu
e
n
cin
g
m
Hea
lth
u
s
e
an
d
d
iab
etes
s
elf
-
m
an
ag
em
en
t
am
o
n
g
T
2
DM
p
atien
ts
in
UNRW
A
h
ea
lth
ca
r
e
ce
n
ter
s
in
Pal
esti
n
e.
T
h
e
s
tu
d
y
is
ex
p
lo
r
ato
r
y
i
n
n
at
u
r
e,
g
iv
en
t
h
e
lim
ited
e
x
is
tin
g
r
esear
ch
o
n
m
Hea
lth
a
d
o
p
tio
n
f
o
r
s
elf
-
ca
r
e
in
t
h
e
co
n
tex
t
o
f
r
ef
u
g
ee
p
o
p
u
latio
n
s
an
d
g
o
v
e
r
n
m
en
t
-
r
u
n
h
e
alth
ca
r
e
s
ec
to
r
s
in
Palest
in
e.
T
h
e
d
esig
n
is
also
ca
teg
o
r
ized
as
cr
o
s
s
-
s
ec
tio
n
al
an
d
d
escr
ip
tiv
e,
wh
ich
u
s
es
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
es
to
g
ath
er
e
m
p
ir
ical
d
ata
at
a
s
p
ec
if
ic
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
7
7
6
I
n
t J I
n
f
&
C
o
m
m
u
n
T
ec
h
n
o
l
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
5
5
3
-
5
6
4
556
m
o
m
en
t
in
tim
e.
T
h
is
m
eth
o
d
m
ak
es
it
p
o
s
s
ib
le
to
id
e
n
tify
th
e
m
ai
n
b
eh
a
v
io
r
al,
t
ec
h
n
o
lo
g
ical,
an
d
p
s
y
ch
o
lo
g
ical
elem
e
n
ts
in
f
lu
e
n
cin
g
th
e
u
s
e
o
f
m
Hea
lth
a
n
d
t
h
e
m
an
ag
e
m
en
t o
f
d
iab
etes self
-
ca
r
e.
T
h
e
h
y
p
o
th
eses
b
ased
o
n
th
r
e
e
r
eliab
le
th
eo
r
etic
al
f
r
am
ewo
r
k
s
lik
e
T
AM
,
T
T
F,
an
d
SET
ar
e
test
ed
u
s
in
g
a
d
ed
u
ctiv
e
a
p
p
r
o
ac
h
.
T
h
e
d
e
v
elo
p
m
e
n
t
o
f
th
e
id
ea
s
an
d
co
n
n
ec
tio
n
s
t
h
at
will
b
e
in
v
esti
g
ated
i
n
th
e
s
tu
d
y
is
d
r
iv
e
n
b
y
th
ese
m
o
d
els.
T
h
e
s
tu
d
y
ac
k
n
o
wled
g
es
th
e
im
p
o
r
ta
n
ce
o
f
m
ix
e
d
-
m
et
h
o
d
s
r
esear
ch
ev
en
th
o
u
g
h
its
m
ain
’
s
f
o
c
u
s
is
q
u
an
titativ
e
[
2
4
]
.
T
h
e
s
tu
d
y
'
s
p
r
elim
in
ar
y
n
atu
r
e
an
d
its
ch
allen
g
in
g
a
n
d
u
n
iq
u
e
r
esear
ch
en
v
ir
o
n
m
en
t
at
UNRW
A
-
m
an
ag
ed
r
ef
u
g
ee
ca
m
p
s
m
ak
e
f
o
r
a
m
o
r
e
c
o
m
p
r
e
h
en
s
iv
e
v
iewp
o
in
t
.
T
h
er
ef
o
r
e,
ev
e
n
th
o
u
g
h
t
h
e
m
ain
to
o
l
f
o
r
g
ath
e
r
in
g
d
ata
is
s
till
a
s
tr
u
ctu
r
ed
,
clo
s
ed
-
en
d
e
d
q
u
esti
o
n
n
ai
r
e
f
o
r
T
2
DM
p
atien
ts
,
d
ata
f
r
o
m
th
e
s
e
p
atien
ts
is
v
alu
ed
f
o
r
m
o
d
el
d
ev
elo
p
m
en
t
[
2
5
]
.
3
.
2
.
Study
s
et
t
ing
a
nd
po
pu
la
t
io
n
T
h
e
s
tu
d
y
f
o
c
u
s
es
o
n
T
2
DM
p
atien
ts
wh
o
ar
e
tr
ea
ted
at
U
NR
W
A
p
r
im
ar
y
h
ea
lth
ca
r
e
cli
n
ics
s
p
r
ea
d
th
r
o
u
g
h
o
u
t
Palest
in
e's
W
est
B
an
k
r
ef
u
g
ee
ca
m
p
s
.
Ad
u
lt
T
2
DM
p
atien
ts
wh
o
liv
e
in
t
h
ese
ca
m
p
s
an
d
a
r
e
en
r
o
lled
i
n
UNRW
A
h
ea
lth
ca
r
e
s
er
v
ices
m
ak
e
u
p
th
e
tar
g
et
p
o
p
u
latio
n
.
T
h
e
g
o
v
e
r
n
m
en
t
-
r
u
n
r
ef
u
g
ee
h
ea
lt
h
s
y
s
tem
,
wh
ich
p
r
o
v
i
d
es
ca
r
e
f
o
r
a
v
u
ln
e
r
ab
le
an
d
u
n
d
er
p
r
iv
ileg
ed
p
o
p
u
latio
n
,
m
o
n
it
o
r
s
UNRW
A
clin
ic
o
p
er
atio
n
s
.
Du
e
to
s
tr
ict
laws
an
d
r
eg
u
latio
n
s
,
r
estricte
d
p
atien
t
ac
ce
s
s
,
an
d
th
e
p
r
iv
at
e
n
atu
r
e
o
f
h
ea
lth
-
r
elate
d
d
ata
in
r
ef
u
g
ee
c
o
m
m
u
n
ities
,
co
n
d
u
ctin
g
r
esear
ch
in
th
is
co
n
tex
t
is
tech
n
ically
an
d
leg
ally
d
if
f
icu
lt.
Desp
ite
th
ese
o
b
s
tacle
s
,
th
is
s
ettin
g
p
r
esen
ts
a
s
p
ec
ial
ch
a
n
ce
to
in
v
esti
g
ate
d
iab
etes
s
elf
-
ca
r
e
m
a
n
ag
em
en
t
an
d
m
Hea
lth
ad
o
p
tio
n
in
o
n
e
o
f
th
e
m
o
s
t u
n
d
er
s
tu
d
ies in
d
i
g
it
al
h
ea
lth
r
esear
ch
.
T
h
is
s
tu
d
y
is
u
n
iq
u
e
b
ec
au
s
e
i
t
f
o
cu
s
es
o
n
g
ath
er
in
g
em
p
ir
i
ca
l
d
ata
d
ir
ec
tly
f
r
o
m
T
2
DM
p
atien
ts
in
th
ese
g
o
v
er
n
m
en
t
-
r
u
n
r
e
f
u
g
e
e
ca
m
p
s
,
an
en
v
ir
o
n
m
en
t
in
wh
ich
f
ew
s
tu
d
ies
o
f
th
is
k
in
d
ar
e
ca
r
r
ied
o
u
t
b
ec
au
s
e
o
f
lo
g
is
tical,
ad
m
in
is
tr
at
iv
e,
an
d
p
o
liti
ca
l
lim
itatio
n
s
.
I
t
is
b
eliev
ed
th
at
th
e
r
esu
lts
will
p
r
o
v
id
e
h
is
to
r
ically
b
ased
in
s
ig
h
ts
in
to
h
o
w
m
Hea
lth
ca
n
h
elp
r
e
f
u
g
ee
s
in
en
v
i
r
o
n
m
e
n
ts
with
lim
ited
r
eso
u
r
ce
s
m
an
ag
e
th
eir
d
iab
etes.
3
.
3
.
Sa
m
pli
ng
t
ec
hn
iqu
e
a
n
d sa
m
ple size
Giv
en
th
e
lo
g
i
s
tical
d
if
f
icu
lties
in
lo
ca
tin
g
an
d
r
ea
ch
in
g
T
2
DM
p
atien
ts
in
UN
R
W
A
m
ed
ical
clin
ics
in
Palest
in
ian
r
ef
u
g
ee
ca
m
p
s
,
th
is
s
tu
d
y
will
u
s
e
a
n
o
n
-
p
r
o
b
a
b
ilit
y
s
am
p
lin
g
ap
p
r
o
ac
h
,
wh
ich
is
m
o
r
e
r
ea
lis
tic.
T
o
f
in
d
T
2
DM
p
atie
n
ts
wh
o
ar
e
av
ailab
le
an
d
willin
g
to
p
ar
ti
cip
ate
d
u
r
in
g
clin
ic
v
is
its
,
co
n
v
en
ie
n
ce
s
am
p
lin
g
will
b
e
em
p
lo
y
e
d
.
Giv
en
th
e
s
en
s
itiv
e
n
atu
r
e
o
f
h
ea
lth
ca
r
e
d
ata
in
r
e
f
u
g
ee
s
ett
in
g
s
an
d
th
e
lim
ited
ac
ce
s
s
to
p
atien
t lis
ts
an
d
co
n
tact
in
f
o
r
m
atio
n
,
th
is
ap
p
r
o
ac
h
is
m
o
s
t su
itab
le
an
d
ap
p
r
o
p
r
iat
e.
Gu
id
elin
e
s
f
r
o
m
ea
r
lier
s
tu
d
ie
s
wer
e
u
s
ed
to
d
eter
m
in
e
th
e
p
r
o
p
er
s
am
p
le
s
ize.
Sek
ar
an
a
n
d
B
o
u
g
ie
(
2
0
1
6
)
s
tate
th
at
f
o
r
s
u
r
v
ey
-
b
ased
q
u
a
n
titativ
e
r
esear
ch
,
a
s
am
p
le
s
ize
o
f
3
0
t
o
5
0
0
r
esp
o
n
d
en
ts
is
ad
e
q
u
ate
[
2
6
]
.
W
h
ile
s
o
m
e
r
esear
ch
in
d
icate
s
th
at
2
0
0
r
esp
o
n
d
e
n
t
s
i
s
ty
p
ically
en
o
u
g
h
f
o
r
m
o
s
t
s
u
r
v
ey
r
esear
ch
d
esig
n
s
,
o
th
er
s
tu
d
ies
h
a
v
e
s
u
g
g
ested
a
s
am
p
le
s
ize
o
f
1
0
0
to
2
0
0
f
o
r
r
e
g
r
ess
io
n
a
n
aly
s
is
[
2
7
]
.
T
h
is
s
tu
d
y
aim
s
to
in
clu
d
e
at
least
3
0
0
T
2
DM
p
atien
ts
,
with
an
o
v
er
s
am
p
lin
g
g
o
al
o
f
3
5
0
p
a
r
ticip
an
ts
,
in
ac
co
r
d
an
ce
with
th
ese
r
ec
o
m
m
en
d
atio
n
s
a
n
d
to
tak
e
in
to
co
n
s
id
er
atio
n
n
o
n
-
r
esp
o
n
s
es,
o
u
tlier
s
,
an
d
m
is
s
in
g
v
alu
es.
T
h
is
will
g
u
ar
an
tee
th
e
v
alid
ity
o
f
s
tatis
tical
an
aly
s
es
an
d
th
e
s
tr
en
g
th
o
f
th
e
c
o
n
clu
s
io
n
s
ab
o
u
t
th
e
ad
o
p
tio
n
o
f
m
o
b
ile
h
ea
lth
a
n
d
th
e
m
an
ag
e
m
en
t o
f
d
i
ab
etes self
-
ca
r
e.
3
.
4
.
Dev
el
o
pm
ent
o
f
re
s
ea
rc
h ins
t
rum
ent
Data
f
r
o
m
T
2
DM
p
atien
ts
will
b
e
o
b
tain
ed
v
ia
a
clo
s
ed
-
e
n
d
ed
,
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e.
Usi
n
g
an
y
o
f
th
e
th
r
ee
m
o
d
els
tak
en
in
t
o
co
n
s
id
er
atio
n
i
n
th
e
th
eo
r
etica
l
f
r
am
ewo
r
k
,
th
e
q
u
esti
o
n
n
air
e
will
b
e
cr
ea
ted
b
ased
o
n
th
e
f
in
d
i
n
g
s
o
f
p
r
e
v
io
u
s
r
elev
an
t
r
esear
ch
.
Ad
d
iti
o
n
ally
,
th
e
r
elev
an
c
e
o
f
ea
ch
q
u
esti
o
n
n
air
e
item
f
o
r
th
e
Palest
in
ian
co
n
tex
t
wil
l
b
e
ev
alu
ated
.
T
h
er
e
will
b
e
f
iv
e
s
ec
tio
n
s
to
th
e
q
u
esti
o
n
n
ai
r
e.
I
tem
s
n
ec
ess
ar
y
f
o
r
g
ath
e
r
in
g
p
a
r
ticip
an
t
d
em
o
g
r
ap
h
ic
in
f
o
r
m
atio
n
,
in
clu
d
i
n
g
g
en
d
er
,
ag
e
,
o
cc
u
p
atio
n
,
h
o
u
s
eh
o
ld
i
n
co
m
e,
n
u
m
b
er
o
f
d
ep
en
d
en
ts
,
an
d
r
esid
en
tial
ar
ea
s
,
will
b
e
in
clu
d
ed
in
Par
t
1
.
I
tem
s
aim
ed
at
ass
ess
in
g
p
atien
ts
'
p
er
ce
p
tio
n
s
o
f
th
e
v
alu
e
an
d
u
s
ab
ilit
y
o
f
m
o
b
ile
h
ea
lth
f
o
r
d
iab
etes
s
elf
-
m
an
ag
em
en
t
will
b
e
m
ak
in
g
u
p
Par
t
2
.
I
tem
s
f
o
r
ass
ess
in
g
p
ar
ticip
an
ts
'
s
o
cial
an
d
clin
ical
s
u
p
p
o
r
t w
ill b
e
in
clu
d
ed
in
Par
t 3
.
I
n
th
e
m
ea
n
tim
e,
d
ata
o
n
s
elf
-
ef
f
icac
y
an
d
s
elf
-
ca
r
e
p
r
ac
tices
will
b
e
o
b
tain
e
d
in
Par
t
4
.
T
h
e
d
ep
e
n
d
en
t
v
ar
iab
l
e,
m
o
b
ile
h
e
alth
u
s
e
f
o
r
d
iab
etes
s
elf
-
m
an
a
g
em
en
t
,
will
b
e
th
e
f
o
cu
s
o
f
Par
t
5
o
f
th
e
q
u
esti
o
n
n
air
e.
T
h
e
f
iv
e
-
p
o
in
t
L
ik
er
t
s
ca
le,
wh
ich
r
an
g
es
f
r
o
m
1
=
s
tr
o
n
g
ly
d
is
ag
r
ee
to
5
=
s
tr
o
n
g
ly
ag
r
ee
,
will
b
e
u
s
ed
t
o
ev
alu
a
te
ea
ch
item
.
T
h
is
f
o
r
m
at
is
well
-
k
n
o
wn
f
o
r
its
ac
cu
r
ac
y
in
b
eh
av
i
o
r
al
s
tu
d
ies
[
2
8
]
.
3
.
5
.
I
ns
t
rum
ent
v
a
lid
it
y
a
nd
re
lia
bil
it
y
E
x
p
er
t r
ev
iew
was
ca
r
r
ied
o
u
t
as
ad
v
is
ed
b
y
to
g
u
ar
a
n
tee
th
e
v
alid
ity
o
f
th
e
in
s
tr
u
m
en
t
[
2
9
]
.
A
p
an
el
o
f
ac
ad
em
ic
a
n
d
clin
ical
e
x
p
er
ts
u
s
ed
a
v
alid
atio
n
f
o
r
m
to
ev
alu
ate
th
e
q
u
esti
o
n
n
air
e
item
s
cr
ea
ted
f
o
r
T
2
DM
p
atien
ts
.
T
h
e
q
u
esti
o
n
n
air
e
w
as
im
p
r
o
v
ed
a
f
ter
th
eir
f
ee
d
b
ac
k
was
r
ev
iewe
d
.
Stro
n
g
co
n
ten
t
v
alid
ity
was
d
em
o
n
s
tr
ated
b
y
th
e
e
x
p
er
t
v
a
lid
atio
n
'
s
o
u
ts
tan
d
in
g
ag
r
ee
m
e
n
t r
ate
o
f
m
o
r
e
th
a
n
9
0
%.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J I
n
f
&
C
o
m
m
u
n
T
ec
h
n
o
l
I
SS
N:
2252
-
8
7
7
6
A
mHe
a
lth
a
d
o
p
tio
n
m
o
d
el
fo
r
d
ia
b
etes self
-
ma
n
a
g
eme
n
t:
p
a
tien
t
-
ce
n
t
ered
… (
S
a
leem
Mo
h
a
mma
d
F
a
r
a
j
)
557
A
p
ilo
t
s
tu
d
y
was
co
n
d
u
cted
wi
th
a
s
am
p
le
o
f
3
0
T
2
DM
p
atien
ts
ch
o
s
en
f
r
o
m
UNRW
A
h
ea
lth
ca
r
e
clin
ics
to
f
u
r
th
er
ass
u
r
e
f
ac
e
an
d
co
n
s
tr
u
ct
v
alid
ity
.
Acc
o
r
d
in
g
to
[
3
0
]
,
u
s
in
g
a
b
o
u
t
1
0
%
o
f
th
e
p
lan
n
ed
s
am
p
le
s
ize
is
ad
eq
u
ate
f
o
r
p
il
o
t
s
tu
d
ies.
C
r
o
n
b
ac
h
'
s
Alp
h
a,
a
s
tatis
tical
in
d
icato
r
o
f
in
te
r
n
al
co
n
s
is
ten
cy
,
was
u
s
ed
to
ev
al
u
ate
th
e
i
n
s
tr
u
m
en
t'
s
r
eliab
ilit
y
.
A
C
r
o
n
b
ac
h
'
s
Alp
h
a
v
alu
e
o
f
0
.
7
0
o
r
h
i
g
h
er
is
r
e
g
ar
d
e
d
as
ac
ce
p
tab
le;
v
alu
es
less
th
an
0
.
6
0
s
u
g
g
est
p
o
o
r
r
eliab
ilit
y
an
d
r
eq
u
ir
e
th
e
r
em
o
v
al
o
r
r
ev
is
io
n
o
f
th
e
im
p
o
r
tan
t
item
s
[
3
1
]
.
T
h
e
in
s
tr
u
m
e
n
t'
s
a
cc
ep
tab
le
r
eliab
ilit
y
was
co
n
f
ir
m
ed
b
y
th
e
p
ilo
t
ex
p
er
im
e
n
t,
in
d
icatin
g
th
at
it
is
ap
p
r
o
p
r
iate
f
o
r
lar
g
e
-
s
ca
le
d
at
a
co
llectio
n
.
3
.
6
.
Da
t
a
c
o
llect
io
n pro
ce
du
re
T
2
DM
p
atien
ts
wh
o
s
atis
f
ied
th
e
in
clu
s
io
n
r
eq
u
i
r
em
en
ts
a
n
d
v
is
ited
UNRW
A
p
r
im
ar
y
h
ea
lth
ca
r
e
clin
ics
in
Palest
in
e
wer
e
th
e
f
o
cu
s
o
f
t
h
e
d
ata
co
llecti
o
n
.
Du
r
i
n
g
th
eir
r
eg
u
lar
cli
n
ic
v
is
its
,
elig
ib
le
p
ar
ticip
an
ts
wer
e
ap
p
r
o
ac
h
ed
,
b
r
ief
ed
ab
o
u
t
th
e
s
tu
d
y
'
s
g
o
als,
g
iv
en
th
e
ass
u
r
an
ce
th
at
th
eir
an
s
wer
s
wo
u
ld
r
em
ain
p
r
i
v
ate,
an
d
to
ld
th
a
t
t
h
ey
co
u
ld
with
d
r
aw
at
a
n
y
tim
e
with
o
u
t
f
ac
in
g
an
y
p
en
alties.
Prio
r
to
p
ar
ticip
atio
n
,
co
n
s
en
t
was
o
b
t
ain
ed
b
o
t
h
o
r
ally
a
n
d
i
n
wr
itin
g
.
A
s
elf
-
ad
m
i
n
is
ter
ed
q
u
est
io
n
n
air
e
with
clea
r
in
s
tr
u
ctio
n
s
f
o
r
c
o
m
p
letio
n
w
as
th
en
g
iv
en
t
o
ea
ch
p
ar
ticip
an
t
wh
o
h
ad
g
i
v
en
th
eir
co
n
s
en
t.
T
o
f
ac
ilit
ate
p
a
r
t
i
c
i
p
a
n
t
c
o
m
p
r
e
h
e
n
s
i
o
n
,
t
h
e
r
e
s
e
a
r
c
h
e
r
s
'
c
o
n
t
a
c
t
d
et
a
il
s
w
e
r
e
p
r
o
v
i
d
e
d
f
o
r
a
n
y
i
n
q
u
i
r
ie
s
o
r
c
la
r
i
f
i
c
at
i
o
n
s
p
e
r
t
a
i
n
i
n
g
t
o
t
h
e
s
u
r
v
e
y
.
D
a
t
a
co
l
l
e
c
t
i
o
n
t
o
o
k
p
l
a
ce
b
e
t
w
ee
n
J
an
u
a
r
y
2
0
2
4
a
n
d
M
a
y
2
0
2
4
,
a
s
p
a
n
o
f
f
i
v
e
m
o
n
t
h
s
.
3
.
7
.
Da
t
a
a
na
ly
s
is
T
h
e
Statis
tical
Pack
ag
e
f
o
r
So
cial
Scien
ce
(
SP
SS
)
Ver
s
io
n
2
4
an
d
AM
OS
f
o
r
SEM
wer
e
u
s
ed
to
an
aly
ze
all
t
h
e
d
ata.
T
h
e
d
ata
s
et
was
ev
alu
ated
f
o
r
n
o
n
-
r
es
p
o
n
s
e
b
ias,
co
m
m
o
n
m
eth
o
d
b
ias,
m
is
s
in
g
d
ata,
an
d
n
o
r
m
ality
o
f
d
is
tr
ib
u
tio
n
p
r
io
r
to
a
n
aly
s
is
.
Ku
r
to
s
is
an
d
s
k
ewn
ess
v
alu
es
wer
e
u
s
ed
to
ass
ess
n
o
r
m
ality
.
T
h
e
T
2
DM
p
atien
t
s
am
p
le
was
ch
ar
ac
ter
ized
u
s
in
g
d
escr
ip
tiv
e
s
tati
s
tics
.
W
h
er
ea
s
f
r
eq
u
en
cies
an
d
p
er
ce
n
tag
es
wer
e
u
s
ed
f
o
r
c
ateg
o
r
ical
d
ata,
m
ea
n
s
an
d
s
tan
d
ar
d
d
e
v
iatio
n
s
wer
e
r
ep
o
r
ted
f
o
r
co
n
t
in
u
o
u
s
v
ar
iab
les.
SEM
was
u
s
ed
wit
h
AM
OS
to
in
v
esti
g
ate
th
e
c
o
n
n
ec
tio
n
s
b
etwe
en
m
Hea
lth
ad
o
p
tio
n
an
d
th
e
id
en
tifie
d
b
e
h
av
io
r
al
,
p
s
y
ch
o
l
o
g
ical,
an
d
tech
n
o
lo
g
ical
f
ac
t
o
r
s
.
T
h
is
m
ad
e
it
p
o
s
s
ib
le
to
ass
ess
m
o
d
el
f
it,
co
n
s
tr
u
ct
v
alid
ity
,
an
d
th
e
d
ir
ec
tio
n
an
d
s
tr
en
g
th
o
f
p
r
o
p
o
s
ed
p
ath
s
.
T
h
e
s
u
g
g
ested
m
o
d
el's
g
o
o
d
n
ess
-
of
-
f
it
was e
v
alu
ated
u
s
in
g
m
o
d
el
f
it
in
d
ices lik
e
C
h
i
-
s
q
u
ar
e
(
χ²)
,
R
MSE
A,
C
FI,
an
d
T
L
I
.
4.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
Usi
n
g
th
e
s
tatis
tical
p
r
o
g
r
a
m
SP
SS
v
er
s
io
n
2
4
,
t
h
e
r
el
iab
ilit
y
an
d
in
ter
n
al
co
n
s
is
te
n
cy
o
f
th
e
o
b
s
er
v
ed
v
ar
iab
les
wer
e
ass
ess
ed
u
s
in
g
C
r
o
n
b
ac
h
’
s
test
m
et
h
o
d
p
r
io
r
to
co
n
f
ir
m
in
g
th
e
f
ir
s
t
d
ev
elo
p
ed
SEM
.
T
h
e
C
r
o
n
b
ac
h
'
s
α
v
alu
es
f
o
r
T
2
DM
p
atien
ts
o
f
th
e
o
b
s
er
v
ed
v
ar
iab
le
u
s
ed
in
th
e
s
tu
d
y
ar
e
d
is
p
lay
ed
in
T
ab
le
1
.
Acc
o
r
d
in
g
to
th
e
r
esu
lts
b
elo
w,
C
r
o
n
b
ac
h
'
s
α
v
alu
es
r
an
g
e
f
r
o
m
0
.
8
0
8
to
0
.
9
6
6
,
with
T
2
DM
p
atien
ts
h
av
in
g
a
t
o
tal
alp
h
a
v
alu
e
o
f
0
.
9
8
6
.
Acc
o
r
d
i
n
g
to
ce
r
tain
r
esear
ch
,
C
r
o
n
b
ac
h
’
s
α
v
alu
e
t
h
at
g
r
ea
ter
th
a
n
0
.
7
in
d
icate
s
h
ig
h
in
te
r
n
al
co
n
s
is
ten
cy
an
d
r
eliab
ilit
y
[
3
2
]
,
[
3
3
]
.
T
h
u
s
,
it
ca
n
b
e
s
aid
th
at
th
e
s
am
p
les
ar
e
tr
u
s
two
r
th
y
f
o
r
co
n
f
ir
m
in
g
th
e
SEM
.
T
ab
le
1
.
R
eliab
ilit
y
test
r
esu
lts
o
f
T
2
DM
p
atien
ts
F
a
c
t
o
r
s
N
u
mb
e
r
o
f
o
b
ser
v
e
d
v
a
r
i
a
b
l
e
s
C
r
o
n
b
a
c
h
’
s (α
)
Ta
sk
r
e
q
u
i
r
e
me
n
t
(
T
R
)
5
0
.
9
0
3
Ta
sk
Te
c
h
n
o
l
o
g
y
F
i
t
(
TT)
5
0
.
9
4
8
To
o
l
f
u
n
c
t
i
o
n
i
n
g
(
TF)
4
0
.
8
0
8
A
c
t
u
a
l
t
o
o
l
u
se
(
A
T)
6
0
.
8
7
8
I
n
t
e
n
t
i
o
n
t
o
u
se
t
o
o
l
(
I
T)
4
0
.
9
4
2
P
e
r
c
e
i
v
e
d
e
a
s
e
o
f
u
se
(
P
E)
6
0
.
8
4
8
P
e
r
c
e
i
v
e
d
U
s
e
f
u
l
n
e
ss (P
U
)
5
0
.
9
5
5
B
e
h
a
v
i
o
r
(
B
)
6
0
.
9
5
6
I
n
d
i
v
i
d
u
a
l
p
e
r
f
o
r
ma
n
c
e
(
I
P
)
5
0
.
9
6
0
P
e
r
c
e
i
v
e
d
sel
f
-
e
f
f
i
c
a
c
y
(
P
S
E)
5
0
.
9
6
1
O
u
t
c
o
m
e
e
x
p
e
c
t
a
t
i
o
n
(
O
E)
5
0
.
9
6
6
To
t
a
l
56
0
.
9
8
6
4
.
1
.
Descript
iv
e
a
na
ly
s
is
o
f
t
he
s
a
m
ple da
t
a
T
h
e
s
tu
d
y
s
am
p
les
co
n
s
is
t
o
f
5
0
3
in
d
iv
id
u
als
with
T
2
DM
,
p
ar
ticip
an
ts
ad
d
itio
n
al
d
e
m
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
wer
e
o
b
tain
ed
in
clu
d
in
g
g
en
d
e
r
,
ag
e,
ed
u
ca
tio
n
al
lev
el,
an
d
s
o
o
n
.
Par
ticip
a
n
ts
wer
e
5
9
.
7
y
ea
r
s
o
ld
o
n
av
er
a
g
e
with
a
s
tan
d
ar
d
d
ev
iatio
n
o
f
1
0
.
3
y
ea
r
s
.
T
h
e
m
ajo
r
ity
(
6
0
.
0
%)
o
f
T
2
DM
s
am
p
le
wer
e
f
em
ales
an
d
(
3
6
.
6
%)
m
ales,
m
o
s
t
(
7
1
.
0
%)
o
f
th
e
p
ar
ticip
an
ts
ar
e
o
f
h
ig
h
s
ch
o
o
l
ed
u
ca
tio
n
lev
el
o
r
less
,
(
1
1
.
5
%)
o
f
th
em
h
av
e
a
d
ip
lo
m
a,
wh
ile
(
7
.
6
%)
o
f
th
em
wer
e
illi
ter
ate,
an
d
(
1
.
6
%)
o
n
ly
o
f
th
e
n
h
o
l
d
in
g
Ma
s
te
r
o
r
Ph
D
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
7
7
6
I
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t J I
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f
&
C
o
m
m
u
n
T
ec
h
n
o
l
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
5
5
3
-
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6
4
558
d
eg
r
ee
.
Ma
jo
r
ity
o
f
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esp
o
n
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en
ts
(
4
6
.
5
%)
h
a
v
e
s
u
f
f
e
r
ed
f
r
o
m
d
iab
etes
m
ellitu
s
f
o
r
o
v
e
r
1
0
y
ea
r
s
.
T
ab
le
2
s
h
o
w
th
e
s
u
m
m
ar
ize
o
f
d
em
o
g
r
ap
h
ic
ch
a
r
ac
ter
is
tics
.
T
ab
le
2
.
T
2
DM
p
atien
t’
s
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
V
a
r
i
a
b
l
e
C
h
a
r
a
c
t
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r
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s
t
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c
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A
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n
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r
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e
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t
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e
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e
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l
e
1
8
4
3
6
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6
%
F
e
mal
e
3
0
2
6
0
.
0
%
M
i
ss
i
n
g
17
3
.
4
%
Ed
u
c
a
t
i
o
n
I
l
l
i
t
e
r
a
t
e
38
7
.
6
%
H
i
g
h
sc
h
o
o
l
o
r
l
e
ss
3
5
7
7
1
.
0
%
D
i
p
l
o
m
a
58
1
1
.
5
%
B
a
c
h
e
l
o
r
d
e
g
r
e
e
31
6
.
2
%
M
a
s
t
e
r
o
r
d
o
c
t
o
r
8
1
.
6
%
M
i
ss
i
n
g
11
2
.
2
%
D
u
r
a
t
i
o
n
o
f
T
2
D
M
Le
ss
t
h
a
n
y
e
a
r
45
8
.
9
%
F
r
o
m
1
t
o
5
y
e
a
r
s
1
4
2
2
8
.
2
%
M
o
r
e
t
h
a
n
5
t
o
1
0
y
e
a
r
s
75
1
4
.
9
%
M
o
r
e
t
h
a
n
1
0
y
e
a
r
s
2
3
4
4
6
.
5
%
M
i
ss
i
n
g
7
1
.
4
%
T
h
e
SEM
tak
en
in
to
co
n
s
id
e
r
atio
n
in
th
is
s
tu
d
y
was
d
ev
elo
p
ed
u
s
in
g
I
B
M
an
aly
s
is
o
f
m
o
m
en
t
s
tr
u
ctu
r
es
(
AM
OS)
.
SEM
was
u
s
ed
to
ca
lcu
late
th
e
ca
u
s
al
r
e
latio
n
s
h
ip
s
b
etwe
en
ea
ch
laten
t
v
ar
iab
le
[
3
4
]
.
As
in
m
an
y
o
th
er
s
tu
d
ies,
it
was
u
s
ed
to
ev
alu
ate
h
o
w
co
n
s
tr
u
c
tio
n
,
s
tak
eh
o
ld
er
s
,
m
ater
ials
,
d
esig
n
,
a
n
d
ex
ter
n
al
f
ac
to
r
s
r
elate
to
p
r
o
ject
q
u
ality
[
3
5
]
.
4
.
2
.
St
a
t
is
t
ica
l a
na
ly
s
is
Po
ten
tial
in
f
lu
en
cin
g
f
ac
to
r
s
wer
e
g
ath
er
ed
th
r
o
u
g
h
a
s
cien
tific
r
esear
ch
r
ev
iew
to
s
tu
d
y
th
e
im
p
ac
t
o
f
all
p
o
ten
tial
f
ac
to
r
s
o
n
s
elf
-
c
ar
e
m
a
n
ag
em
en
t
am
o
n
g
T
2
DM
p
atien
ts
.
1
1
p
r
im
ar
y
ca
te
g
o
r
ies
wer
e
u
s
ed
to
g
r
o
u
p
th
ese
f
ac
to
r
s
:
‘
T
ask
R
e
q
u
ir
em
en
t’
(
T
R
)
,
‘
T
ask
T
ec
h
n
o
lo
g
y
Fit
’
(
T
T
)
,
‘
T
o
o
l
Fu
n
ctio
n
in
g
’
(
T
F),
‘
Actu
al
T
o
o
l
Use’
(
AT
)
,
‘
I
n
ten
tio
n
to
Use
T
o
o
l’
(
I
T
)
,
‘
Per
ce
iv
ed
E
ase
o
f
Use’
(
PE)
,
‘
P
er
ce
iv
e
d
Usef
u
ln
ess
’
(
PU)
,
‘
B
eh
av
io
r
’
(
B
)
,
‘
I
n
d
iv
id
u
al
Per
f
o
r
m
a
n
ce
’
(
I
P),
‘
Per
ce
iv
e
d
Self
-
E
f
f
icac
y
’
(
PS
E
)
,
an
d
‘
Ou
tco
m
e
E
x
p
ec
tatio
n
’
(
OE
)
.
1
2
laten
t
v
a
r
iab
les
wer
e
cr
ea
ted
b
y
co
m
b
in
in
g
th
o
s
e
ca
teg
o
r
ies
with
‘
Self
-
C
ar
e
M
an
ag
em
en
t’
(
SC
M)
as
th
e
o
u
tco
m
e
v
ar
ia
b
le
.
A
L
i
k
er
t
s
ca
le
with
a
r
a
n
g
e
o
f
1
(
s
tr
o
n
g
ly
d
is
ag
r
ee
)
to
5
(
s
tr
o
n
g
ly
ag
r
ee
)
was u
s
ed
to
m
ea
s
u
r
e
th
e
o
b
s
er
v
ed
v
ar
iab
le
s
th
at
m
ad
e
u
p
ea
c
h
laten
t v
a
r
iab
le.
B
ased
o
n
th
e
r
esu
lts
s
h
o
wn
in
T
ab
le
1
,
t
h
e
s
ec
o
n
d
p
h
a
s
e
o
f
t
h
e
a
n
aly
s
is
is
SC
M
f
o
r
T
2
DM
.
C
r
o
n
b
ac
h
'
s
α
v
alu
es
wer
e
h
ig
h
er
t
h
an
0
.
7
.
T
h
is
w
o
u
ld
d
e
m
o
n
s
tr
ate
th
e
f
in
al
m
o
d
el'
s
in
ter
n
al
v
ali
d
ity
an
d
d
ep
en
d
a
b
ilit
y
.
Ad
d
itio
n
ally
,
t
h
e
m
o
d
els
f
it
tak
en
in
to
co
n
s
id
er
atio
n
in
th
is
s
tu
d
y
ar
e
s
h
o
wn
in
T
ab
le
3
.
I
n
ac
co
r
d
an
ce
with
a
p
r
io
r
s
tu
d
y
'
s
r
ec
o
m
m
en
d
atio
n
[
3
6
]
,
wh
ile
th
e
in
cr
em
en
tal
f
it
in
d
ex
(
I
FI)
,
tu
ck
e
r
lewis
in
d
ex
(
T
L
I
)
,
an
d
co
m
p
ar
ativ
e
f
it
in
d
e
x
(
C
FI)
c
o
u
ld
h
av
e
a
m
in
im
u
m
o
f
0
.
9
t
o
s
h
o
w
th
e
m
o
d
el
h
as
a
n
ac
ce
p
tab
le
f
it,
th
e
g
o
o
d
n
ess
o
f
f
it
in
d
ex
(
GFI
)
an
d
th
e
ad
ju
s
ted
g
o
o
d
n
ess
o
f
f
it
(
AGFI
)
co
u
ld
h
av
e
v
alu
es
g
r
ea
ter
t
h
an
0
.
8
0
.
A
d
d
itio
n
all
y
,
th
e
r
o
o
t
m
ea
n
s
q
u
ar
e
er
r
o
r
o
f
ap
p
r
o
x
im
atio
n
(
R
MSE
A)
v
alu
e
n
ee
d
s
to
b
e
b
elo
w
0
.
0
7
.
Mo
r
e
o
v
er
,
C
h
i
-
Sq
u
ar
e
was m
ea
s
u
r
ed
.
T
h
u
s
,
th
e
f
in
al
m
o
d
els ar
e
ac
ce
p
tab
le.
T
ab
le
3
.
T
2
DM
Mo
d
el’
s
Go
o
d
n
ess
-
of
-
Fit
G
o
o
d
n
e
ss
o
f
f
i
t
m
e
a
s
u
r
e
Pa
r
a
me
t
e
r
e
st
i
ma
t
e
C
u
t
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o
f
f
G
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I
0
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9
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1
>
0
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8
A
G
F
I
0
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8
8
3
>
0
.
8
I
F
I
0
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9
5
2
>
0
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9
C
F
I
0
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9
2
7
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0
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9
TLI
0
.
9
3
6
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0
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9
R
M
S
EA
0
.
0
4
8
3
<
0
.
0
7
C
h
i
-
sq
u
a
r
e
=
5
9
5
4
.
5
0
2
D
e
g
r
e
e
s
o
f
f
r
e
e
d
o
m =
1
3
1
4
p
-
v
a
l
u
e
<
0
.
0
0
1
Fig
u
r
e
2
r
ep
r
esen
ts
th
e
SEM
m
o
d
els
f
o
r
f
ac
to
r
s
af
f
ec
tin
g
SC
M
am
o
n
g
d
iab
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p
atien
ts
(
T
2
DM
SEM
Mo
d
el)
.
C
er
tain
f
ac
to
r
l
o
ad
in
g
s
f
all
b
elo
w
th
e
s
tu
d
y
'
s
th
r
esh
o
ld
[
3
7
]
,
in
d
icatin
g
th
e
u
s
e
o
f
g
r
ea
ter
c
u
t
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o
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s
r
an
g
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g
f
r
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m
0
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3
2
(
p
o
o
r
)
,
0
.
4
5
(
f
air
)
,
0
.
5
5
(
g
o
o
d
)
,
0
.
6
3
(
v
er
y
g
o
o
d
)
,
o
r
0
.
7
1
(
e
x
ce
llen
t)
.
T
h
e
v
ar
iab
les
o
f
T
F
an
d
PE
(
Q3
_
3
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1
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an
d
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_
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)
h
a
v
e
s
in
ce
b
ee
n
r
e
m
o
v
ed
f
r
o
m
th
e
m
o
d
el.
T
a
b
le
4
r
esu
lts
s
h
o
w
th
at
ev
er
y
c
o
m
p
o
n
en
t
o
f
th
e
T
2
D
M
m
o
d
el
af
f
ec
ts
SC
M,
with
th
e
m
o
s
t
in
f
lu
en
tial
b
ein
g
th
e
f
ac
to
r
Per
ce
iv
ed
Usef
u
ln
ess
(
PU)
an
d
th
e
least in
f
lu
en
tial b
ein
g
th
e
Facto
r
T
a
s
k
r
eq
u
ir
em
e
n
t (
T
R
)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J I
n
f
&
C
o
m
m
u
n
T
ec
h
n
o
l
I
SS
N:
2252
-
8
7
7
6
A
mHe
a
lth
a
d
o
p
tio
n
m
o
d
el
fo
r
d
ia
b
etes self
-
ma
n
a
g
eme
n
t:
p
a
tien
t
-
ce
n
t
ered
… (
S
a
leem
Mo
h
a
mma
d
F
a
r
a
j
)
559
Fig
u
r
e
2
.
T
2
DM
SEM
m
o
d
el
T
ab
le
4
.
Path
co
e
f
f
icien
t a
n
d
t
-
s
tatis
tic
s
o
f
T
2
DM
m
o
d
el
H
y
p
o
t
h
e
s
i
z
e
d
p
a
t
h
S
t
a
n
d
a
r
d
i
z
e
d
(
β)
t
-
t
e
s
t
p
-
v
a
l
u
e
P
U
S
C
M
0
.
9
3
9
2
2
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8
5
2
.
0
0
0
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E
S
C
M
0
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9
2
7
2
3
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3
8
2
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0
0
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P
S
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M
0
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9
2
2
3
.
0
9
3
.
0
0
0
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T
S
C
M
0
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9
0
8
2
2
.
6
.
0
0
0
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S
E
S
C
M
0
.
9
0
3
2
3
.
8
1
2
.
0
0
0
B
S
C
M
0
.
8
8
1
2
2
.
8
5
.
0
0
0
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T
S
C
M
0
.
8
7
2
1
3
.
7
3
7
.
0
0
0
O
E
S
C
M
0
.
8
6
2
1
.
2
5
9
.
0
0
0
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S
C
M
0
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8
5
4
2
0
.
0
3
2
.
0
0
0
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S
C
M
0
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8
1
9
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9
9
6
.
0
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C
M
0
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7
3
8
1
6
.
2
5
5
.
0
0
0
Le
v
e
l
o
f
S
i
g
n
i
f
i
c
a
n
t
α
≤
0
.
0
5
T
h
e
th
ir
d
s
tag
e
o
f
an
aly
s
is
is
th
e
h
y
p
o
th
esis
m
o
d
els
f
o
r
T
2
DM
,
f
ac
to
r
lo
ad
i
n
g
s
in
th
e
AM
OS
an
d
th
e
s
tan
d
ar
d
ized
β
co
ef
f
icien
t
in
t
h
e
r
eg
r
ess
io
n
an
aly
s
is
wer
e
s
i
m
ilar
.
T
h
e
β
d
en
o
ted
th
e
ex
p
e
cted
v
ar
iatio
n
in
th
e
d
ep
en
d
e
n
t
co
n
s
tr
u
ct
f
o
r
a
u
n
it
v
ar
iatio
n
i
n
t
h
e
in
d
ep
e
n
d
en
t
co
n
s
tr
u
cts.
E
ac
h
p
ath
in
th
e
p
r
o
p
o
s
ed
m
o
d
el
h
ad
its
β
v
alu
e
ca
lcu
lated
wh
ich
t
h
e
h
ig
h
er
th
e
β
v
alu
e,
th
e
m
o
r
e
s
ig
n
if
ican
t
th
e
im
p
ac
t
o
n
th
e
in
ter
n
al
h
id
d
en
co
n
s
tr
u
ct.
All
th
e
o
b
s
er
v
ed
v
ar
iab
les
in
th
e
T
2
DM
SEM
Mo
d
el
in
Fig
u
r
e
2
h
av
e
β
v
al
u
es
g
r
ea
ter
th
an
0
.
4
,
in
d
icatin
g
th
at
th
e
y
m
ea
s
u
r
e
a
n
d
h
av
e
an
im
p
ac
t o
n
t
h
eir
lat
en
t v
ar
iab
les.
T
h
e
h
y
p
o
th
eses
test
in
g
o
f
t
h
is
r
esear
ch
wer
e
test
ed
p
ar
tially
f
o
r
ea
c
h
p
ath
o
f
th
e
an
aly
s
is
r
esu
lt
u
s
in
g
th
e
SEM
.
St
an
d
ar
d
ized
p
at
h
c
o
ef
f
icien
ts
o
f
T
2
DM
p
at
h
Mo
d
el
ar
e
s
h
o
wn
in
T
a
b
le
5
r
ev
ea
led
th
at
th
e
p
ath
m
o
d
el'
s
f
ac
to
r
lo
ad
in
g
s
o
f
late
n
t
an
d
o
b
s
er
v
ed
v
ar
iab
les
as
i
n
p
r
ev
i
o
u
s
SEM
m
o
d
el
wer
e
f
o
u
n
d
to
b
e
g
r
ea
ter
th
an
0
.
4
an
d
p
o
s
itiv
e,
in
d
icati
n
g
th
at
all
o
b
s
er
v
ed
v
ar
iab
les
wer
e
p
o
s
itiv
e
im
p
ac
t o
n
th
eir
l
aten
t v
ar
iab
les.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
7
7
6
I
n
t J I
n
f
&
C
o
m
m
u
n
T
ec
h
n
o
l
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
5
5
3
-
5
6
4
560
T
ab
le
5
.
Path
co
e
f
f
icien
t a
n
d
t
-
s
tatis
tic
s
o
f
T
2
DM
f
in
al
m
o
d
el
H
y
p
o
t
h
e
s
i
z
e
d
p
a
t
h
S
t
a
n
d
a
r
d
i
z
e
d
(
β)
S
.
E.
t
-
t
e
s
t
p
-
v
a
l
u
e
TT
TR
.
6
4
1
.
0
3
5
1
7
.
1
5
0
.
0
0
0
TT
TF
.
4
9
9
.
0
3
1
1
4
.
7
7
7
.
0
0
0
A
T
TT
.
2
0
8
.
0
2
4
6
.
9
3
0
.
0
0
0
A
T
IT
.
6
9
7
.
0
5
0
9
.
8
7
8
.
0
0
0
A
T
B
.
1
2
1
.
0
3
3
2
.
2
2
3
.
0
2
6
B
IT
.
8
7
0
.
0
4
4
2
2
.
5
6
4
.
0
0
0
I
T
PU
.
8
5
0
.
0
3
4
2
3
.
5
8
5
.
0
0
0
I
T
PE
.
0
6
5
.
0
3
0
2
.
2
1
4
.
0
2
7
P
U
PE
.
8
8
9
.
0
3
6
2
4
.
0
0
6
.
0
0
0
I
P
AT
.
8
8
4
.
0
4
0
2
3
.
9
5
8
.
0
0
0
B
PSE
.
8
3
6
.
0
7
6
1
3
.
7
1
6
.
0
0
0
TR
OE
-
.
0
1
0
.
0
2
7
-
.
3
8
5
.
7
0
0
Ad
d
itio
n
ally
,
th
e
s
tan
d
ar
d
ized
p
ath
co
e
f
f
icien
t
v
al
u
e
(
0
.
6
4
1
)
an
d
t
h
e
t
-
v
al
u
e
(
1
7
.
5
1
)
wer
e
o
b
tain
ed
f
r
o
m
th
e
an
aly
s
is
o
f
th
e
im
p
a
ct
o
f
T
R
o
n
T
T
am
o
n
g
T
2
D
M
p
atien
ts
.
As
a
r
esu
lt,
it
wa
s
ass
u
m
ed
th
at
T
R
p
o
s
itiv
ely
af
f
ec
ts
T
T
(
p
<
.
0
0
1
)
(
H_
1
s
u
p
p
o
r
te
d
)
.
T
h
e
r
esu
lts
also
co
n
f
ir
m
th
e
h
y
p
o
th
esis
th
at
T
F
s
ig
n
if
ican
tly
im
p
r
o
v
es
T
T
(
p
<.
0
0
1
)
(
H_
2
s
u
p
p
o
r
ted
)
.
Ho
wev
er
,
t
h
e
r
esu
lts
s
h
o
wed
th
at
B
i
s
n
o
t
s
ig
n
if
ican
tly
af
f
ec
ted
b
y
th
e
PS
E
(
p
>.
0
5
)
(
H_
1
2
No
t S
u
p
p
o
r
ted
)
.
4
.
3
.
Dis
cus
s
io
n
T
h
e
p
u
r
p
o
s
e
o
f
th
is
s
tu
d
y
was
to
cr
ea
te
an
d
v
alid
ate
a
m
Hea
lth
ad
o
p
tio
n
m
o
d
el
f
o
r
SC
M
am
o
n
g
p
atien
ts
with
T
2
DM
wh
o
v
is
it
Palest
in
ian
p
r
im
ar
y
h
ea
lth
c
ar
e
f
ac
ilit
ies.
T
h
e
s
tu
d
y
ev
al
u
ated
h
o
w
d
if
f
e
r
en
t
th
eo
r
etica
l
co
n
s
tr
u
cts
b
ased
o
n
th
e
T
AM
,
T
T
F,
a
n
d
SET
a
f
f
ec
t
ac
t
u
al
m
Hea
lth
u
s
e
am
o
n
g
T
2
DM
p
atien
ts
u
s
in
g
a
s
tr
u
ctu
r
al
e
q
u
atio
n
m
o
d
elin
g
(
SEM
)
ap
p
r
o
ac
h
with
S
PS
S a
n
d
AM
OS.
W
ith
a
co
n
ce
n
tr
atio
n
o
n
d
is
c
o
v
er
in
g
wh
at
v
ar
iab
les
b
est
p
r
ed
ict
th
e
p
er
ce
i
v
ed
b
e
n
ef
it
a
n
d
u
s
e
o
f
m
Hea
lth
,
th
e
m
o
d
el
ass
ess
ed
1
1
im
p
o
r
ta
n
t
d
im
en
s
io
n
s
.
T
h
e
m
ain
p
r
ed
icto
r
o
f
m
Hea
lth
b
en
ef
its
ac
co
r
d
in
g
t
o
th
e
r
esu
lts
,
was
PU.
T
h
is
is
co
n
s
is
ten
t
with
ea
r
lier
T
AM
-
b
ased
r
esear
ch
th
at
em
p
h
asizes
PU
as
a
k
ey
f
ac
to
r
in
tech
n
o
lo
g
y
ad
o
p
tio
n
.
T
h
is
i
m
p
lies
th
at
T
2
DM
p
atie
n
ts
ar
e
m
o
r
e
lik
ely
t
o
ad
o
p
t
a
n
d
s
tick
with
m
Hea
lth
ap
p
licatio
n
s
wh
en
th
ey
b
elie
v
e
th
ey
ar
e
h
elp
f
u
l
f
o
r
m
an
a
g
in
g
th
eir
c
o
n
d
itio
n
,
s
u
ch
as
m
o
n
ito
r
in
g
b
lo
o
d
g
lu
co
s
e
o
r
g
ettin
g
m
e
d
icatio
n
r
em
in
d
er
s
.
I
t'
s
in
ter
es
tin
g
to
n
o
te
th
at
T
R
was
f
o
u
n
d
to
b
e
th
e
least
r
eliab
le
p
r
ed
icto
r
.
T
h
is
in
d
icate
s
th
at
wh
ile
p
atien
ts
ac
k
n
o
wled
g
e
th
e
v
al
u
e
o
f
m
Hea
lth
,
th
e
ali
g
n
m
en
t
b
etwe
en
th
eir
s
p
ec
if
ic
s
elf
-
ca
r
e
task
s
an
d
th
e
f
u
n
ctio
n
alities
o
f
f
er
ed
b
y
m
o
b
ile
to
o
ls
m
ay
s
till
b
e
lack
in
g
.
T
h
is
f
i
n
d
in
g
m
ay
p
o
i
n
t
to
a
n
ee
d
f
o
r
b
etter
cu
s
to
m
izatio
n
o
r
cu
ltu
r
ally
r
e
lev
an
t
d
es
ig
n
f
ea
tu
r
es
in
m
H
ea
lth
ap
p
licatio
n
s
tailo
r
ed
f
o
r
Palest
in
ian
T
2
DM
p
atien
ts
.
T
ab
le
6
p
r
o
v
i
d
ed
a
s
u
m
m
ar
y
o
f
th
e
h
y
p
o
th
esis
test
in
g
.
T
h
e
r
esu
lts
in
d
icate
th
at
wh
ile
T
T
F
will
h
av
e
an
im
p
ac
t
o
n
ac
tu
al
m
o
b
ile
u
s
e
am
o
n
g
T
2
DM
p
atien
ts
,
T
R
will
h
av
e
an
im
p
ac
t
o
n
T
TF
am
o
n
g
T
2
DM
p
atien
ts
as
well
as
T
F.
On
ce
m
o
r
e,
am
o
n
g
T
2
DM
p
atien
t
s
,
I
T
will
af
f
ec
t
AT
u
s
e
f
o
r
m
o
b
ile
u
s
e,
w
h
er
ea
s
B
will a
f
f
ec
t A
T
u
s
e
f
o
r
m
o
b
ile
u
s
e.
T
ab
le
6
.
Su
m
m
a
r
y
o
f
h
y
p
o
th
e
s
ized
r
elatio
n
s
h
ip
s
o
f
T
2
DM
h
y
p
o
th
eses
H
y
p
o
t
h
e
s
e
s
D
e
c
i
s
i
o
n
S
t
a
n
d
a
r
d
i
z
e
d
(
β)
p
-
v
a
l
u
e
1
:
Ta
sk
r
e
q
u
i
r
e
me
n
t
s wi
l
l
a
f
f
e
c
t
T2
D
M
p
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t
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e
n
t
s
o
n
Ta
s
k
Te
c
h
n
o
l
o
g
y
F
i
t
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u
p
p
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r
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e
d
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6
4
1
.
0
0
0
2
:
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sk
Te
c
h
n
o
l
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t
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T
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M
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l
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m
p
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d
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4
9
9
.
0
0
0
3
:
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sk
Te
c
h
n
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l
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y
F
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t
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l
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f
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d
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2
0
8
.
0
0
0
4
:
T2
D
M
p
a
t
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t
s'
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t
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l
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mo
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6
9
7
.
0
0
0
5
:
P
a
t
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t
s w
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2
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f
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m
S
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p
p
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d
.
1
2
1
.
0
2
6
6
:
P
a
t
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e
n
t
s w
i
t
h
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y
p
e
2
d
i
a
b
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l
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t
i
o
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t
o
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se
t
h
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t
o
o
l
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p
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.
8
7
0
.
0
0
0
7
:
T2
D
M
p
a
t
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n
t
s'
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se
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t
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p
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8
5
0
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0
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8
:
A
mo
n
g
T2
D
M
p
a
t
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n
t
s,
p
e
r
c
e
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l
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p
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8
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8
3
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12
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P
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n
t
s w
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p
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2
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b
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0
1
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7
0
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13
:
Th
e
u
s
e
o
f
sm
a
r
t
p
h
o
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e
s
a
n
d
m
o
b
i
l
e
h
e
a
l
t
h
b
y
T2
D
M
p
a
t
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n
t
s w
i
l
l
b
e
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f
l
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b
y
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c
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me
e
x
p
e
c
t
a
t
i
o
n
s
S
u
p
p
o
r
t
e
d
.
6
3
8
.
0
0
0
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J I
n
f
&
C
o
m
m
u
n
T
ec
h
n
o
l
I
SS
N:
2252
-
8
7
7
6
A
mHe
a
lth
a
d
o
p
tio
n
m
o
d
el
fo
r
d
ia
b
etes self
-
ma
n
a
g
eme
n
t:
p
a
tien
t
-
ce
n
t
ered
… (
S
a
leem
Mo
h
a
mma
d
F
a
r
a
j
)
561
T
h
e
f
in
d
in
g
s
also
s
u
p
p
o
r
ted
o
th
er
h
y
p
o
t
h
esized
r
elatio
n
s
h
ip
s
s
u
ch
as
T
R
an
d
T
F
s
ig
n
if
ican
tly
in
f
lu
en
ce
T
T
F,
co
n
f
ir
m
in
g
th
a
t
p
er
ce
iv
ed
alig
n
m
e
n
t
b
etwe
e
n
th
e
m
Hea
lth
to
o
l
an
d
t
h
e
u
s
er
s
’
s
elf
-
ca
r
e
n
ee
d
s
co
n
tr
ib
u
tes
to
p
er
ce
iv
ed
f
it.
T
T
F
h
ad
a
p
o
s
itiv
e
im
p
ac
t
o
n
ac
tu
al
m
Hea
lth
u
s
ag
e,
r
ein
f
o
r
cin
g
th
at
th
e
b
etter
th
e
to
o
l
m
atch
es
th
e
p
atien
t’
s
h
ea
lth
task
s
,
th
e
m
o
r
e
lik
ely
it
is
to
b
e
ad
o
p
ted
.
B
an
d
I
T
wer
e
b
o
th
f
o
u
n
d
to
h
av
e
a
s
ig
n
if
ican
t
im
p
ac
t
o
n
a
ctu
al
m
Hea
lth
u
s
ag
e,
h
ig
h
lig
h
tin
g
th
e
d
ir
ec
t
in
f
l
u
en
ce
o
f
BI
an
d
h
ea
lth
-
r
elate
d
b
eh
av
io
r
s
o
n
tech
n
o
lo
g
y
u
s
e
i
n
th
e
m
an
a
g
em
en
t
o
f
ch
r
o
n
ic
d
is
ea
s
es.
PSE
h
ad
litt
le
im
p
ac
t
o
n
B
,
wh
ich
was
u
n
ex
p
ec
ted
.
T
h
i
s
co
u
ld
b
e
ex
p
lain
ed
b
y
th
e
f
ac
t
th
at
co
n
f
id
en
ce
its
elf
is
in
s
u
f
f
icie
n
t
in
th
e
ab
s
en
ce
o
f
u
s
ef
u
l
ass
is
tan
ce
,
in
s
tr
u
ctio
n
,
o
r
u
s
er
-
f
r
ien
d
ly
a
p
p
d
esig
n
.
T
h
e
im
p
ac
t
o
f
s
elf
-
ef
f
icac
y
m
ay
also
b
e
r
ed
u
ce
d
f
o
r
T
2
DM
p
atien
ts
in
r
ef
u
g
ee
s
ettin
g
s
b
y
ex
ter
n
al
b
ar
r
ier
s
lik
e
d
ig
ital
liter
ac
y
,
d
ev
ice
ac
ce
s
s
,
o
r
cu
ltu
r
al
f
ac
to
r
s
.
T
h
e
th
eo
r
etica
l
f
r
am
ewo
r
k
wa
s
v
alid
ated
in
th
e
en
v
ir
o
n
m
en
t
o
f
Palest
in
ian
T
2
DM
p
atien
ts
b
y
th
e
SEM
m
o
d
el'
s
o
v
er
all
g
o
o
d
f
it
in
d
ices.
T
h
ese
r
esu
lts
h
ig
h
lig
h
t
th
e
s
ig
n
if
ica
n
ce
o
f
cr
ea
tin
g
m
Hea
lth
to
o
ls
th
at
a
d
d
r
ess
g
ap
s
i
n
u
s
er
co
n
f
id
en
ce
an
d
ac
ce
s
s
ib
ilit
y
wh
ile
g
iv
in
g
atten
tio
n
to
p
e
r
ce
iv
ed
u
s
ef
u
ln
ess
an
d
task
ali
g
n
m
en
t.
5.
CO
NCLU
SI
O
N
T
h
e
o
u
tco
m
es
o
f
th
is
s
tu
d
y
s
u
p
p
o
r
t
th
e
o
r
ig
in
al
g
o
al
o
f
c
r
ea
tin
g
an
d
v
e
r
if
y
in
g
a
m
Hea
lth
ad
o
p
tio
n
m
o
d
el
f
o
r
T
2
DM
p
atien
ts
'
s
el
f
-
ca
r
e
m
an
a
g
em
en
t
in
Palest
i
n
e'
s
p
r
im
ar
y
h
ea
lth
ca
r
e
f
ac
ilit
ies.
T
h
e
r
o
b
u
s
tn
ess
o
f
th
e
m
o
d
el
in
ca
p
tu
r
in
g
k
ey
v
ar
iab
les
in
f
lu
en
cin
g
ad
o
p
tio
n
was
co
n
f
ir
m
ed
b
y
SEM
,
wh
ich
s
h
o
wed
s
ig
n
if
ican
t
co
n
n
ec
tio
n
s
am
o
n
g
th
e
1
1
d
im
e
n
s
io
n
s
o
f
m
Hea
lth
u
s
e.
T
h
e
m
o
s
t
s
ig
n
if
ican
t
f
ac
to
r
was
f
o
u
n
d
to
b
e
PU,
u
n
d
er
s
co
r
in
g
th
e
s
ig
n
if
ican
ce
o
f
cr
ea
tin
g
m
Hea
lt
h
ap
p
licatio
n
s
th
at
ar
e
n
o
t
o
n
ly
u
s
ef
u
l
b
u
t
also
v
iewe
d
f
av
o
r
ab
ly
b
y
u
s
er
s
.
T
h
e
p
r
ac
tical
im
p
licatio
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RE
F
E
R
E
NC
E
S
[
1
]
M
.
G
h
o
s
h
a
n
d
F
e
r
d
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-
Al
-
I
sl
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N
D
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mac
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n
2
0
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1
I
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e
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Art
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3
4
.
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.
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.
[
2
]
A
.
A
b
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.
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3
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.
[
3
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S
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A
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me
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2
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.
[
4
]
B.
B
a
c
h
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r
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I
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ET’
2
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2
0
:
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5
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M
.
T.
G
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mp
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p
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2
d
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s:
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[
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[
1
3
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1
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Pr
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[
1
5
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.
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2
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Fr
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[
1
6
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T.
Ly
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,
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1
7
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