The effect of AI-assisted nursing care on digital health literacy, symptom management, and continuity of care among pulmonary outpatients: A quasi-experimental study at Bhayangkara Surabaya Hospital

Main Article Content

Heri Nur Cahyanto, S.Kep., Ns., M.T
Dr. Agustin, S.Kep., Ns., M.Kes
Novita Ana Anggraini, S.Kep., Ns., M.Kep., Ph.D
Dr. Prima Dewi K., S.Kep., Ns., M.Kes
Dr. Atik Setiawan W., S.Kep., Ns., M.Kep

Abstract


Background: Pulmonary outpatients often experience recurrent respiratory symptoms requiring continuous support. Limited consultation time, increasing digital health use, and the need for symptom monitoring highlight the importance of AI-assisted nursing care in outpatient pulmonary services.




Purpose: This study analyzed the effect of AI-assisted nursing care on digital health literacy, symptom management, and continuity of care among pulmonary outpatients at Bhayangkara Surabaya Hospital.




Methods: A quasi-experimental study with a two-group pretest-posttest design involved 70 pulmonary outpatients (35 intervention, 35 control). The intervention group received AI-assisted nursing care; the control group received standard care. Data were collected using the Digital Health Literacy Instrument, a symptom management questionnaire, and the Nijmegen Continuity Questionnaire. Analysis used paired t-test, Wilcoxon Signed-Rank Test, independent t-test, and Mann-Whitney U Test.




Results: The intervention group showed significantly greater improvements than the control group. Digital health literacy was significantly higher (t = 9.11, p < 0.001), symptom management improved significantly (Z = −7.84, p < 0.001), and continuity of care differed significantly between groups (t = 8.99, p < 0.001). Change scores were substantially greater in the intervention group, particularly for continuity of care (18.95 vs. 2.26), with small effect sizes across all outcomes.



Conclusion:
AI-assisted nursing care can strengthen digital nursing support for pulmonary outpatients. Integrating structured digital education, chatbot interaction, symptom tracking, reminders, and nurse monitoring improves digital health literacy, symptom management, and continuity of care in outpatient pulmonary services.

Article Details

Section
Research Articles

References

[1] A. Agustí et al., “Global Initiative for Chronic Obstructive Lung Disease 2024 Report: GOLD Executive Summary,” Eur. Respir. J., vol. 63, no. 1, p. 2301381, 2023, doi: 10.1183/13993003.01381-2023.

[2] I. M. W. Dewi, R. N. P. Fauziyyah, D. Wanda, I. D. Kulsum, B. W. Lestari, and A. Y. Soeroto, “Chronic respiratory symptoms among TB survivors in a high-TB burden setting in Indonesia: A preliminary study,” J. Respirologi Indones., vol. 45, no. 3, pp. 194–198, 2025, doi: 10.36497/jri.v45i3.844.

[3] G. I. for C. O. L. Disease, “Global strategy for prevention, diagnosis and management of COPD: 2024 report,” Global Initiative for Chronic Obstructive Lung Disease, 2024. [Online]. Available: https://goldcopd.org/2024-gold-report/

[4] K. K. R. Indonesia, “Indonesia’s Movement to End TB,” 2025, Kementerian Kesehatan Republik Indonesia. [Online]. Available: https://kemkes.go.id/id/indonesias-movement-to-end-tb

[5] A. C. on S. and Q. in H. Care, “Chronic obstructive pulmonary disease clinical care standard,” Australian Commission on Safety and Quality in Health Care, Sydney, 2024. [Online]. Available: https://www.safetyandquality.gov.au/

[6] W. H. Organization, “Chronic obstructive pulmonary disease (COPD),” World Health Organization, Geneva, 2024. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

[7] W. H. Organization, “Global tuberculosis report 2025: TB treatment coverage and outcomes,” World Health Organization, Geneva, 2025. [Online]. Available: https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2025

[8] S. Surabaya, “Angka kasus TBC masih tinggi di Jatim: deteksi dini dan pengobatan tepat kunci penyembuhan,” May 18, 2024, Suara Surabaya. [Online]. Available: https://www.suarasurabaya.net/kelanakota/2024/angka-kasus-tbc-masih-tinggi-di-jatim-deteksi-dini-dan-pengobatan-tepat-kunci-penyembuhan/

[9] J. Times, “TBC di Surabaya tembus 12.096 kasus pada 2024, ini sederet langkah Dinkes,” May 18, 2025, Jatim Times. [Online]. Available: https://jombang.jatimtimes.com/baca/335181/20250413/081700/tbc-di-surabaya-tembus-12-096-kasus-pada-2024-ini-sederet-langkah-dinkes/

[10] J. Schrijver, A. Lenferink, M. Brusse-Keizer, M. Zwerink, P. D. L. P. M. van der Valk, and J. van der Palen, “Self-management interventions for people with chronic obstructive pulmonary disease,” Cochrane Database Syst. Rev., vol. 2022, no. 1, p. CD002990, 2022, doi: 10.1002/14651858.CD002990.pub4.

[11] J. Dummer, C. Baggott, and R. Hogan, “Improving continuity of care of patients with respiratory disease at hospital discharge,” Breathe, vol. 16, no. 4, p. 200161, 2020, doi: 10.1183/20734735.0161-2020.

[12] S. Salvado, A. Marques, and A. Paiva, “Pulmonary rehabilitation nursing interventions promoting self-management in people with chronic obstructive pulmonary disease: A scoping review,” Int. J. Nurs. Stud. Adv., vol. 8, p. 100283, 2025, doi: 10.1016/j.ijnsa.2025.100283.

[13] R. van der Vaart and C. Drossaert, “Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills,” J. Med. Internet Res., vol. 19, no. 1, p. e27, 2017, doi: 10.2196/jmir.6709.

[14] M. Senek, D. Drummond, H. Pinnock, K. Hansen, A. Ankolekar, and Ú. O’Connor, “Impact of Digital Health on Patient-Provider Relationships in Respiratory Secondary Care Based on Qualitative and Quantitative Evidence: Systematic Review,” J. Med. Internet Res., vol. 27, p. e70970, 2025, doi: 10.2196/70970.

[15] R. van der Vaart, I. Tuitert, J. van ’t Veer, and C. Drossaert, “Validation of the Updated Digital Health Literacy Instrument and Development of a Short Form: Online Survey Study of the General Population,” J Med Internet Res, vol. 28, p. e86879, 2026, doi: 10.2196/86879.

[16] A. A. Uijen, F. G. Schellevis, W. J. H. M. van den Bosch, H. G. A. Mokkink, C. van Weel, and H. J. Schers, “Nijmegen Continuity Questionnaire: Development and Testing of a Questionnaire That Measures Continuity of Care,” J. Clin. Epidemiol., vol. 64, no. 12, pp. 1391–1399, 2011, doi: 10.1016/j.jclinepi.2011.03.006.

[17] J. L. Haggerty, R. J. Reid, G. K. Freeman, B. H. Starfield, C. E. Adair, and R. McKendry, “Continuity of Care: A Multidisciplinary Review,” BMJ, vol. 327, no. 7425, pp. 1219–1221, 2003, doi: 10.1136/bmj.327.7425.1219.

[18] H. N. Cahyanto, A. P. Hidayathillah, D. Farida, A. Jayadi, W. T. Lestari, and P. Pamungkas, “Artificial Intelligence in Nursing Care: A Systematic Literature Review and Bibliometric Analysis,” Gac. Med. Caracas, vol. 134, no. Supl. 1 SE-ARTÍCULOS DE REVISIÓN, pp. S206–S220, Jan. 2026, [Online]. Available: https://saber.ucv.ve/ojs/index.php/rev_gmc/article/view/32016

[19] H. N. Cahyanto, M. D. Lantasary, N. Mayasari, J. Prasetyo, and S. Singgih, “Penerapan Media E-Leaflet Digital sebagai Upaya Peningkatan Literasi Kesehatan Pasien Demam Tifoid di Rumah Sakit,” Kolaborasi J. Pengabdi. Masy., vol. 5, no. 6 SE-Artikel, pp. 953–961, Oct. 2025, doi: 10.56359/kolaborasi.v5i6.713.

[20] R. A. El Arab, O. A. Al Moosa, F. H. Abuadas, and J. Somerville, “The Role of AI in Nursing Education and Practice: Umbrella Review,” J Med Internet Res, vol. 27, p. e69881, 2025, doi: 10.2196/69881.

Similar Articles

1 2 > >> 

You may also start an advanced similarity search for this article.