Designing a mobile health intervention for diabetes management in India Fiona Y. Akhtar MBA, MS | Mobile Health Design | June 10,
What is this?
2013 top smartphones
But what if I have this?
Smartphones in India Source: IDC
Integrating 3 components DiabetesIndiamHealth
Source: International Diabetes Federation
Organization
mHealth WellnessPreventionDiagnosisTreatmentMonitoring The application of emerging mobile communications and technologies for healthcare systems.
Diabetes specialty care Chennai, India More than 8000 patients 60 to 75% of patients are over age 60 Agada Diabetes Care
Problem Patient adherence to diabetes care is low In-person and phone-based follow-up care is costly No proven guidelines for mHealth interventions for diabetes care
Goals & objectives Goals 1. Improve patient health by increasing adherence 2. Reduce overall costs of patient care Objective: create an intervention that Agada can pilot
Methods
Literature review & Environmental Scan New & unproven SMS as the mHealth approach 1-way v. 2-way Message content is key Cost is a concern
Expert interviews Based on TTM 1-way SMS Proprietary messages
Existing surveys: 2011 & 2012 Objectives: Demographics: age, sex, and education SMS usage Perceptions about existing health services Interest in SMS for health information Methodology: Convenience sample of patients Sample size 30 – 195 Verbal consent All data was provided de-identified Coded and analyzed with Excel
Findings: communication channels n = 165
Findings: access n = 30
Findings: sending information n = 24
Findings: asking questions n = 24
Findings: communicating with patients n = 23
Findings: topics of interest n = 28
Findings: family engagement n = 26
What else?
Follow-up survey Attitudes to mobile phones Perceptions about SMS for health information v. reminders Attitudes and self-efficacy re: diabetes management Do you use social media sites? How concerned are you about the cost? How frequently would you like to receive SMS? Would you like to use SMS to ask questions? Would your family members be interested? Do you own/ plan to purchase a smartphone? Do you share your phone?
How can SMS help with patient care? Patients take a proactive role in treatment plan 1. Scheduling follow-up visits 2. Exercise plan 3. Diet: increase knowledge about what to eat 4. Check feet 5. Medication adherence
Intervention pilot Knowledge & behavior: Meas1c Scheduling follow-up visits Following exercise plan Understanding diet Checking feet Adhering to medication Clinical outcomes: HbA1c control LDL control Eye examination Nephropathy assessment Foot examination
Intervention design Design: 300 patient participants quasi-experimental control trial 1 year duration 2-way SMS Cost reimbursement Substudy for family: support prevention Inclusion criteria: diagnosed with type 2 diabetes mobile phone access Exclusion criteria: under age 18 incapable of 30 minutes of daily aerobic exercise not English speaking
Future directions Smartphones Rural reach Additional geographies Other chronic diseases
Next steps
Questions?