1. Designing a mobile health intervention for diabetes management in India Fiona Y. Akhtar MBA, MS | Mobile Health Design | June 10, 2013 fiona.akhtar@outlook.com @fionayasminelinkedin/fionaa

2. What is this?

4. 2013 top smartphones

5. But what if I have this?

6. Smartphones in India Source: IDC

7. Integrating 3 components DiabetesIndiamHealth

8. Source: International Diabetes Federation

10. Organization

11. mHealth WellnessPreventionDiagnosisTreatmentMonitoring The application of emerging mobile communications and technologies for healthcare systems.

12.  Diabetes specialty care  Chennai, India  More than 8000 patients  60 to 75% of patients are over age 60 Agada Diabetes Care

13. 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

14. 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

15. Methods

16. Literature review & Environmental Scan  New & unproven  SMS as the mHealth approach  1-way v. 2-way  Message content is key  Cost is a concern

17. Expert interviews  Based on TTM  1-way SMS  Proprietary messages

18. 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

19. Findings: communication channels n = 165

20. Findings: access n = 30

21. Findings: sending information n = 24

22. Findings: asking questions n = 24

23. Findings: communicating with patients n = 23

24. Findings: topics of interest n = 28

25. Findings: family engagement n = 26

26.  What else?

27. 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?

28. 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

29.  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

30. 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

31. Future directions  Smartphones  Rural reach  Additional geographies  Other chronic diseases

32. Next steps

33.  Questions?