Designing a mobile health intervention for diabetes management in India

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

8. Source: International Diabetes Federation

9. Source: International Diabetes Federation

10. Organization

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

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

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 • Improve patient health by increasing adherence • Reduce overall costs of patient care • Objective: create an intervention that Agada can pilot

15. Methods Intervention pilot

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? Would you like to use SMS to ask questions? Do you own/ plan to purchase a smartphone? Do you share your phone? How frequently would you like to receive SMS? How concerned are you about the cost? Would your family members be interested?

28. How can SMS help with patient care? Patients take a proactive role in treatment plan • Scheduling follow-up visits • Exercise plan • Diet: increase knowledge about what to eat • Check feet • Medication adherence Intervention pilot

29. Clinical outcomes: • HbA1c control • LDL control • Eye examination • Nephropathy assessment • Foot examination Intervention pilot Intervention pilot Knowledge & behavior: Meas1c Scheduling follow-up visits Following exercise plan Understanding diet Checking feet Adhering to medication

30. Intervention design 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 Design: • 300 patient participants • quasi-experimental control trial • 1 year duration • 2-way SMS • Cost reimbursement Substudy for family: • support • prevention

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

32. Next steps

33. Questions?