mHealth Intervention to Improve Diabetes Risk Behaviors in India: A Prospective, Parallel Group Cohort Study

Abstract

BackgroundIn low/middle income countries like India, diabetes is prevalent and health care access limited. Most adults have a mobile phone, creating potential for mHealth interventions to improve public health. To examine the feasibility and initial evidence of effectiveness of mDiabetes, a text messaging program to improve diabetes risk behaviors, a global nonprofit organization (Arogya World) implemented mDiabetes among one million Indian adults.ObjectiveA prospective, parallel cohort design was applied to examine whether mDiabetes improved fruit, vegetable, and fat intakes and exercise.MethodsIntervention participants were randomly selected from the one million Nokia subscribers who elected to opt in to mDiabetes. Control group participants were randomly selected from non-Nokia mobile phone subscribers. mDiabetes participants received 56 text messages in their choice of 12 languages over 6 months; control participants received no contact. Messages were designed to motivate improvement in diabetes risk behaviors and increase awareness about the causes and complications of diabetes. Participant health behaviors (exercise and fruit, vegetable, and fat intake) were assessed between 2012 and 2013 via telephone surveys by blinded assessors at baseline and 6 months later. Data were cleaned and analyzed in 2014 and 2015.Results982 participants in the intervention group and 943 in the control group consented to take the phone survey at baselne. At the end of the 6-month period, 611 (62.22%) in the intervention and 632 (67.02%) in the control group completed the follow-up telephone survey. Participants receiving texts demonstrated greater improvement in a health behavior composite score over 6 months, compared with those who received no messages F(1, 1238) = 30.181, P<.001, 95% CI, 0.251-0.531. Fewer intervention participants demonstrated health behavior decline compared with controls. Improved fruit, vegetable, and fat consumption (P<.01) but not exercise were observed in those receiving messages, as compared with controls.ConclusionsA text messaging intervention was feasible and showed initial evidence of effectiveness in improving diabetes-related health behaviors, demonstrating the potential to facilitate population-level behavior change in a low/middle income country.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ACTRN): 12615000423516; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367946&isReview=true (Archived by WebCite at http://www.webcitation.org/6j5ptaJgF)

Diabetes and data in many forms

“…Studies from India have shown mHealth is feasible and improves health outcomes in subjects with diabetes. Text messaging improved health behavior related to diabetes [8]. Similarly, a pilot study of mHealth intervention was compared to usual care in three metropolitan cities across India over a 6-month period [9].…”

Protocol for a cluster randomised controlled trial on information technology-enabled nutrition intervention among urban adults in Chandigarh (India): SMART eating trial

“…The majority of the identified interventions had no theoretical basis, and most of them used traditional methods of education such as individual/group counseling or printed material, and most did not achieve a significant change in dietary behaviour [40–45,48]. Whilst a few studies have reported change in one or another dietary behaviour using information technology tools most had one of the methodological flaws mentioned above [40,49,50,51]. Moreover, most interventions to date have been developed and evaluated in developed countries, except a few previous studies in India [49–51].…”

“…Whilst a few studies have reported change in one or another dietary behaviour using information technology tools most had one of the methodological flaws mentioned above [40,49,50,51]. Moreover, most interventions to date have been developed and evaluated in developed countries, except a few previous studies in India [49–51]. The effectiveness of interventions based on information technology has not been established as yet.…”

mDiabetes initiative using text messages to improve lifestyle and health-seeking behaviour in India

“…Pfammatter et al 14 also used mHealth procedure to motivate the participants to follow a healthy lifestyle. In both the studies participants were also contacted through personal reviews or through telephonic interview.…”