The effectiveness of text messages support for diabetes self-management: protocol of the TEXT4DSM study in the democratic Republic of Congo, Cambodia and the Philippines

Abstract

BackgroundPeople with diabetes find it difficult to sustain adequate self-management behaviour. Self-Management Support strategies, including the use of mobile technology, have shown potential benefit. This study evaluates the effectiveness of a mobile phone support intervention on top of an existing strategy in three countries, DR Congo, Cambodia and the Philippines to improve health outcomes, access to care and enablement of people with diabetes, with 480 people with diabetes in each country who are randomised to either standard support or to the intervention.Design/methodsThe study consists of three sub-studies with a similar design in three countries to be independently implemented and analysed. The design is a two-arm Randomised Controlled Trial, in which a total of 480 adults with diabetes participating in an existing DSME programme will be randomly allocated to either usual care in the existing programme or to usual care plus a mobile phone self-management support intervention. Participants in both arms complete assessments at baseline, one year and two years after inclusion.Glycosylated haemoglobin blood pressure, height, weight, waist circumference will be measured. Individual interviews will be conducted to determine the patients’ assessment of chronic illness care, degree of self-enablement, and access to care before implementation of the intervention, at intermediate moments and at the end of the study.Analyses of quantitative data including assessment of differences in changes in outcomes between the intervention and usual care group will be done. A probability of <0.05 is considered statistically significant. Outcome indicators will be plotted over time. All data are analysed for confounding and interaction in multivariate regression analyses taking potential clustering effects into account.Differences in outcome measures will be analysed per country and realistic evaluation to assess processes and context factors that influence implementation in order to understand why it works, for whom, under which circumstances. A costing study will be performed.DiscussionThe intervention addresses the problem that the greater part of diabetes management takes place without external support and that many challenges, unforeseen problems and questions occur at moments in between scheduled contacts with the support system, by exploiting communication technology.Trial registrationISRCTN86247213

Content, participants and outcomes of three diabetes care programmes in three low and middle income countries

“…The selection process started at a workshop on chronic care in LMIC in 2009 in Belgium, where these programmes were identified for their offering care, self-management education and support to diabetic patients, and their willingness to participate in the TEXT4DSM study (ISRCTN 86247213) [12,13]. A theoretical framework was developed to understand relationships between care, self-management and health outcomes (Fig.…”

“…These were sufficiently high in all programmes (0.85 in Kin-réseau; 0.93 in MoPoTsyo; and 0.91 in FiLDCare). Further details on the TEXT4DSM study are published elsewhere [13].…”

Mobile phone use among female entertainment workers in Cambodia: an observation study

“…In Cambodia, several successful mHealth health programs have been introduced in the areas of post-abortion contraceptive use (29), pharmacovigilance (30), diabetes self-management (31), case detection/notification (32), and HIV education (33). This current evidence base for using mobile phones to make health assessments and encourage uptake of services in hard-to-reach populations that face stigma and discrimination in developing countries is promising, but stronger impact evaluations are needed to understand the full benefits of such interventions.…”

“…This current evidence base for using mobile phones to make health assessments and encourage uptake of services in hard-to-reach populations that face stigma and discrimination in developing countries is promising, but stronger impact evaluations are needed to understand the full benefits of such interventions. Results from recent studies show that mHealth tools can be successfully implemented in Cambodia in an urban setting (29,32), for HIV prevention (33), and with young people using participatory approaches (29)(30)(31)(32)(33).…”

Assessing the Feasibility of Smartphone Apps for HIV-Care Research with MSM and Transgender Individuals in Mpumalanga, South Africa

“…These tools have been shown to improve various chronic conditions and health behaviors including ART adherence among HIV-positive individuals in low-resource settings. [19][20][21] Also, mhealth tools have been effective in helping individuals navigate structural and social determinants of health to address individual HIV care and prevention behaviors. 22 However, there remains limited understanding of the feasibility of these mhealth tools for MSM and transgender individuals in African areas and how these tools can be integrated into HIV intervention research.…”