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

• Type of Material: Article
• Authors: Angela Pfammatter, Northwestern University; Bonnie Spring, Northwestern University; Nalini Saligram, Arogya World; Raj Davé, Health ARC, Pennington, NJ, United States; Arun Gowda, Focus Scientific Research Center, Bengaluru, India; Linelle Blais, Emory University; Monika Arora, Public Health Foundation of India, Haryana, India; Harish Ranjani, Madras Diabetes Research Foundation, Chennai, India; Om Ganda, Joslin Diabetes Center, Boston, MA, United States; Donald Hedeker, University of Chicago; Sethu Reddy, Joslin Diabetes Center, Boston, MA, United States; Sandhya Ramalingam, Arogya World
• Language: English
• Date: 2016-08-01
• Publisher: JMIR PUBLICATIONS, INC
• Publication Version: Final Published Version
• Copyright Statement: ©Angela Pfammatter, Bonnie Spring, Nalini Saligram, Raj Davé, Arun Gowda, Linelle Blais, Monika Arora, Harish Ranjani, Om Ganda, Donald Hedeker, Sethu Reddy, Sandhya Ramalingam. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.08.2016.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://dx.doi.org/10.2196/jmir.5712
• Title of Journal or Parent Work: JOURNAL OF MEDICAL INTERNET RESEARCH
• Volume: 18
• Issue: 8
• Start Page: e207
• End Page: e207
• Keywords: mHealth; health promotion; Health Care Sciences & Services; diabetes; Medical Informatics; PREVENTION PROGRAM; HEALTH; Life Sciences & Biomedicine; PREVALENCE; PROJECTIONS; Science & Technology
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: In 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. Objective: A prospective, parallel cohort design was applied to examine whether mDiabetes improved fruit, vegetable, and fat intakes and exercise. Methods: Intervention 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. Results: 982 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. Conclusions: A 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.