A programme that sent twice-weekly text messages to a million people in India advising them to exercise, eat less fat, and eat more fruits and vegetables increased the health behaviors known to prevent diabetes, according to a study published in the Journal of Medical and Internet Research.
The research, undertaken by Northwestern University and non-profit health organisation Arogya World, claims to be the first to use the reach of mobile phones to try and change diabetes risk factors in a large number of people in a vast country like India.
India has rising numbers of people with diabetes, with 66m now affected. But it also has soaring mobile phone use, with 900m owning a device. More than 200m of them are smartphones, making it the second largest market in the word, behind only China.
In this study, intervention participants (942) were randomly selected from the 1m Nokia subscribers who elected to opt in to the mDiabetes programme. They received 56 text messages in their choice of 12 languages over six months; control participants (983) received no contact. Messages were designed to motivate improvement in diabetes risk behaviors and increase awareness about the causes and complications of diabetes.
Preventative barriers
“The size and heterogeneity of India’s population, limited access to health services, and scarcity of quality-controlled clinical laboratory facilities create barriers to intervening preventively on diabetes,” states the report.
“Access challenges are particularly acute in India’s rural areas, where almost 70% of the population resides. Growing evidence indicates that Indians have heightened genetic risk and a lowered disease threshold in response to diabetes risk factors… increasing an urgent need for effective interventions that can be scalable to all regions.”
Researchers compared composite scores of the experimental group's fruit, vegetable and fat intake and exercise with the control group. While people in both the experimental and control group improved their health behaviors over six months, the experimental group improved significantly more.
Almost 40 percent more people improved their health behaviors as a result of the texting (299 showing improvement in the experimental group versus 185 in the control group), based on data in the paper.
"This shows the potential for even the most basic of mobile phones to be used as a viable tool to deliver public health messages on a large scale across a diverse population," said lead study author Angela Fidler Pfammatter, research assistant professor in preventive medicine at Northwestern University Feinberg School of Medicine. "And you just need a basic mobile phone. This can make an impact."
The 56 text messages were sent twice a week for six months and were developed with Emory University and culturally adapted for India with extensive consumer feedback.
Asian roll-out
Northwestern University researchers contributed to the study design and data analysis. By using statistical analysis to correct for baseline differences, and by scoring each study participant on positive and negative behaviors, the authors showed clear health behavior differences between those who received the text messages and those who did not.
Researchers now suggest the text message model could play a crucial role in promoting good health and nutrition in other Asian countries.
“With its low cost and burden, text messaging intervention holds the potential to represent sound and effective public health investment. The cost of Arogya World’s one million-person program was $0.65 per person, including program development, transmission, and measurement. The current global epidemic of non-communicable disease creates an urgent need for proven, simple, transportable, readily executable strategies that offer hope for chronic disease prevention at the population level particularly in LMICs.
“Population-level mobile health promotion interventions like the one described, show promise to meet that need. Additional evaluation using randomized trial design with measurement of objective outcomes will add to the evidence base for the use of mobile technology in chronic disease prevention,” they added.
Source: Journal of Medical and Internet Research
2016;18(8):e207: doi:10.2196/jmir.5712
“Health Intervention to Improve Diabetes Risk Behaviors in India: A Prospective, Parallel Group Cohort Study”
Authors: A Pfammatter, et al