mDiabetes: Leveraging Mobile Technology for Diabetes Prevention in India

Nalini Saligram, Ph.D.19 April 2012

Arogya World is a U.S. based non-profit 501 © 3 organization.  The name of the organization is simply an articulation of our mission: Arogya in Sanskrit means good health.  More literally it means to live a life without disease.

Geneva Health Forum PL03 Innovation & Inclusion: Opportunities & Challenges for Chronic Diseases

Changing the Course of Chronic Disease, One Community at a Time

UN High Level Meeting on NCDs* Sep 19/20 2011• NCDs: one of the leading health and development challenges of the century

• Political Declaration: “whole of government” and “whole of society” approach

Nearly 2 out of every 3 deaths in the world due to NCDs• 80% of NCD deaths occur in low- and middle-income countries

• But, only 3% of overall global development assistance for NCDs.

Cost of inaction > cost of action• Economic Burden of NCDs: World Economic Forum/ Harvard** : NCDs (+ mental health) have

cumulative loss of economic output = $ 47 trillion.

• Action: WHO Best Buys*** cost $11 billion per year in LMICs , roughly 1$ per person per year

Prevalence of NCDs alarmingly high• >20% of population in India**** has at least one chronic disease; >10% more than one

Non-Communicable Diseases (NCDs) - An Urgent Issue

2© 2010 Arogya World. All Rights Reserved.

* NCDs = Cardiovascular diseases, diabetes, cancers + chronic respiratory disease**WEF/Harvard Global Economic Burden of NCDs Sep 2011; ***WEF / WHO Report – From Burden to Best Buys 2011****The Lancet series January 12, 2011

Non-Communicable Diseases (NCDs) - An Urgent Issue

Non-Communicable Diseases (NCDs) - An Urgent Issue

Non-Communicable Diseases (NCDs): An Urgent Issue

WHO: a healthy diet, exercise and avoiding tobacco can prevent • 80% of premature heart disease• 80% type II diabetes• 40% of cancers

Compelling Clinical Proof Exists that Diabetes Can Be Prevented

Landmark Trial - Diabetes Prevention Program (DPP) • 3234 high-risk adults in the US. 30 min physical activity/ day + low-fat diet reduced

chance of getting diabetes by 58%, ( metformin: 31%) NEJM Feb 7, 2002. • The Lancet (2009) …diabetes prevention through lifestyle changes sustained 10 years.

Finnish Diabetes Prevention Study NEJM May 3, 2001.

Indian Diabetes Prevention Programme Diabetologia. 2006 Feb;49(2):289-97.

Prevention: The Holy Grail for Tackling NCDs

3© 2010 Arogya World. All Rights Reserved.

4© 2010 Arogya World. All Rights Reserved.

The Arogya World Approach to the NCD Crisis

Galvanize global action to address non-communicable diseases (NCDs)

► Leverage UN NCD Summit Sep 2011► Op-ed, blog and social media campaign ► Case studies► Women and NCDs ► Women for a Healthy Future Petition► 10,000 Women “Perspectives on NCDs”

Global Survey

Implement Diabetes Prevention through Lifestyle Changes in India

► Multipronged Approach in schools, workplaces and the community

► mDiabetes: leverage mhealth and partnerships. Culturally relevant.

► Science based work ► Measure effectiveness and impact

Two-fold mission

mHealth (Nokia Life):Scalable Development Platform

Encourage Micro Entrepreneurship

Functional English Skills

MDG 8: Global Partnership for Development

MDG 2: Universal Primary Education

MDG 3: Gender Equality and Women’s

Empowerment

MDG 4: Reduce Child Mortality

MDG 5: Improve Maternal Health

Prevent Non-Communicable

Diseases

MDG 6: Combat HIV, Malaria and other diseases

Hygiene, sanitation, tobacco control and

fitness

The Promise of mHealth: Increasing Access to Healthcare. 5.9 billion people (87% global population) have access to mobile phones.

Life Skills and Financial Literacy

The Case for mDiabetes in India

Accessible

PreventionProgram

PreventionProgram

Scalable

Persuasive

Adaptable

Integrated

Nokia Life broad reach in rural, urban India

Nokia Life broad reach in rural, urban India

53% population have mobile phones (2011 Census)

53% population have mobile phones (2011 Census)

mHealth success in maternal health + HIV. Arogya applying to

diabetes prevention. Expert + consumer insights.

mHealth success in maternal health + HIV. Arogya applying to

diabetes prevention. Expert + consumer insights.

12 languages. Cultural relevance. Content, frequency adaptable

from research + tech advances

12 languages. Cultural relevance. Content, frequency adaptable

from research + tech advances

Future: integrate with workplace + rural health worker programs

Future: integrate with workplace + rural health worker programs

Arogya WorldmDiabetes

Arogya WorldmDiabetes

Nokia Life: Livelihood & Life Improvement Services High appeal and daily relevance in the lives of the Next Billion users

Know more, Live more.

Built for Emerging Markets High appeal and daily relevance in the lives of the Next Billion users

Nokia Life, Arogya World mDiabetes Offering

Slide 9 © PharmARC Analytic Solutions Pvt. Ltd., 2009

2011 Clinton Global Initiative Commitment

Nokia Life Platform

1,000,000 Consumers

Free for 6 months

2x/wk; 12 languages

Accuracy, Cultural Relevance - Behavior Change Task Force

Current Partners

Nokia, Emory, Ipsos

Aetna, J&J, Biocon

Program Development

(2nd Half-2011)

56 Messages - Emory Pre-Tested with

consumers 9 Jan 2012 roll-out 30,000 recipients Mar mDiabetes name 25 messages x 30

consumers = 750 consumer insights.

Telephone feedback

Real-world consumer insights to refine messages

Message Refinement

(2011 - 1st Half-2012)

Full Roll-Out 1 million

Multiphased evaluation

Effectiveness Eval insights from 1,000 consumers, phone

Village Testing: face-to-face in-depth feedback

Data analysis and Publication

Effectiveness Testing

(2012-2013)

Comprehensive evaluation of outcomes

Extending free content to 1 year

Content, Sequencing Improvement

Interactive Technology Incorporation

Sustainability and Scalability

Evaluation and Expansion

Arogya World mDiabetes Program At A Glance

mDiabetes Initial Consumer Insights

Pretesting Nov/Dec 2011. Consumers. Simulated situations. Part I N= 44, N + S India (Hindi + Kannada); Telephone interviews Part II – N=8 Semi-Urban Tamil Nadu; face to face interviews

KEY TAKEAWAYS Overall messages liked and found to be useful Simple short sentence with one concept will improve ease of reading Direct call to action is desirable compared to indirect persuasive messages Messages with no specific action scored low on likability and usefulness Link messages to diabetes Message should communicate whether it is primarily for control or prevention of diabetes Message frequency could be increased in the beginning

ACTION TAKEN Messages were modified per consumer feedback obtained Frequency of messages was increased to 6 messages for the 1st week and then 2 messages

per week

mDiabetes – Adaptation of Content

mDiabetes First Real World Consumer Insights

1 2 3 4 50

20

40

60

80

100

80 9067 70

86

Recalled receiving and reading the message

1 2 3 4 50

20

40

60

80

100

8870 70

81 80

Message Usefulness

Perceived message to be useful or very useful

1 2 3 4 50

20

40

60

80

100

92 87 85 95 88

Ease of Understanding

Perceived message to be easy or very easy to understand

1 2 3 4 50

20

40

60

80

100

88 96 88 85100

Willing to share

Yes, willing to share

Message Recall

Y axis = % consumers. X axis represents messages.

Compelling messages: science + behavior change Consumer-testing and local adaptation Behavior Change Task Force: Medical & non-medical experts =

technical accuracy + cultural relevancy Comprehensive measurement and evaluation In-house expertise + external evaluation partner Multisector partnership: Industry (mobile phone, pharma,

health insurance), academia, civil society Unifying purpose: Make meaningful public health impact,

improve outcomes Scalability, sustainability Innovation; leverage technology advances

Critical Success Factors

Back-Up

Board* Dr. Nalini Saligram – Arogya World; Dr. Pamela Yih, Treasurer – Pamela Y-F Yih Inc.; Kathryn Graves – Emory Univ Rollins School of Public Health; Dr. Meryle Melnicoff – formerly at WISTAR Institute

Indo-US Scientific Steering Committee* Based in India - Dr K. Srinath Reddy – President, Public Health Foundation of India, Dr V. Mohan – Madras Diabetes

Research Foundation, Dr Ashok K. Das – Additional Director General Health Services, Dr Prabhakaran – Centre for Chronic Disease Control, and PHFI, Dr Nikhil Tandon – All India Institute of Medical Sciences, Dr. Prasanna Kumar – Bangalore Diabetes Hospital

Based in the US - Dr K.M. Venkat Narayan – Emory University, Dr Sreekumar Nair – Mayo Clinic, Dr Francine Kaufman – Medtronic, Dr Karmeen Kulkarni – Abbott Diabetes Care, Dr Sethu Reddy – Merck, Dr. Om Ganda -Joslin

Advisors*Dr A Ramachandran - India Diabetes Research Foundation, Chennai; Dr Subhankar Chowdhury-IPGME&R and SSKM Hospital, Kolkata; Monika Arora Hriday-Shan; C.V. Madhukar PRS Legislative Research; Deanna M. Hoelscher Michael and Susan Dell Center for Advancement of Healthy Living; Dr Sudeep Singh Gadok, International Health and Development Expert; Raj Dave ARE Consulting, Dr. Arun Chockalingam World Hypertension League, Dr. David C U’Prichard Druid Consulting

Behavior Change Task Force* Based in the US - Dr. Fran Kaufman, Medtronic, Dr. Linelle Blais, Emory University, Andrea Falls, Edelman Based in the UK – Zoe Hellman, Weight Watchers Based in India – Dr. Ranjani Harish, Dr. Mohan’s Diabetes Specialities Centre, Dr. Monika Arora, Hriday-Shan,

Sukanti Ghosh, APCO Worldwide, Dr. Kanav Kahol – PHFI

*all working pro-bono

+

Consultants

Thea Joselow (Washington DC – digital media expert), Dr. S Kumar (Bangalore - senior consultant India), Dr. Sandhya Ramalingam (Bangalore – market research expert), Beau Young (Philadelphia- accountant)

Arogya World Network of Influencers

Our Track Record

• Feb 2009 – Workshop with 66 stakeholders in Delhi to gather input on priorities.• World Diabetes Day 2009; 40 community walks in Delhi; 6,000 children asked Mrs Gursharan Kaur, wife of Prime

Minister of India, for help in making policy changes• Formalized as US-based non-profit organization March 2010. • New Diabetes Friendly Recipe Created for Arogya World by celebrated Manhattan chef from Devi Nov 2010• Initiated Schools diabetes education program in India 2011; completed year 1 program, encouraging results• Clinton Global Initiative Commitment 2011 – 1 million consumers diabetes mHealth campaign in India; 30,000

consumers received messages through March 2012. • Healthy Workplace Stakeholder Input Session in India Bangalore, Feb 24, 2012 • Women for a Healthy Future – 2011 petition;