BRIDGES RESEARCH PROJECT:

MOBILE PHONE DIABETES SELF-MANAGEMENT SUPPORT

MARCH 20, 2014

a 3-country analysis of its implementationin existing Diabetes Self-Management Education Programs in

DR Congo, Cambodia & The Philippines,

Institute for Tropical Medicine (ITM) in Belgium

I. INTRODUCTION OF RESEARCH

• Research Topic: Evaluation of effectiveness of a mobile phone Diabetes Self-Management Support (DSMS) intervention on top of an existing Diabetes Self Management Education (DSME) strategy in 3 countries:

• DR Congo, • Cambodia • Philippines.

• Time period : Sept 2011- Dec 2014

• Beneficiaries: 484 Diabetes patients in MoPoTsyo peer education network (>8000 Diabetes patients are registered in Cambodia,2013)

• Permission from National Ethical Committee

I. 1. DIABETES PEER EDUCATORPROGRAM (MOPOTSYO )

• Cambodian (NGO) for people with chronic

Non Communicable Disease (NCD): 1. Diabetes & associated diseases (kidney,

cholesterol problems, retinopathy etc.)

2. High Blood Pressure (non-diabetic)

• Poor & Remote communities • Not clinic-based, but community-based

• Peer Education Networks provide care and access through Peer Educator to medical services

• National Strategy for Prevention of NCD 2013-2020 recognizes the care system

I. 1. DIABETES PEER EDUCATOR PROGRAM (CONT.)

1. FOLLOW-UP PATIENTS

4

Session group weekly’s and member follow up’s

activities

I. 1. DIABETES PEER EDUCATOR PROGRAM (CONT.)

2. PE HELPS TO ORGANIZE MEDICAL CONSULTATION

5

Two Peer Educators help & cooperate with HC nurse:

• Explain + let do urine protein test

• Administration:

• Fill the lab-service-request form for patient

• Register name and code on blood tube

• Prepare serum + put on ice

• Collect revenue from patient-member+ put in bank

• Send Serum + Blood to Laboratory

I. 2. OBJECTIVES OF RESEARCH PROJECT

To evaluate the effectiveness of a mobile phone DSMS intervention:By assessing the differences before and after the intervention:Between the DSME and the DSME+DSMS groups In each country on:

1. health outcomes:• HemoglobinA1C (HbA1C) • blood pressure• Body Mass Index (BMI) & waist circumference• percentage of people with diabetic foot problems

2. Adequate use of care resources:• failure-to-attend rate • perceived quality of care• health care expenditure

3. Enablement• level of knowledge on diabetes (care)• self-management and ability to cope• adherence to glucose monitoring & control regimes & healthy lifestyle

To understand the differences in effectiveness of the intervention between countries.

I. 3. RESEARCH PROJECT DESIGN

DR Congo Cambodia Philippines

Month 15: - Physical data

- Laboratory data

Month 21: - Questionnaires

- Physical data

- Laboratory data

Month 27: - Physical data

- Laboratory data

Month 33: - Questionnaires

- Physical data

- Laboratory data

- Costing data

- Informed consent

- Collection of baseline data

- Randomisation

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Assessment of baseline data per country (400 people with diabetes per country) & Multi-country analysis

Target population: people with diabetes

in existing DSME strategy

People receiving DSME + DSMS

(intervention study-group)

(200 in each country)

People receiving DSME only

(control study-group)

(200 in each country)

- Ongoing DSME

- DSMS: - provision mobile phone

- Project initiated Communication

- training about phone use

- collect sms/calls/toll-free 800 numbers for PatIC

- Participate in research data collection

Month 15: - Physical data

- Laboratory data

Month 21: - Questionnaires

- Physical data

- Laboratory data

Month 27: - Physical data

- Laboratory data

Month 33: - Questionnaires

- Physical data

- Laboratory data

- Costing data

- Ongoing DSME

- No DSMS: - provision mobile phone

- no project-initiated communication

- might use their phone for communication,

but they will not receive any specific

explanation of stimulus to do so)

- Participate in research data collection

HbA1 (t0)

HbA1C (t-end)

Diff

eren

ce t0

-ten

d

HbA1C (t0)

HbA1C (t-end)

Diff

eren

ce t0

-ten

d

Multi-countryanalysis

(comparison of results of each country)

Evaluation of DSMS intervention per country (200 people in each group in each country)

mean reduction of HBA1C in people in DSME+DSMS group vs mean reduction in DSME only group

I. 4. STUDY INTERVENTION: MOBILE PHONE DSMS

• Provision of phones

• Beeline Phone and SIM• Phone is fill account 1$ per 3month (to keep activate)

• Project initiated communication (SMS)

• General knowledge of Diabetes• Diet & Exercise• Glucose monitoring & medication• Foot care• Smoking & Drinking alcohol • Self-recording• Problem solving and Empowerment

I. 5. THE FRONTLINE SOFTWARE

I. 6. SMS CONTENT (EXAMPLES)

• លទ្ធផលតេស្តជាេិស្ករបង្ហា ញថាជាេិស្ករតោកអ្នកតៅខ្ពស្់តេក ដូចត េះស្ូមត្វើការណាេ់ជួបគ្រូតេទ្យជំនាញ តដើមបីេិតគ្រេះត ើងវិញ អ្ំេីការតគ្បើថាន ំ

• ស្ូមតគ្បើថាន ំតេទ្យ តោយបា គ្េឹមគ្េូវតាមកំរិេកំណេ់ ិងតទ្ៀេទាេ់តាមតវជជបញ្ជជ របស្់គ្រូតេទ្យ ក ំបីខា !

• ស្ំោេតជើង ជាមួយទ្ឹក ឹងសាប ូ ជាគ្បចំតដើមបីតជើង មា ស្ ខ្ភាេលអ!

• ហាេ់គ្បាណរឺលអ ស្គ្មាប់អ្នកជំងឺ ទ្ឹកតនាមផ្ផអម ិងស្គ្មាប់ អ្នកទាំងអ្ស្់រន !

• មួយថ្ងៃមា ១៤៤០នាទ្ី អ្នកហាេ់គ្បាណ តោយបា ៣០ នាទ្ី តេេ អ្វីេិបាក?????

• ហាេ់គ្បាណយ៉ា ងតហាចណាស្់៣០នាទ្ីជា តរៀងរាល់ថ្ងៃ ត្វើតោយស្ ខ្ ភាេរឹងមាំ!

• ជិេះកង់លអ ស្គ្មាប់ស្ ខ្ភាេ ិងចំតណញ ជាងជិេះម៉ាូេ.ូ..!

• ស្ូមក ំេូបោហារ តាមទ្ំោប់ របបីេូបោហារ តដើមបីស្ ខ្ភាេលអ!

• គ្េូវ ឹកត ើញដល់ ស្ ខ្ភាេអ្នក ម តេលចប់តផតើម បរិតភារោហារ!

• េីរា៉ា មីេទឹ្កតនាមផ្ផអម តគ្បៀបបា ឹង តស្ៀវតៅម ខ្មាូប ស្គ្មាប់អ្នក ិងគ្រួសារ• ………….

II. PROJECT PROBLEMS AND SOLUTIONS

• Problems• Patient can’t read the text message. • Text message is limited to 1 sms (as protocol)• Patients lost the phone/phone number (no renew provision)• Patients can’t check inbox/inbox is full• Phone number is cutoff from system (no account >6months)• Phone must support KHMER fonts

• Solution• Other household member can read for patients• Form group discuss to create SMS to ensure SMS is simple and

understandable• We top-up account 1$ per 3months for those use Beeline number provided

by research• We ask PE to help delete sms from inbox about one per 4 or 5months• Patients pay their own money to buy new Beeline SIM, just inform us the

new number.

III. VERBOICE INTERVENTION

• Has starting in January 2014

• We send 6 call flows per week

• We can schedule one per week

• We always get warmly technical support from inSTEDD team in Cambodia

IV. SUCCESSES AND CHALLENGES OF VERBOICE

• Successes: • Patients seem happier with voice message

• It works with all number networks and kind of phones

• Challenges• Higher service cost…sustainability?

• With voice message, patients cannot re-listen

• Still some patients “no answer”. Maybe it takes longer time (than sms) for each transaction.

• Some technical errors????

V. CONCLUSION & SUGGESTIONS

• We appreciate verboice system. It is a good alternative solution to sending text messages . We will use this voice message till the end of the project in December 2014.

• Suggestion:

• Could you design for save number with name???

• Could you extend call log more than 10 displays??

• Could you display history of call log by date??? (normally, I did download as “.csv”, then sort by date, does it have another solution??)

THANKS YOU !