Abstract
Background: Mobile health (m-health) work in low- and middle-income countries (LMICs) mainly consists of small pilot programs with an unclear path to scaling and dissemination. We describe the deployment and testing of an m-health platform for non-communicable disease (NCD) self-management support in Bolivia.Methods: Three hundred sixty-four primary care patients in La Paz with diabetes or hypertension completed surveys about their use of mobile phones, health and access to care. One hundred sixty-five of those patients then participated in a 12-week demonstration of automated telephone monitoring and self-management support. Weekly interactive voice response (IVR) calls were made from a platform established at a university in La Paz, under the direction of the regional health ministry.Results: Thirty-seven percent of survey respondents spoke indigenous languages at home and 38% had six or fewer years of education. Eighty-two percent had a mobile phone, 45% used text messaging with a standard phone, and 9% had a smartphone. Smartphones were least common among patients who were older, spoke indigenous languages, or had less education. IVR program participants completed 1007 self-management support calls with an overall response rate of 51%. IVR call completion was lower among older adults, but was not related to patients’ ethnicity, health status, or healthcare access. IVR health and self-care reports were consistent with information reported during in-person baseline interviews. Patients’ likelihood of reporting excellent, very good, or good health (versus fair or poor health) via IVR increased during program participation and was associated with better medication adherence. Patients completing follow-up interviews were satisfied with the program, with 19/20 (95%) reporting that they would recommend it to a friend.Conclusion: By collaborating with LMICs, m-health programs can be transferred from higher-resource centers to LMICs and implemented in ways that improve access to self-management support among people with NCDs.
Highlights
M-HEALTH IN LOW AND MIDDLE-INCOME COUNTRIES Most people die from non-communicable diseases (NCDs), 80% of which occur in low- and middle-income countries (LMICs) where mortality rates are twice those of industrialized nations [1,2,3,4]
The current study suggests that this may be fairly common among patients with diabetes and hypertension in LMICs, and that regular between-visit follow-up via IVR or other m-health tools could be useful to catch emerging health problems before they become acute
M-health trials will continue to need evidence for their effectiveness in multiple locations that represent the vast diversity of patients, health systems, and capacity for sustaining large m-health services. With these caveats, the present study provides important evidence regarding the feasibility and potential benefit of establishing an independent m-health service in an LMIC
Summary
M-HEALTH IN LOW AND MIDDLE-INCOME COUNTRIES Most people die from non-communicable diseases (NCDs), 80% of which occur in low- and middle-income countries (LMICs) where mortality rates are twice those of industrialized nations [1,2,3,4]. More than one in four adults worldwide has hypertension, with two-thirds living in LMICs [7]. In Latin America, more than 100 million adults are hypertensive, with rates among the highest in the world [7]. Most adults with hypertension and other NCDs rely on primary care for disease management. LMICs still have weak primary care systems that lack capacity and resources to help patients effectively treat these conditions. We describe the deployment and testing of an m-health platform for non-communicable disease (NCD) self-management support in Bolivia
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
