Can texting health advice curb diabetes in India?

To promote diabetes prevention, researchers tried sending twice-weekly text messages to a million people in India. The messages, which advised them to exercise, eat less fat, and eat more fruits and vegetables, seem to have worked.

This effort is the first to use the power and reach of mobile phones to change diabetes risk behaviors in a large number of people from different parts of a vast country like India. It has implications for diabetes prevention in low and middle-income countries.

An estimated 66 million people in India live with the disease, and 1 million die from it each year. Indian Americans also are hard hit with diabetes. Indians tend to get diabetes in their 30s and 40s, 10 years earlier than most Americans. Two-thirds of the population of India is under age 35.

Changing behavior

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.

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“Our mDiabetes study suggests mobile health technology is a smart solution and has broad implications for diabetes prevention at the population level in low and middle-income countries,” says Nalini Saligram, founder and CEO of Arogya World, a global health non-profit organization.

“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,” says 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.”

12 languages, 1 million subscribers

The study gathered responses from nearly 1,000 people who received text messages as part of Arogya World’s mDiabetes initiative and compared them to responses from a similar number of people who didn’t receive the text messages. The randomly chosen 1,000 individuals, who were surveyed by phone in the language of their choice, were considered a representative sample of the one million participants.

The study scored for fruit, vegetable, and fat consumption as well as exercise in participants at baseline and six months. There were 943 people in the control group, 982 in the experimental one.

Arogya World partnered with Nokia during 2012-2013 on mDiabetes to send text messages on diabetes and its prevention in 12 languages, twice a week for six months, to 1 million of its subscribers from all over India who opted in.

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The 56 text messages were developed with Emory University and culturally adapted for India with extensive consumer feedback.

Northwestern University researchers contributed to the study design and data analysis. Using rigorous 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.

In addition to the text message program, Arogya World has developed a mobile app, myArogya, to help working Indians prevent chronic disease.

The study appears in the Journal of Medical and Internet Research.

Source: Northwestern University