166 lines
5.5 KiB
YAML
166 lines
5.5 KiB
YAML
abstract: 'Background: The burden of non-communicable diseases (NCDs) is increasing
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in low-and middle-income countries (LMICs) where NCDs cause 4:5 deaths,
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disproportionately affect poorer populations, and carry a large economic
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burden. Digital interventions can improve NCD management for these
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hard-to-reach populations with inadequate health systems and high
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cell-phone coverage; however, there is limited research on whether
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digital health is reaching this potential. We conducted a process
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evaluation to understand challenges and successes from a digital health
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intervention trial to support Cambodians living with NCDs in a peer
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educator (PE) program. Methods: MoPoTsyo, a Cambodian non-governmental
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organization (NGO), trains people living with diabetes and/or
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hypertension as PEs to provide self-management education, support, and
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healthcare linkages for better care management among underserved
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populations. We partnered with MoPoTsyo and InSTEDD in 2016-2018 to test
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tailored and targeted mHealth mobile voice messages and eHealth tablets
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to facilitate NCD management and clinical-community linkages. This
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cluster randomized controlled trial (RCT) engaged 3,948 people and 75
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PEs across rural and urban areas. Our mixed methods process evaluation
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was guided by RE-AIM to understand impact and real-world implications of
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digital health. Data included patient (20) and PE interviews (6),
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meeting notes, and administrative datasets. We triangulated and analyzed
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data using thematic analysis, and descriptive and complier average
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causal effects statistics (CACE). Results: Reach: intervention
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participants were more urban (66\% vs. 44\%), had more PE visits (39 vs.
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29), and lower uncontrolled hypertension {[}12\% and 7\% vs. 23\% and
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16\% uncontrolled systolic blood pressure (SBP) and diastolic blood
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pressure (DBP)]. Adoption: patients were sent mean {[}standard deviation
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(SD)] 30 {[}14] and received 14 {[}8] messages; 40\% received no
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messages due to frequent phone number changes. Effectiveness: CACE found
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clinically but not statistically significant improvements in blood
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pressure and sugar for mHealth participants who received at least one
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message vs. no messages. Implementation: main barriers were limited
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cellular access and that mHealth/eHealth could not solve structural
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barriers to NCD control faced by people in poverty. Maintenance: had the
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intervention been universally effective, it could be paid for from
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additional revolving drug fund revenue, new agreements with mobile
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networks, or the government. Conclusions: Evidence for digital health to
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improve NCD outcomes in LMICs are limited. This study suggests digital
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health alone is insufficient in countries with low resource health
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systems and that high cell phone coverage did not translate to access.
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Adding digital health to an NCD peer network may not significantly
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benefit an already effective program; mHealth may be better for
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hard-to-reach populations not connected to other supports. As long as
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mHealth remains an individual-level intervention, it will not address
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social determinants of health that drive outcomes. Future digital health
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research and practice to improve NCD management in LMICs requires
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engaging government, NGOs, and technology providers to work together to
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address barriers.'
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affiliation: 'Steinman, L (Corresponding Author), Univ Washington, Hlth Promot Res
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Ctr, UW Box 354804, Seattle, WA 98105 USA.
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Steinman, Lesley, Univ Washington, Sch Publ Hlth, Dept Hlth Serv, Seattle, WA 98105
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USA.
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van Pelt, Maurits; Hen, Heang, MoPoTsyo Patient Informat Ctr, Phnom Penh, Cambodia.
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Chhorvann, Chhea; Te, Vannarath, Natl Inst Publ Hlth, Phnom Penh, Cambodia.
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Lan, Channe Suy, InSTEDD, Phnom Penh, Cambodia.
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LoGerfo, James; Fitzpatrick, Annette L., Univ Washington, Sch Publ Hlth, Dept Global
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Hlth, Seattle, WA 98105 USA.
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LoGerfo, James, Univ Washington, Dept Med, Seattle, WA 98105 USA.
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Fitzpatrick, Annette L., Univ Washington, Sch Med, Dept Family Med, Seattle, WA
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98105 USA.
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Fitzpatrick, Annette L., Univ Washington, Sch Publ Hlth, Dept Epidemiol, Seattle,
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WA 98105 USA.'
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article-number: '40'
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author: Steinman, Lesley and van Pelt, Maurits and Hen, Heang and Chhorvann, Chhea
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and Lan, Channe Suy and Te, Vannarath and LoGerfo, James and Fitzpatrick, Annette
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L.
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author-email: lesles@uw.edu
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author_list:
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- family: Steinman
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given: Lesley
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- family: van Pelt
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given: Maurits
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- family: Hen
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given: Heang
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- family: Chhorvann
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given: Chhea
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- family: Lan
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given: Channe Suy
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- family: Te
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given: Vannarath
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- family: LoGerfo
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given: James
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- family: Fitzpatrick
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given: Annette L.
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da: '2023-09-28'
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doi: 10.21037/mhealth-19-249
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eissn: 2306-9740
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files: []
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journal: MHEALTH
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keywords: Diabetes; hypertension; mHealth; Cambodia; implementation science
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keywords-plus: 'NONCOMMUNICABLE DISEASE; PREVENTION; INTERVENTION; TECHNOLOGY;
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ADHERENCE; PROGRAM; SERVICE; BURDEN; IMPACT'
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language: English
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month: OCT
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number: '4'
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number-of-cited-references: '82'
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papis_id: 50b3f52055b82213f72fbc7bb57feeb5
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ref: Steinman2020canmhealth
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times-cited: '7'
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title: Can mHealth and eHealth improve management of diabetes and hypertension in
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a hard-to-reach population? -lessons learned from a process evaluation of digital
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health to support a peer educator model in Cambodia using the RE-AIM framework br
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type: article
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unique-id: WOS:000850208600007
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usage-count-last-180-days: '2'
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usage-count-since-2013: '6'
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volume: '6'
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web-of-science-categories: Health Care Sciences \& Services; Medical Informatics
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year: '2020'
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