Learning from a diabetes mHealth intervention in rural Bangladesh: what worked, what did not and what next?

ABSTRACT

There is an urgent need for population-based interventions to slow the growth of the diabetes epidemic in low-and middle-income countries. We tested the effectiveness of a population-based mHealth voice messaging intervention for T2DM prevention and control in rural Bangladesh through a cluster randomised controlled trial. mHealth improved knowledge and awareness about T2DM but there was no detectable effect on T2DM occurrence. We conducted mixed-methods research to understand this result. Exposure to messages was limited by technological faults, high frequency of mobile phone number changes, message fatigue and (mis)perceptions that messages were only for those who had T2DM. Persistent social norms, habits and desires made behaviour change challenging, and participants felt they would be more motivated by group discussions than mHealth messaging alone. Engagement with mHealth messages for T2DM prevention and control can be increased by (1) sending identifiable messages from a trusted source (2) using participatory design of mHealth messages to inform modelling of behaviours and increase relevance to the general population (3) enabling interactive messaging. mHealth messaging is likely to be most successful if implemented as part of a multi-sectoral, multi-component approach to address T2DM and non-communicable disease risk factors.

KEYWORDS:

• mhealth
• diabetes
• non-communicable diseases
• process evaluation

Acknowledgements

We would like to thank the study participants, the DMagic trial steering committee (Graham Hitman [Chair], Martin McKee, Dina Balabanova, David Beran, Katherine Fielding, Lou Atkins, and Sophia Wilkinson) and Audrey Prost. We are grateful to Fatima Zannat and Kazi Faisal Mahmud from mWorld for their contributions to the development of our mHealth intervention and Md Golam Azam for his contributions to field activities.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the UK Medical Research Council (MR/M016501/1) under the Global Alliance for Chronic Diseases (GACD) Diabetes Programme.