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

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 rand...

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Bibliographic Details
Published in:Global public health 2022-07, Vol.17 (7), p.1299-1313
Main Authors: Morrison, Joanna, Akter, Kohenour, Jennings, Hannah, Ahmed, Naveed, Kumer Shaha, Sanjit, Kuddus, Abdul, Nahar, Tasmin, King, Carina, Haghparast-Bidgoli, Hassan, Khan, A. K. Azad, Costello, Anthony, Azad, Kishwar, Fottrell, Edward
Format: Article
Language:English
Subjects:
Behavior change
Change agents
Diabetes
Epidemics
Fatigue
Habits
Infectious diseases
Intervention
Learning
Medicin och hälsovetenskap
Messages
mhealth
Mobile phones
non-communicable diseases
Norms
Prevention
Prevention programs
process evaluation
Risk analysis
Risk factors
Social norms
Telemedicine
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Summary: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.
ISSN:1744-1692
1744-1706
1744-1706
DOI:10.1080/17441692.2021.1923776