Effects of traditional versus m-Health educational interventions for diabetic patients: a randomised controlled trial in peripheral district of Bangladesh

Abstract

Background: Mobile Health i.e. m-Health Education (MHE) and Traditional Health Education (THE) interventions are both used for education of diabetic patients. However, it is not yet reported which one is the most effective. This study was designed to compare the effectiveness of these two types of intervention on adherence to the seven dimensions of diabetes' self-management in a peripheral district of Bangladesh. Methods: A randomized controlled trial was conducted in Thakurgaon district, in Bangladesh, with two intervention arms (-MHE and THE- and one control group. All groups received an initial educational session including the control group. During the educational session pictorial materials was used and patients received a logbook to register their different activities related to diabetes. The intervention was conducted over a period of 12 months. MHE group received additionally a monthly reminder and monitoring through mobile phone calls. THE group received a monthly home visit reminder and monitoring through personal visits. 330 adult diabetics patients were included in each group. Data were collected by face-to-face interview using a semi-structured questionnaire at baseline and endline. Adherence to the seven self-management dimensions was measured and compared in the different groups before and after the intervention using analysis of co-variance (ANCOVA) and logistic regression technique. Findings: Study participants took place from January 2016 to June 2017. Among the 990 included patients, 86 were lost to follow-up. Both MHE and THE groups showed significant (p< 0.01) improvement in knowledge, adherence to self-management and health outcomes compared to the control group. Bonferroni post-hoc comparison between groups showed that knowledge (regarding diet, physical exercise, follow-up visit and blood glucose test, stopping tobacco, basic and technical knowledge of diabetes) and waist circumference improved significantly more in the MHE group than in the THE group. Adherence to drug, physical exercise, follow-up visit and blood glucose test and stopping tobacco improved significantly more in the THE group than the MHE group. Furthermore, MHE was found to be more cost-effective. Interpretation: The MHE intervention was more effective than the THE intervention in improving knowledge, adherence to most of the self-management recommendations and health outcomes for peripheral diabetic patients in Bangladesh. MHE intervention has a positive impact also in peripheral areas in LMICs. Thisintervention could be replicated for the self-management of diabetes and other non-communicable diseases in LMICs. Funding: Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany and Bangladesh University of Health Sciences, Dhaka, Bangladesh.