Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country

Background: Patients' engagement in mobile health (m-health) interventions using interactive voice response (IVR) calls is less in low- and middle-income countries (LMICs) than in industrialized ones. We conducted a study to determine whether automated telephone feedback to informal caregivers (?CarePartners?) increased engagement in m-health support among diabetes and hypertension patients in Bolivia. Materials and Methods: Patients with diabetes and/or hypertension were identified through ambulatory clinics affiliated with four hospitals. All patients enrolled with a CarePartner. Patients were randomized to weekly IVR calls including self-management questions and self-care education either alone (?standard m-health?) or with automated feedback about health and self-care needs sent to their CarePartner after each IVR call (?m-health+CP?). Results: The 72 participants included 39 with diabetes and 53 with hypertension, of whom 19 had ≤6 years of education. After 1,225 patient-weeks of attempted IVR assessments, the call completion rate was higher among patients randomized to m-health+CP compared with standard m-health (62.0% versus 44.9%; p?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140289/1/tmj.2015.0099.pd

Exploring chronic disease in Bolivia: A cross-sectional study in La Paz.

This study seeks to develop an understanding that can guide development of programs to improve health and care for individuals with Non-Communicable Diseases (NCDs) in La Paz, Bolivia, where NCDs are prevalent and primary care systems are weak. This exploratory investigation examines the characteristics of chronic disease patients in the region, key health related behaviors, and their perceptions of the care that they receive. The longer-term goal is to lay groundwork for interventional studies based on the principles of the Chronic Care Model (CCM).The study is based on two surveys of adults (> 18 years old) administered in 2014 in La Paz, Bolivia. A total of 1165 adult patients participated in the first screening survey. A post-screening second survey, administered only on those who qualified based on Survey 1, collected more detailed information about the subjects' general health and health related personal circumstances, several health behaviors, health literacy, and their perceptions of care received. A final data set of 651 merged records were used for analysis.Characteristic of a low-income country, the majority of participants had low levels of education, income, health literacy and high rates of under/unemployment. Nearly 50% of participants reported 2 or more NCDs. Seventy-four percent (74%) of respondents reported low levels of medication adherence and 26% of the population was found to have an undiagnosed depressive disorder. Overall, the perception of care quality was low (60%), particularly in those under the age of 45. Significant relationships emerged between several sociodemographic characteristics, health behaviors, and perceptions that have major implications for improving NCD care in this population.These findings illustrate some of the challenges facing low-income countries where reversing the tide of NCDs is of great importance. The prevalence of NCDs coupled with challenging social determinants of health, poor medication adherence, low health literacy, and perceptions of low quality of healthcare highlight several areas of opportunity for intervention

Study design reflecting recruitment, inclusion, and exclusion.

<p>Study design reflecting recruitment, inclusion, and exclusion.</p

Regressions by number and type of NCDs.

<p>Regressions by number and type of NCDs.</p

Sample characteristics.

<p>Sample characteristics.</p

Sociodemographic characteristics by health behaviors (chi-square tests).

<p>Sociodemographic characteristics by health behaviors (chi-square tests).</p

Adjusted odds ratios from logistic regression on 4 outcomes of interest.

<p>Adjusted odds ratios from logistic regression on 4 outcomes of interest.</p

Number of NCDs & occupation by age.

<p>Number of NCDs & occupation by age.</p