Effectiveness of Mobile Phone Text Messages to Enhance Treatment Adherence in the Elderly with Diabetes in a Sub-urban Area in Vietnam

BACKGROUND

The prevalence of non-communicable diseases (NCDs), such as diabetes and cardiovascular disease (CVD), is rapidly rising in the Asia-Pacific region, leading to what is referred to as the “double-burden of disease” (i.e. infectious diseases and NCDs).  Twenty years ago, NCDs caused 41.8% of deaths, however, this has since risen to 60.1%, with NCDs now the leading cause of death in the region. NCDs are responsible for 71% of total burden of disease in the region, with diabetes is a major contributor.

The largest numbers of people with diabetes were estimated to be from South-East Asia and Western Pacific Regions, accounting for approximately half the diabetes cases in the world. Middle-income countries have the highest proportion of deaths attributed to high blood glucose, for both men and women, at the age of 50 and over.  The has significant implications for the social and economic development of low-and-middle income countries, largely due to loss of productivity (HelpAge International, 2011).

In Viet Nam, the prevalence of diabetes is growing at alarming rates and has almost doubled within the past 10 years. Currently, one in every 20 Vietnamese adults has diabetes (WHO Vietnam, 2016) and in 2015, it was estimated that 53,458 deaths could be attributed to diabetes. Alarmingly, the number of people with a pre-diabetic condition, i.e. higher than optimal blood glucose, is three times higher than those with diabetes.

[1] If not properly managed, diabetes can lead to complications such as blindness, kidney failure and/or lower limb amputation, significantly impacting a person’s quality of life and putting extensive pressure on the health care system

During the last 20 years, the use of Information Communication Technology (ICTs) has grown significantly, with mobile phones increasingly becoming the preferred mechanism for communication

A growing number of publications have demonstrated the potential of Information Communication Technology, such as mobile phones, to effectively deliver health care messages (see, for instance, Ramachandran et al., 2018; Garnett et al., 2018; Wargny et al., 2018). Bringing together communication and computing technology, mobile phone-based interventions can address individual-level factors in health by facilitating timely patient access to relevant health information and support (Heron & Smyth, 2010).

Text messages have the potential to provide information alone (informational) or provide two-way communication (interactive or bi-directional). Previous studies highlighted the importance of tailoring the text message intervention to the preferences of participants, in terms of timing and frequency of messages and to the demographic of participants, for most efficacious behavior change to occur (see, for example, Head et al., 2013; Arampebola et al., 2016; Sahin et al., 2019). 

A number of studies have provided evidence for the effectiveness of mobile-based interventions on increasing knowledge and promoting behavior change in persons with diabetes- but none yet targeted at older persons in the resource setting of Vietnam.In collaboration with UNESCAP, ISMS researchers implemented the study “Effectiveness of Mobile Phone Text Messages to Enhance Treatment Adherence in the Elderly with Diabetes in a Sub-urban Area in Vietnam”.

This study will begin to fill significant gaps in research on mobile-based interventions on increasing knowledge and promoting behavior change in persons with diabetes in LMICs, and specifically in South East Asian Countries (SEACs).

GOALS
 

There were four main specific objectives of this pilot study:

1. To assess the feasibility of a mobile phone text message intervention for older persons in Vietnam;
2. To assess the acceptability (message frequency, timing and content) of a mobile phone text message intervention for older persons in Vietnam;
3. To identify the effectiveness of the intervention on basic knowledge of diabetes of older persons; and
4. To identify the effectiveness of the intervention on adherence to treatment for older persons with diabetes. 

STUDY DESIGN

A three-stage approach was used to develop and then test the feasibility, accessibility and preliminary effect of a text message intervention for improving basic knowledge on diabetes and consequently in enhancing the adherence to treatment by older persons (aged 50 and over).

Stage 1 (Weeks 1-4): A text message ‘library’, was developed by collating relevant messages from sources, such as WHO and KHIDI. A focus group was then held to linguistically and culturally adapt the text messages to participants.

Phase 2 (Weeks 5-16):  An iterative approach was taken to developing the feasibility and acceptability of text messages in terms of message content, frequency and timing. Twenty-two OPs were enrolled according to the inclusion criteria above to participate in the pre-test . The sample messages were sent to OPs (two messages per day, 7 days per week) for 4 consecutive weeks, presents the baseline survey for these participants, in which their various individual and household characteristics were asked.

Phase 3 (Weeks 17-32): After 3-months, the preliminary effect of the text message intervention was measured. A baseline survey and a survey completed via text message three months later were used to compare change in basic knowledge of and adherence to treatment of diabetes

Forty OPs who has not participated in Phase 1 (text message adaptation) nor Phase 2 (text message pre-test) and met the inclusion criteria, participated in Phase 3. SMS informational text messages (providing diabetes related education, medication pick-up reminders, and medication adherence support) were sent to participants 7 days a week for 3 consecutive months.

Study setting

The study was conducted in Tay Mo Ward, Nam Tu Liem District, Hanoi, Vietnam in 2018-2019.