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Telemed J E Health. 2016 Apr;22(4):261-8. doi: 10.1089/tmj.2015.0099. Epub 2015 Sep 9.

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

Author information

1
1 Ann Arbor Department of Veterans Affairs Center for Clinical Management Research , Ann Arbor, Michigan.
2
2 School of Public Health, University of Michigan , Ann Arbor, Michigan.
3
3 School of Medicine, University of Michigan , Ann Arbor, Michigan.
4
4 Universidad Católica Bolivìana , La Paz, Bolivia .
5
5 Universidad Pública de El Alto , El Alto, Bolivia .

Abstract

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 < 0.047). CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy (p < 0.001 for both). M-health+CP patients were more likely to report excellent health via IVR (adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI], 1.07, 6.32) and less likely to report days in bed due to illness (AOR = 0.42; 95% CI, 0.19, 0.91).

CONCLUSIONS:

In this study we found that caregiver feedback increased engagement in m-health and may improve patients' health status relative to standard approaches. M-health+CP represents a scalable strategy for increasing the reach of self-management support in LMICs.

KEYWORDS:

behavioral health; cardiology/cardiovascular disease; extreme environments; mobile health; telemedicine

PMID:
26352854
PMCID:
PMC4968278
DOI:
10.1089/tmj.2015.0099
[Indexed for MEDLINE]
Free PMC Article

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