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J Telemed Telecare. 2017 Jan;23(1):96-105. doi: 10.1177/1357633X15617885. Epub 2016 Jul 8.

Process evaluation of a mobile health intervention for people with diabetes in low income countries - the implementation of the TEXT4DSM study.

Author information

  • 11 Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
  • 28 Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands.
  • 33 MoPoTsyo, Cambodia.
  • 44 Kin-rĂ©seau, Kinshasa, DR Congo.
  • 55 Institute of Health Policy & Development Studies, University of the Philippines, Manila, Philippines.
  • 66 Memisa, Brussels, Belgium.
  • 77 Netherlands Institute for Health Services Research, Utrecht, the Netherlands.


Introduction Evidence about mobile health (mHealth) approaches to manage diabetes shows modest effects on outcomes, but little is known about implementation variability. This is a process evaluation of an mHealth intervention to improve diabetes self-management through Short Message Service (SMS) provision in three diabetes care programmes in the Democratic Republic of Congo (DRC), Cambodia and the Philippines. Methods The intervention involved Diabetes Self-Management Support via text messages. The content and process of the intervention is based upon the core principles of diabetes self-management and behaviour theory. In each country, messages were sent by project managers to 240 participants in each country, who were randomly assigned to the intervention group. Contracts were negotiated with national phone providers and open access software was used to send the messages. Participants received a mobile phone and SIM card. We analysed data about the implementation process over a one year period. Results The mean monthly number of messages delivered to recipients' phones was 67.7% of the planned number in DRC, 92.3% in Cambodia and 83.9% in the Philippines. A telephone check revealed problems with one-third of the phones, including breakage, loss and cancelled subscriptions. The number of people reached at least once was 177 (70.0%) in DRC; 147 (60.7%) in Cambodia; five in the Philippines (2.0%). Those reached each time was 144 in DRC (56.9%), 28 (9.9%) in Cambodia, none in the Philippines. People used their phone more frequently than before the intervention. Discussion Implementation of the intervention meets constraints at every step in the process. Barriers relate to the technology, the context and the participants.


Mobile health; diabetes care; diabetes care programmes; diabetes education; eHealth; implementation research; low income countries

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