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Using Mobile Phone Reminders to improve Adherence to Quarterly Outreach among Children and Young Adults with Type 1 Diabetes - A non-randomized three-arms pilot study in rural Rwanda
Date Issued
2018-04-16
Author(s)
Arsène Florent Hobabagabo
University of Global Health Equity
Abstract
Background: Type 1 Diabetes Mellitus (T1DM) is an emerging epidemic in sub-Saharan Africa.
The Rwandan Diabetic Association (RDA) is a non-governmental organization helping pediatric
and young adult T1DM patients, through the support in public district hospitals in rural Rwanda.
TIDM patients are required to come back every quarter for their clinic follow-up, insulin refill
and plasma glucose concentration monitoring (HbA1C). They are reminded about their clinic
visits through radio communication. However, adherence to the quarterly visits was low. We
explore the impact of a mobile health (mHealth) intervention on adherence to clinic visits and
HbA1C check-up through a pilot study, in three rural sites in Rwanda.
Objectives: To determine the effectiveness of phone calls and SMS reminders in improving
attendance to follow-up visit.
Methods: Multicenter non-randomized three-arms pilot study: i) using SMS and radio
communication as a reminder; ii) using phone calls by clinic staff, in addition to radio
communication, to remind patients of their visit and iii) relying exclusively on the radio
announcements RDA makes prior to every visit (control group). The data, pre and postintervention,
was analyzed using Excel to describe patients’ demographics and clinical status
using percentages, frequencies, and medians with their interquartile ranges. Fisher’s Exact Test
was conducted to assess the difference in outcomes between the three groups. The primary
measure is the attendance to clinic visits and change in HbA1C level among the intervention
study arms. A cost assessment of the budget needed to conduct the outreach visits was also
performed, adding the cost of the interventions. A multilevel logistic analysis was also
performed to compare the odds of attending in the different groups.
Results: A total of 49 patients were enrolled in the study. Attendance rates of control, SMS
messaging and phone calls groups were 71.4%, 91.6% and 100%, respectively. The attendance
rates of the interventions groups were not statistically significant (0.11 for the phone calls group
and 0.17 for the SMS group). There was an increase in HbA1c between baseline and follow-up
visits (9.5% versus 10.3%). The cost of SMS messaging was lower compared to phone calls
reminders (US$ 0.06 per text versus US$ 0.35 per phone call).
Conclusions: Associating phone calls reminders and SMS reminders to the usual RDA’s
procedure of radio announcements is more effective than radio announcements only in increasing
attendance to follow-up visits. SMS reminders involve lower costs. Limitations to this study
included duration of the study, sample size and funding.
Keywords: Type 1 Diabetes Mellitus, sub-Saharan Africa, follow-up, mHealth.
The Rwandan Diabetic Association (RDA) is a non-governmental organization helping pediatric
and young adult T1DM patients, through the support in public district hospitals in rural Rwanda.
TIDM patients are required to come back every quarter for their clinic follow-up, insulin refill
and plasma glucose concentration monitoring (HbA1C). They are reminded about their clinic
visits through radio communication. However, adherence to the quarterly visits was low. We
explore the impact of a mobile health (mHealth) intervention on adherence to clinic visits and
HbA1C check-up through a pilot study, in three rural sites in Rwanda.
Objectives: To determine the effectiveness of phone calls and SMS reminders in improving
attendance to follow-up visit.
Methods: Multicenter non-randomized three-arms pilot study: i) using SMS and radio
communication as a reminder; ii) using phone calls by clinic staff, in addition to radio
communication, to remind patients of their visit and iii) relying exclusively on the radio
announcements RDA makes prior to every visit (control group). The data, pre and postintervention,
was analyzed using Excel to describe patients’ demographics and clinical status
using percentages, frequencies, and medians with their interquartile ranges. Fisher’s Exact Test
was conducted to assess the difference in outcomes between the three groups. The primary
measure is the attendance to clinic visits and change in HbA1C level among the intervention
study arms. A cost assessment of the budget needed to conduct the outreach visits was also
performed, adding the cost of the interventions. A multilevel logistic analysis was also
performed to compare the odds of attending in the different groups.
Results: A total of 49 patients were enrolled in the study. Attendance rates of control, SMS
messaging and phone calls groups were 71.4%, 91.6% and 100%, respectively. The attendance
rates of the interventions groups were not statistically significant (0.11 for the phone calls group
and 0.17 for the SMS group). There was an increase in HbA1c between baseline and follow-up
visits (9.5% versus 10.3%). The cost of SMS messaging was lower compared to phone calls
reminders (US$ 0.06 per text versus US$ 0.35 per phone call).
Conclusions: Associating phone calls reminders and SMS reminders to the usual RDA’s
procedure of radio announcements is more effective than radio announcements only in increasing
attendance to follow-up visits. SMS reminders involve lower costs. Limitations to this study
included duration of the study, sample size and funding.
Keywords: Type 1 Diabetes Mellitus, sub-Saharan Africa, follow-up, mHealth.
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