mHealth for Diabetes care in rural populations

Improving public awareness to help prevent and diagnose type 2 diabetes in México.

Sai Ko Ko Zaw Rajashekar Palavalli Karen Horwitz Paul Cuciureanu Mooka Sitali Jose Gutierrez

Valdez

Diabetes in México

In Mexico, diabetes is the leading cause of death in adults 45 to 65 years old and represents an expenditure of more than 3 billion U.S. dollars per year.

9.2% of the population is diagnosed with diabetes. Due to the type of diet, the states with the highest prevalence are Mexico City and two states that border with the U.S.: Nuevo León and Tamaulipas.

Three governmental institutions provide universal social insurance (IMSS for all workers, ISSSTE for state workers, and SSA's "Seguro Popular" for vulnerable populations), but not all people make the appropriate arrangements to receive coverage.

Key Risk Factor: Obesity

The main risk factors for diabetes in Mexico include age, central obesity, lack of physical activity, inadequate diet and stress.

Obesity is the biggest risk factor in Mexico. There is a close relationship between obesity and diabetes mellitus. People are 4.5% more likely to have diabetes for each kilogram they gain. The total prevalence of overweight / obesity in Mexico according to The Mexican Federation of Diabetes is 71.28% for adults and 34.4% for children.

Our proposal in Mexico is to build on the experiences of the school’s program by designing a non-technological awareness campaign that takes place at least three times each year, starting in industrialized cities but moving to rural populations in the future.

1) desks full of information about risks and prevention measurements

The campaign would be based in a mobile unit, such as a motorhome or truck that contains:

The campaign would be based in a mobile unit, such as a motorhome or truck that contains:

2) a sterile room in the mobile unit to perform blood pressure and blood glucose tests (including specialized tests for pregnant women)

The campaign would be based in a mobile unit, such as a motorhome or truck that contains:

3) an area to give talks explaining risks, prevention, and monitoring measures, especially oriented to housewives and children, and to demonstrate practice of exercise

The campaign would be based in a mobile unit, such as a motorhome or truck that contains:

4) medicine for people who are already diagnosed.

The unit would be staffed by trained health care providers, since most people respond best to a figure of authority and knowledge such as a doctor or nutritionist. Medicine, testing supplies, and other required materials will be provided to the unit. In urban areas, traditional and socialmedia could be used to advertise the mobile unit’s upcoming locations. In rural communities, educators could go to people’s homes to make them aware of the campaign and let them know the location. For example, in Nuevo Leon (Monterrey), rural zones are distributed along highways and often have a Municipal Capital with a village square where the mobile unit could be set up.

mHealth Solution

According to an eMarketer.com article, Mexico leads Latin America smartphone penetration with 50% growth in 2013. Mexico could reach approximately 33.3 million smartphone users, which is more than one-quarter of the country's population (118 million inhabitants). Therefore, apps and websites may be a possible source of diabetes education for a segment of the population, but other strategies will be required as well.

Our program would be supplemented by a free app that every person can install on their phones and computers. The app will include a program of exercise and a balanced diet, an alarm to provide reminders for exercise or other self care, a database of calorie and other relevant nutritional information for different foods, and calculators where people can estimate their risk based on factors such as age, weight, blood pressure, cholesterol, etc.

Face to Face Interviews with Customers

I spoke with 20 potential customers in the urban region of Monterrey, México.

I asked about their knowledge of Diabetes type 2 and their willingness to change their bad habits.

With my knowledge of the theme as medical student I consider only the half of the interviewed have a clear and accurate concept of diabetes.

An alarming figure for urban population, wich make me think knowledge in rural zones are much lower

Face to Face Interviews with Customers

Face to Face Interviews with Customers

Etiology Risk Factors Symptoms Complications Prevention0

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Well-informed

Misinformed

I ask for their knowledge about etiology, risk factors, classic symptoms, common complications and prevention measurements.

There's a graphic of the results.

Face to Face Interviews with Customers

A good point is that 15 of them have total disposition (5 in a scale from 1 to 5) to change their diet and physical activity if they had the right advice. The rest range from 2 to 4.

I applied a test from ADA and the result was that all of them had low risk for developing Diabetes, being a bad diet the principal reversible risk factor.

Face to Face Interviews with Customers

All of them agree with the idea of an App for mobile devices with information, diet/exercise programs, alarm and a schedule for the activities.

Also, almost half of the interviewed suggest sharing the information and programs via PC.

So we devise launch versions of the information in the app provided by other means for people who do not have a smartphone or other access to the app.

Face to Face Interviews with Customers

Face to Face Interviews with Customers

A web page can be developed parallel to the app with recent tidings and new diet and fitness programs.