mHealth: An Effective Education Channel for Hard-to-Reach Ethnic Minority Populations in Vietnam

Le NgocHue,¹LuongChi Thanh,²Tonvan der Velden,¹Le NgocBao,¹MarionMcNabb,^3
1Pathfinder Vietnam² Centre Health Information and Technology Institute, MOH ³Pathfinder International, Headquaters

Journal MTM 1:4S:17, 2012
DOI:10.7309/jmtm.40

Abstract

Lack of health knowledge and access primary health care services for hard-to-reach ethnic minorities is an issue in Vietnam. Recognizing unmet needs, Pathfinder International designed an innovative, culturally and linguistically appropriate mHealth intervention. The project was implemented in two provinces with the Ministry of Health’s (MOH) Central Health Information and Technology Institute (CHITI) as the main collaborating partner. Three messages in three languages were delivered through SMS and interactive voice response (IVR) channels, focusing on sexual and reproductive health (SRH), tobacco, and health insurance topics. The project measured client acceptance of the program to understand the value in MOH investing in scale up.

From November 2010 – 2011, two toll free numbers were created creating a database of 7,116 mobile phone subscribers. 2,313 subscribers received SRH messages; 2,073 received health insurance messages; and 2,730 received tobacco messages. The IVR system received 984 calls (67% male and 33% female). 547 SRH calls (56%), 143 health insurance calls (14%), and 294 tobacco calls (30%) were received. Of all IVR users, 44% were 15-24 year olds, highlighting youth as an important target group. Based on a rapid assessment, 57% of respondents reported increased adoption of safer sexual practices, 40% of smokers reported they smoked less and 13% reported they stopped smoking as a result of the program. 80-90% of IVR callers were outside of the target areas suggesting a broader reach of the intended intervention population. Key lessons learned include:

1. Government partnership and guidance is critical for ownership and sustainability in implementation, collaboration with mobile providers and developing appropriate marketing strategies.
2. Effective collaboration with multiple mobile operators is important for interoperability.
3. Further investigation of the IVR system to assess cost implications of callers outside of program areas.
4. Close follow up with government and other partners new to mHealth interventions is critical to buildcapacity and confidence to expand services.

Annexes:

1. Detailed description of recommendations
2. Final project report

Use of Booster Calls in a Behavioral Intervention for Adolescents with Type 1 Diabetes

Rachel Sweenie,¹ Linda Herbert,¹Eleanor Macky,¹Clarissa Holmes,² Randi Streisand,^1
1Children’s National Medical Centre²Virginia Commonwealth University

Journal MTM 1:4S:16, 2012
DOI:10.7309/jmtm.39

Abstract

Behavioral interventions are commonly utilized to prevent declines in adherence and glycemic control among adolescents with type 1 diabetes (T1D). Mobile health strategies may maintain participant engagement and improve retention rates and outcomes in such interventions. The present study explored the use of booster calls (BCs; quick telephone check-ins), in maintaining participant engagement throughout an ongoing RCT for adolescents with T1D.

Data are available from 143 adolescent-parent dyads (Mchild age= 12.96 years) who were randomized to the treatment condition. Most adolescents were female (54%) and Caucasian (68%), and ninety-two percent of parents were mothers. Most were prescribed a basal bolus or pump regimen (75%), and average glycosolatedhemoglobin (HbA1c) at baseline was 8.69%. Dyads participated in four treatment sessions designed to improve coping skills and promote medical regimen adherence. BCs were conducted one month after each session, and participants completed follow-up assessment 3 months after their final session.

Ninety-six percent of participants completed at least one BC; 29% completed all four. On average, 2.88 contact attempts were made per BC and completed calls lasted eight minutes. Adolescents on a basal bolus/pump regimen were more likely to complete BCs (p < .05); however, child age, gender, and A1c were unrelated to BC completion. Families who completed at least one BC were more likely to participate in follow-up assessment (p < .05). Overall, families reported that BCs were “somewhat helpful” (34%), or “pretty helpful”/ “very helpful” (46%).

Many families participated in BCs and found them helpful, and completion of BCs was related to participant retention at 3 month follow-up, suggesting that this mHealth strategy may be a promising tool for improving participant retention and treatment outcomes in behavioral interventions. Further exploration of the use of mhealth strategies among adolescents with T1D participating in behavioral RCTs and their families is warranted.

Use of parent consultants in a telehealth intervention for parents of children newly diagnosed with Type 1 diabetes

Randi Streisand,¹Linda Herbert,¹Victoria Owen,¹Maureen Monaghan^1
1Children’s National Medical Centre

Journal MTM 1:4S:15, 2012
DOI:10.7309/jmtm.38

Abstract

Management of type 1 diabetes (T1D) in young children requires significant parent effort and parents often report feeling overwhelmed following diagnosis. The current study examined the use of a novel mHealthcomponent, parent consultant (PC) contact via telephone, to augment an ongoing randomized controlled trial for parents of young children recently diagnosed with diabetes. Pilot data are available on the PC development and training process and from 13 parents randomized to the treatment condition.

Four out of 5 parents who were invited to serve as PCs completed a 4-hour PC training with our team. All PCs (100% female; 75% Caucasian) had children diagnosed with T1D at a young age (M age at diagnosis=3.72 years; M disease duration=4.87 years). Usage and satisfaction data were examined from 13 primary caregivers (100% female; 76.9% Caucasian) of children age 2-6 with T1D (M age=4.85 years).

The 13 participants randomized to the treatment condition were offered optional PC telephone contact (up to 4 contacts) to augment the intervention (5 telephone sessions with a research counselor).. All but one participant (92.3%) agreed to PC phone contact, and thus far, 7 participants (58.3%) have successfully connected with their assigned PC, ranging from 1-3 phone contacts. PC phone calls ranged from 16-60 minutes and covered a variety of topics including diabetes management, school concerns, nutrition, and sleep.

Satisfaction data suggest that use of a PC via an augmented mHealth strategy (telephone contact) is feasible, and can be a positive addition to behavioral interventions. Participants noted that PCs were ‘extremely helpful,’ with one parent commenting “I loved this”… component. Connecting with trained PCs with a shared history of parenting a young child with T1D may offer additional benefits to regularly used mHealth strategies by promoting parental adjustment to diabetes, quality of life, and child physical and emotional well-being.

Utilizing mHealth Recruitment & Retention Strategies in an RCT with Young Children with Type 1 Diabetes

Victoria Owen,¹LaurenPascarellal,¹LindaHerbert,¹FranCogen,¹RandiStreisand,^1
1Children’s National Medical Centre

Journal MTM 1:4S:14, 2012
DOI:10.7309/jmtm.37

Abstract

Due to an increase in cell phone and email use in recent years, mHealth strategies are commonly used in research data collection and intervention delivery and provide increased flexibility for scheduling and completing assessments and treatment sessions. Dissemination of effective mHealth strategies is vital to their successful use in future studies. The goal of the current study was to examine the use of mHealth strategies in an ongoing RCT to promote parental management of type 1 diabetes (T1D) in young children and specifically explore recruitment/data collection completion/retention rates.

Primary caregivers of children with T1D who were fluent in English and had telephone access completed an eligibility phone screener, a pretreatment phone assessment, an in-person orientation session, 5 telephone-based program sessions, and 3 post-treatment phone assessments. mHealth recruitment/retention strategies included flexible scheduling of assessments/interventions, email communication, and frequent contact according to participants’ phone/email preference.

Of 285 recruits, 16 did not meet inclusion criteria. No recruits were ineligible due to lack of telephone access. The majority of eligible recruits (82.3%) agreed to participate and completed all phone sessions (85% of intervention and 98% of control participants). Most treatment/control phone sessions were completed as scheduled (73%); only 7% needed to be rescheduled more than once. Interruptions occurred for 24% of sessions, with the most frequent interruption being child-related. Of the 127 participants in the study’s follow up portion, over 90% have been completed.

For the current RCT, mHealth strategies encouraged high recruitment/retention in program sessions and follow up and resulted in few rescheduled/interrupted sessions. This may suggest that phone contact for assessment as well as intervention is a strong medium for consistent participant contact. Continuation of flexible contact and the extension of text message reminders, Skype intervention sessions, and online questionnaires may be desirable options for encouraging higher retention rates in future projects.

Using Mobile Technology to Promote Healthy Behaviors in Teens

Misbah Mohammed,¹Meghan Searl,¹Khinlei Myint-U,¹Joseph Kvedar,¹Kamal Jethwani,^1
1Center for Connected Health, Partners Healthcare, Boston MA, USA

Journal MTM 1:4S:13, 2012
DOI:10.7309/jmtm.36

Abstract

The prevalence of childhood obesity has more than tripled in the past 30 years. To combat this growing problem it is essential that public health interventions promote healthy eating and regular physical activity (PA). In March 2011 the Center for Connected Health (CCH) launched the Partners Step it UP program to 200 elementary students at two Boston schools. The health promotion program incorporates PA tracking using a pedometer, educational feedback relating to physical activity and a fun team-oriented foot race. This year the program expanded to 6 schools and 400 students. The program has met with huge success and CCH is currently exploring ways to modify the Step it UP program for use among high school students. As a first step in understanding the needs and preferences of this group, we conducted a focus group session with twenty-four 9th graders to understand what features they would want included in a health promotion program. Participants revealed that on average they text 300times/day and would like this to be a way to engage in this program. Participants also provided useful feedback on the frequency of messages to send, how to frame messages and discussed the importance of competition and incentives to drive health behavior changes. These findings have provided CCH with a clear understanding of how to develop a health promotion program for this population. Thirty high school students will be recruited to participate in a11-week pilot study. The participants will be divided into 2 groups based on their PA levels during Week 1 and will compete to earn points based on their PA level during the study. The purpose of this pilot study is to engage high school students in the program, increase and sustain students’ level of PA, and understand the role of team competition in promoting healthy behavior change.