This document summarizes a research project that evaluated the effectiveness of using mobile phones to provide diabetes self-management support in addition to existing diabetes education programs in the DR Congo, Cambodia, and the Philippines. The project provided mobile phones and SMS messages on diabetes topics to 484 patients in Cambodia over 3 years. It found the voice call intervention added beginning in 2014 was helpful but had challenges with costs and inability to replay messages. Suggestions are made to improve the voice call features to better support the diabetes patients.

1. BRIDGES RESEARCH PROJECT:
MOBILE PHONE DIABETES SELF-MANAGEMENT SUPPORT
MARCH 20, 2014
a 3-country analysis of its implementation
in existing Diabetes Self-Management Education Programs in
DR Congo, Cambodia & The Philippines,
Institute for Tropical Medicine (ITM) in Belgium

2. I. INTRODUCTION OF RESEARCH
• Research Topic: Evaluation of effectiveness of a mobile phone
Diabetes Self-Management Support (DSMS) intervention on top of
an existing Diabetes Self Management Education (DSME) strategy in
3 countries:
• DR Congo,
• Cambodia
• Philippines.
• Time period : Sept 2011- Dec 2014
• Beneficiaries: 484 Diabetes patients in MoPoTsyo peer education
network (>8000 Diabetes patients are registered in Cambodia,2013)
• Permission from National Ethical Committee

3. I. 1. DIABETES PEER EDUCATOR
PROGRAM (MOPOTSYO )
• Cambodian (NGO) for people with chronic
Non Communicable Disease (NCD):
1. Diabetes & associated diseases (kidney,
cholesterol problems, retinopathy etc.)
2. High Blood Pressure (non-diabetic)
• Poor & Remote communities
• Not clinic-based, but community-based
• Peer Education Networks provide care and
access through Peer Educator to medical
services
• National Strategy for Prevention of NCD 2013-
2020 recognizes the care system

4. I. 1. DIABETES PEER EDUCATOR PROGRAM (CONT.)
1. FOLLOW-UP PATIENTS
Session group weekly’s and member follow up’s
activities
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5. I. 1. DIABETES PEER EDUCATOR PROGRAM (CONT.)
2. PE HELPS TO ORGANIZE MEDICAL CONSULTATION
Two Peer Educators help & cooperate with HC nurse:
• Explain + let do urine protein test
• Administration:
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• Fill the lab-service-request form for patient
• Register name and code on blood tube
• Prepare serum + put on ice
• Collect revenue from patient-member+ put in bank
• Send Serum + Blood to Laboratory

6. I. 2. OBJECTIVES OF RESEARCH PROJECT
To evaluate the effectiveness of a mobile phone DSMS intervention:
By assessing the differences before and after the intervention:
Between the DSME and the DSME+DSMS groups
In each country on:
1. health outcomes:
• HemoglobinA1C (HbA1C)
• blood pressure
• Body Mass Index (BMI) & waist circumference
• percentage of people with diabetic foot problems
2. Adequate use of care resources:
• failure-to-attend rate
• perceived quality of care
• health care expenditure
3. Enablement
• level of knowledge on diabetes (care)
• self-management and ability to cope
• adherence to glucose monitoring & control regimes & healthy lifestyle
To understand the differences in effectiveness of the intervention between countries.

7. I. 3. RESEARCH PROJECT DESIGN
DR Congo Cambodia Philippines
Target population: people with diabetes
- Informed consent
- Collection of baseline data
- Randomisation
in existing DSME strategy
People receiving DSME only
(control study-group)
(200 in each country)
Month 15: - Physical data
- Laboratory data
Month 21: - Questionnaires
- Physical data
- Laboratory data
Month 27: - Physical data
- Laboratory data
Month 33: - Questionnaires
- Physical data
- Laboratory data
- Costing data
Collection of baseline
data & recruitment
Evaluation of intervention Intervention
People receiving DSME + DSMS
(intervention study-group)
(200 in each country)
Assessment of baseline data per country (400 people with diabetes per country) & Multi-country analysis
- Ongoing DSME
- DSMS: - provision mobile phone
- Project initiated Communication
- training about phone use
- collect sms/calls/toll-free 800 numbers for PatIC
- Participate in research data collection
Month 15: - Physical data
- Laboratory data
Month 21: - Questionnaires
- Physical data
- Laboratory data
Month 27: - Physical data
- Laboratory data
Month 33: - Questionnaires
- Physical data
- Laboratory data
- Costing data
- Ongoing DSME
- No DSMS: - provision mobile phone
- no project-initiated communication
- might use their phone for communication,
but they will not receive any specific
explanation of stimulus to do so)
- Participate in research data collection
HbA1 (t0)
HbA1C (t-end)
Difference t0-tend
HbA1C (t0)
HbA1C (t-end)
Difference t0-tend
Evaluation of DSMS intervention per country (200 people in each group in each country)
mean reduction of HBA1C in people in DSME+DSMS group vs mean reduction in DSME only group
Multi-countryanalysis
(comparison of results of each country)

8. I. 4. STUDY INTERVENTION: MOBILE PHONE DSMS
• Provision of phones
• Beeline Phone and SIM
• Phone is fill account 1$ per 3month (to keep activate)
• Project initiated communication (SMS)
• General knowledge of Diabetes
• Diet & Exercise
• Glucose monitoring & medication
• Foot care
• Smoking & Drinking alcohol
• Self-recording
• Problem solving and Empowerment

9. I. 5. THE FRONTLINE SOFTWARE

10. I. 6. SMS CONTENT (EXAMPLES)
• លទ្ធផលតេស្តជាេិស្ករបង្ហាញថា ជាេិស្ករតោកអ្នកតៅខ្ពស្់តេក ដូចត េះស្ូមត្វើការណាេ់ជួបគ្រូតេទ្យជំនាញ តដើមបីេិតគ្រេះត ើងវិញ អ្ំេីការតគ្បើថានំ
• ស្ូមតគ្បើថានំតេទ្យ តោយបា គ្េឹមគ្េូវតាមកំរិេកំណេ់ ិងតទ្ៀេទាេ់តាមតវជជបញ្ជជរបស្់គ្រូតេទ្យ ក ំបីខា !
• ស្ំោេតជើង ជាមួយទ្ឹក ឹងសាប ូជាគ្បចំតដើមបីតជើង មា ស្ ខ្ភាេលអ!
• ហាេ់គ្បាណរឺលអស្គ្មាប់អ្នកជំងឺទ្ឹកតនាមផ្ផអម ិងស្គ្មាប់អ្នកទាំងអ្ស្់រន!
• មួយថ្ងៃមា ១៤៤០នាទ្ីអ្នកហាេ់គ្បាណ តោយបា ៣០ នាទ្ីតេេ អ្វីេិបាក?????
• ហាេ់គ្បាណ យ៉ាងតហាចណាស្់ ៣០នាទ្ីជា តរៀងរាល់ថ្ងៃត្វើតោយស្ ខ្ ភាេរឹងមាំ!
• ជិេះកង់លអស្គ្មាប់ស្ ខ្ភាេ ិងចំតណញ ជាងជិេះម៉ាូេូ...!
• ស្ូមក ំេូបោហារ តាមទ្ំោប់របបីេូបោហារ តដើមបីស្ ខ្ភាេលអ!
• គ្េូវ ឹកត ើញដល់ស្ ខ្ភាេអ្នក ម តេលចប់តផតើម បរិតភារោហារ!
• េីរា៉ាមីេទ្ឹកតនាមផ្ផអម តគ្បៀបបា ឹង តស្ៀវតៅម ខ្មាូប ស្គ្មាប់អ្នក ិងគ្រួសារ
• ………….

11. II. PROJECT PROBLEMS AND SOLUTIONS
• Problems
• Patient can’t read the text message.
• Text message is limited to 1 sms (as protocol)
• Patients lost the phone/phone number (no renew provision)
• Patients can’t check inbox/inbox is full
• Phone number is cutoff from system (no account >6months)
• Phone must support KHMER fonts
• Solution
• Other household member can read for patients
• Form group discuss to create SMS to ensure SMS is simple and
understandable
• We top-up account 1$ per 3months for those use Beeline number provided
by research
• We ask PE to help delete sms from inbox about one per 4 or 5months
• Patients pay their own money to buy new Beeline SIM, just inform us the
new number.

12. III. VERBOICE INTERVENTION
• Has starting in January 2014
•We send 6 call flows per week
•We can schedule one per week
•We always get warmly technical support from
inSTEDD team in Cambodia

13. IV. SUCCESSES AND CHALLENGES OF VERBOICE
• Successes:
• Patients seem happier with voice message
• It works with all number networks and kind of phones
• Challenges
• Higher service cost…sustainability?
• With voice message, patients cannot re-listen
• Still some patients “no answer”. Maybe it takes longer time
(than sms) for each transaction.
• Some technical errors????

14. V. CONCLUSION & SUGGESTIONS
• We appreciate verboice system. It is a good alternative solution
to sending text messages . We will use this voice message till the
end of the project in December 2014.
• Suggestion:
• Could you design for save number with name???
• Could you extend call log more than 10 displays??
• Could you display history of call log by date??? (normally, I did
download as “.csv”, then sort by date, does it have another
solution??)

15. THANKS YOU !