mHealth for Diabetes care in rural populations.

1. 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

2. 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.

3. 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.

4.  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.

5. The campaign would be based in a mobile unit,
such as a motorhome or truck that contains:
1) desks full of information about risks and prevention measurements

6. 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)

7. 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

8. 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.

9.  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.

10. 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.

11.  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.

12. 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.

13. Face to Face Interviews with
Customers
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

14. Face to Face Interviews with
Customers
I ask for their knowledge about etiology, risk
factors, classic symptoms, common
complications and prevention measurements.
There's a graphic of the results.
Etiology Risk Factors Symptoms Complications Prevention
20
15
10
5
0
Well-informed
Misinformed

15. 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.

16. 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.

17. Face to Face Interviews with
Customers
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.

18. 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.