Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country

摘要

Background:Patients' engagement in mobile health (m-health) interventions using interactive voice response (IVR) calls is less in low- and middle-income countries (LMICs) than in industrialized ones. We conducted a study to determine whether automated telephone feedback to informal caregivers (CarePartners) increased engagement in m-health support among diabetes and hypertension patients in Bolivia.Materials and Methods:Patients with diabetes and/or hypertension were identified through ambulatory clinics affiliated with four hospitals. All patients enrolled with a CarePartner. Patients were randomized to weekly IVR calls including self-management questions and self-care education either alone (standard m-health) or with automated feedback about health and self-care needs sent to their CarePartner after each IVR call (m-health+CP).Results:The 72 participants included 39 with diabetes and 53 with hypertension, of whom 19 had 6 years of education. After 1,225 patient-weeks of attempted IVR assessments, the call completion rate was higher among patients randomized to m-health+CP compared with standard m-health (62.0% versus 44.9%; p<0.047). CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy (p<0.001 for both). M-health+CP patients were more likely to report excellent health via IVR (adjusted odds ratio [AOR]=2.60; 95% confidence interval [CI], 1.07, 6.32) and less likely to report days in bed due to illness (AOR=0.42; 95% CI, 0.19, 0.91).Conclusions:In this study we found that caregiver feedback increased engagement in m-health and may improve patients' health status relative to standard approaches. M-health+CP represents a scalable strategy for increasing the reach of self-management support in LMICs.