1 Ramachandran A, et al. BMJ Innov 2018;0:1–8. doi:10.1136/bmjinnov-2017-000265 ► Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ bmjinnov-2017-000265). 1 India Diabetes Research Foundation and Dr A Ramachandran’s Diabetes Hospitals, Chennai, Tamil Nadu, India 2 Ministry of Health and Family Welfare, Government of India 3 World Health Organisation, India, New Delhi, India Correspondence to Professor Ambady Ramachandran, India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, Tamilnadu, India; ramachandran@vsnl.com Received 15 December 2017 Revised 29 May 2018 Accepted 2 July 2018 ORIGINAL ARTICLE mDiabetes initiative using text messages to improve lifestyle and health-seeking behaviour in India Ambady Ramachandran, 1 Rajeev Kumar, 2 Arun Nanditha, 1 Arun Raghavan, 1 Chamukuttan Snehalatha, 1 Satheesh Krishnamoorthy, 1 Pradeep Joshi, 3 Fikru Tesfaye 3 To cite: Ramachandran A, Kumar R, Nanditha A, et al. BMJ Innov Epub ahead of print: [please include Day Month Year]. doi:10.1136/ bmjinnov-2017-000265 MHEALTH AND WEARABLE HEALTH TECHNOLOGIES © Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Background Data on the use of mobile technology in public health are sparse. Text messaging is cost-effective in disseminating information to large communities. The Ministry of Health and Family Welfare, Government of India, initiated and executed this mDiabetes programme. Objectives The main objective of this commissioned study was to test the feasibility of using mobile technology to reach a large number of people to improve their lifestyle and health-seeking behaviour. Participants’ interest, acceptability and scope for improvement were assessed. Methods This mDiabetes observational study was done in India between 2016 and 2017. Text messages inviting registrations were sent to 130 million people in the country, mostly to the working class. Respondents (n=107 548) were registered by dialling a given phone number (missed phone call) or through a website. Based on the response, participants were grouped into six categories: persons with diabetes, pregnant/lactating women, high-risk individuals, healthcare professionals, elderly and normal population. They received 90 messages on healthy living during the 6 months. The impact of intervention was assessed at the third and sixth months by feedback messages. Telephonic interviews were conducted at 1 year in a subpopulation (n=855). Results The registered respondents, 31 725, were grouped into six categories. 21.4% had diabetes and 5.3% had multiple risk factors. 15.6% responded to feedback messages. Among them, 57.2% followed a healthy diet, 72.3% practised advice on physical activity, 51.9% screened for diabetes and 67.3% checked their glycaemic status. The telephonic interviews showed that the programme was feasible and acceptable. The participants suggested use of interactive voice response system for registration and motivation. Discussion and conclusion The study demonstrated the feasibility and acceptability of mHealth in a large population to disseminate knowledge regarding diabetes and healthy lifestyle, and to improve health-seeking behaviour. It helped to identify the limitations and scope for future improvements. INTRODUCTION The burden due to non-communicable diseases (NCDs) and injuries as a whole has overtaken that of communicable diseases in every state of India. 1 Among the NCDs, diabetes is one of the disease conditions that reached an epidemic proportion in India. In 2015 there were 69.2 million people with diabetes in the country. 2 Several clinical trials, including the Indian Diabetes Prevention Programme, have shown that intensive lifestyle modification (LSM) in people with impaired glucose tolerance (IGT) can reduce progression to diabetes up to 58%. 3–8 Such programmes are, however, labour-intensive, costly and have not been widely implemented, even in high-income countries. In order to implement a prevention or awareness programme, we need a tool which is cost-effective, is not human resource-intensive and is accessible to all individuals in the country. Mobile phones provide such an opportunity. Mobile phone has become an important tool for day-to-day activities, such as for commu- nication and business transactions. In on 19 July 2018 by guest. Protected by copyright. http://innovations.bmj.com/ BMJ Innov: first published as 10.1136/bmjinnov-2017-000265 on 19 July 2018. Downloaded from