Efficacy, acceptability and feasibility of mhealth technology in promoting adherence to anti-diabetic therapy and glycaemic control among diabetic patients in Eastern Cape, South Africa”

Background: Diabetes mellitus is a disease of a significant public health concern and a leading cause of death and disability worldwide. In Africa, South Africa ranks second among countries with the highest burden of diabetes, and with a poor level of glycaemic control. mHealth technology is an innovative and cost-effective measure of promoting health and the use of text messaging for fostering health is evolving. In South Africa, there is hardly any study involving the use of mobile health technology, including text messaging for promoting health among diabetic patients. Purpose: The aim of this study was to determine the efficacy, feasibility and acceptability of mHealth in promoting adherence and glycaemic control among diabetic patients in resource-poor settings of the Eastern Cape Province of South Africa. Also, the study assessed the impact of text messaging on knowledge, selfmanagement behaviour, self-efficacy and health-related quality of life. Methodology: The study adopted a multi-centre, two-arm, parallel, randomised controlled trial design. Participants were randomly assigned to the intervention (n=108) and control arm (n=108). Participants’ socio-demographic information was obtained using the widely validated WHO STEPwise questionnaire, and a selfdeveloped questionnaire, including previously validated measurement scales were used to obtain information on adherence, self-management behaviour, self-efficacy and health-related quality of life. Participants in the intervention arm received daily text messages related to diabetes management and care for six months. Data were collected at baseline and six months post-intervention. Blood glucose, blood pressure and anthropometric measurements followed standard procedure. Mixed-model analysis was used to assess the impact of the SMS on random blood glucose while xi | P a g e linear and bivariate logistic regression were used to assess for effect on other clinical outcomes. Results: The mean age of the participants was 60.64 (SD± 11.58) years. The majority of the study participants had secondary level of education (95.3%) and earned 1500 to 14200 Rand per month (67.7%). For both the intervention and the control group, majority never used tobacco (98.10% vs 94.40%) or alcohol (88.00% vs 87.00%). Both arms of the study showed improvement in the primary outcome (blood glucose level), with no significant difference, the mean adjusted difference in blood glucose from baseline to six months post-intervention was 0.26 (-0.81 to 1.32), p=0.634. Also, the intervention did not have a significant effect on the secondary outcomes (knowledge, medication adherence, dietary adherence, adherence to physical activity, healthrelated quality of life, self-management behaviour and diabetes distress). Similarly, the intervention did not have any significant effect on secondary clinical outcomes such as weight (p=0.654), body mass index (p=0.439), systolic (p=0.610) and diastolic blood pressure (p=0.535). An overwhelming majority of the participants (90.74%) were pleased with the intervention and felt it was helpful. Of those who took part in the intervention, 91% completed the follow-up study after six months. Conclusion: The use of SMS is a highly acceptable and feasible adjunct to standard clinical care in the promotion of health among diabetic patients in this study setting. Although there was a little improvement, the efficacy of a unidirectional text messaging in promoting health outcomes in this study setting is still doub