Dr Line Kleinebreil WHO consultant BHBM / UNFM

“Can mobiles save lives ? WHO and ITU answered YES in 2013

NCD are on the UN agenda

WHO-ITU mHealth for NCDs

Be Healthy Be Mobile: Timeline

3

INSTITUTIONALISATION

2013 mCessation Toolkit mDiabetes Toolkit Launch services in Costa Rica

mWellness Toolkit mCervical cancer Toolkit Launch services in Senegal Launch services in Zambia Engagement discussions Norway, Philippines,

Russia, UK

mHypertension Toolkit Launch services in Philippines Launch services in all countries

Launch

30+ COUNTRIES INTERESTED 2014

2015 / 2017 7 SIGNED COUNTRY AGREEMENTS

8 NATIONAL mHEALTH INITIATIVES

2018 knowledge & innovation

hubs

m-diabetes in practice

Local team Target population Draft SMS Test by MOH

Registration ++++ SMS campaign

Evaluation

International team

Review by experts

Country Exchanges

Review, dissemination

mDiabète: lutter contre l’explosion mondiale du

diabète grâce aux nouvelles technologies

Une initiative conjointe de l’OMS et ITU .

Une application de la “Santé Mobile” aux Maladies Non

Transmissibles (MNT)

New: Sénégal, mDiabetes laboratory

New : national content prepared by national and international experts (including patients), documented by WHO

Young diabetics Promoting mDiabetes Active role of the patient association ASSAD

Official website

www.mdiabete.gouv.sn

One SMS + One Page on the web

First results Political decision : november 2013

1st campaign : june 2014 “Diabetes & Ramadan”

1000 participants, 6 weeks 2nd campaign : november 2014,

3000 participants, basic diabetes module, 12 weeks 3rd campaign : april 2015,

3000 participants , healthy diet module, 6 weeks 4th campaign : june 2015, “Diabetes & Ramadan”

12 000 participants, 6 weeks 5th campaign : november 2015, “basic module ”

20 000 participants, 12 weeks 6th campaign : march 2016, healthy diet module

15 000 participants, 6 weeks 7th campaign : may 2016, “Diabetes & Ramadan”

51 000 participants, 6 weeks

WHO compiles the different steps, the content and evaluations. The document will be shared with all members states

Take home messages BHBM, is powerful, cheap, easy to scale-up,

well accepted by citizen and HCP

Opportunity for awareness, prevention, continuous training of healthcare professionals

Opportunity to improve health literacy

Thank you for your attention

impact on HCP

Profile of the sample

28.1

59.4

4.7

7.8

doctor

paramedic

pharmacist

other

Professions

“Other”: among those who registered as being in the “health professional” category, a small number are in contact with patients without being healthcare staff as such (medical secretary, educators from the association, community workers, healthcare journalist).

Profile of the sample

84.8

6.1 9.1 Sector of activity

public private (for profit) private (business)

The public sector is strongly represented in this random sampling. The private-sector HPs subsequently signed up for the next m-Diabetes campaigns by means of the SMS registration system introduced by the operators as from May 2016.

Impact on awareness

65.8

21.9

5.5

5.5

1.4

Considerably

A lot

To a fair extent

A little

Not at all

Did these messages increase your knowledge about diabetes?

These results confirm the need to provide continuous training on diabetes and, more generally, on chronic illnesses. This simple format, in which the message is progressively distilled into a clear and succinct text, is appreciated by overloaded HPs who do not need to travel in order to receive a basic training.

Impact on awareness

32.6 18.5 16.3

10.9 7.6

5.4 4.3 4.3

Nutrition Monitoring

Diabetes and Ramadan Physical activity

Medicines Diagnosis

Gestational diabetes Complications

Messages which provided you with information that was new to you (themes)

This reflects the needs previously expressed by HPs with respect to better nutritional information, which gave rise to the “nutrition” module and to advice on fasting. Information relating to the management and monitoring of complications is also highly appreciated.

Impact on self-confidence

57.4 32.8

8.2 1.6

0.0

Considerably A lot

To a fair extent A little

Not at all

Have these messages helped to increase your self-confidence when it comes to working with a patient suffering from

diabetes?

For 90% of the HPs interviewed: yes. Obviously, for senior doctors and paramedics, these simple text messages have not added to their knowledge of diabetes or to their self-confidence in dealing with diabetics.

Impact on behaviour

19.6 17.4

10.9 10.9 10.9

8.7

Nutrition Diagnosis

Complication Diabetes and Ramadan

Medicines Physical activity

Specify a message which changed the way you handle your patients’ diabetes

(themes)

60% of the HPs interviewed cited at least one message which caught their attention and influenced their working methods. While the SMSs on nutrition were the most often cited, those relating to risk factors, diabetes diagnostic criteria and monitoring of complications also helped to improve working methods.

Impact sur les comportements

47.5 28.8

5.1

10.2

8.5

Considerably

A lot

To a fair extent

A little

Not at all

Have these messages changed the way in which you monitor diabetic foot?

If there is one subject that is neglected by university training it is diabetic foot, whereas in the field it is unfortunately a frequent complication that leaves many HPs feeling powerless. The provision of simple guidance on how to take early action to identify those at risk has had a significant impact on working methods.

Appreciation of the campaign Do you wish to continue receiving SMS texts this year?

Yes: 100%

The current format of the m-Diabetes campaigns, with simple SMS texts delivering essential information, is supported. Important is to impart the “base modules” and “nutrition module” to as many HPs as possible at all levels of the health pyramid, while also supplementing the programme with specific SMS modules targeting situations such as gestational diabetes, child diabetes, foot ulcers, recourse to insulin, …

Appreciation of the campaign Would you recommend the m-Diabetes programme to other health professionals?

Yes: 100%

This encouraging result represents a just reward for the efforts made by all those who, at different levels, have made a personal commitment to this innovative programme. While one might initially have doubted the ability of simple text messages to modify working methods, this survey has shown them to be a cost-effective means of rapidly upgrading the skills needed by HPs to handle both crisis situations and routine healthcare.

impact on patients

Profile of the sample

53.8 46.2

GENDER of the diabetics interviewed

MALE FEMALE

The survey carried out in 2015 by ASSAD also found a slight male predominance (men 51%, women 49%). It will be interesting to compare these results with those from the STEPS survey recently conducted in Senegal by the Ministry and WHO.

Profile of the sample

12.9

58.1

19.4

9.7 Age groups of the diabetics interviewed

20-30 years 30-50 years 50-60 years over 60 years

70% of the diabetics interviewed were below 50 years of age, and 90% were below 60. They were therefore, theoretically, still of working age. The 2015 survey revealed 17% of diabetics aged over 66. These two results highlight a diabetes discovery age that is much earlier in Africa than in Europe, with the corresponding impact on companies and economic development.

Profile of the sample

15.4

26.2

40.0

18.5

Education level of the diabetics interviewed

None Primary Secondary University

41% have a minimum level of education (38% in the 2015 ASSAD survey). The SMS texts have to be simply and clearly worded if they are to be understood. The “one sentence at a time”, “only one topic per day” approach has undoubtedly helped to bring people into the programme, in addition to the wide variety of complex information provided during consultations.

Profile of the sample

55.4 44.6

Occupational status of the diabetics

interviewed

Actively employed Unemployed

While 90% are of working age, 44% are without an occupation. Of these,14% are “housewives”, while for the other 30% diabetes makes it difficult to find or hold down a job. Making both employers and employees aware of the need for early treatment of the disease in the interests of employability is a direction to be pursued within m-Diabetes.

Profile of the sample

36.9

44.6

18.5

Type of diabetes of the diabetics interviewed

Type 1 Type 2 Don't know

Type of diabetes is a medical notion. For patients, there is often a confusion between type 1 diabetes and insulin treatment. 18% are unaware of their diabetes type, whereas the differences are important, particularly where the work environment is concerned. This topic should be made more explicit in the “base module” SMS texts.

Receipt of messages

84.6

15.4

Did you receive and read the SMS messages sent within the framework of m-Diabetes?

YES NO

Operator statistics show that, from the technical standpoint, 98% of the thousands of SMS texts sent are delivered. The question was whether the messages in question were actually read. Despite the low education level of the sample and the written format (in French) of the texts, 84% were able to read the messages and benefit from their content.

Impact on awareness

47.2 13.9

11.1

25.0

2.8

Nutrition

Physical activity

Monitoring

Diabetes and Ramadan

Diabetic foot

Messages which had an impact on you (topics)

Messages that are immediately applicable to daily life, such as those relating to the sugar content of certain foodstuffs that are consumed daily or during the period of Ramadan, are those which have the greatest impact on diabetics, helping them to alter their habits.

Impact on awareness

22.2

44.4

33.3

Nutrition

Diabetes and Ramadan

Others

Message which provided information that was new to you (topics)

Despite the country having a large majority of practising Muslims, there is little discussion of the topic of diabetes and Ramadan during consultations. Simple SMS tips on how to remain hydrated and monitor one’s blood sugar during fasting provide patients with useful information.

Impact on self-confidence

34.5

45.5

16.4

1.8

1.8

Considerably

A lot

To a fair extent

A little

Not at all

Have these messages helped to increase your self-confidence when it comes to

managing your diabetes?

Controlling diabetes depends on the patient’s daily behaviour. His/her understanding of the different components of the treatment and degree of self-confidence in terms of making the right decisions between medical consulations are critical. The above result shows how the SMS texts can help.

Impact on self-confidence

93.8

6.3

I check my blood sugar level more regularly than before

YES NO

Most of the time, diabetes is a silent disease. Checking one’s blood sugar level is the only way to verify that the treatment as a whole (nutrition + exercise + medicines) is working. One of the aims of the programme was to make diabetics aware of the need to perform such checks.

Impact on behaviour

30.0

20.0

50.0

once a day

once a week

once a month

If yes, I now do so at least…

This frequency of blood-sugar monitoring is not sufficient for a patient to maintain his/her diabetes within a balance that will protect him/her from complications. While SMS texts can inform and aid awareness, the problem of access to and the affordability of blood-sugar tests should be a key strand of the national diabetes plan.

Impact on behaviour

78.0

22.0

I monitor my weight more regularly than before

YES NO

Here again, the m-Diabetes SMS campaign has shown that it can have a positive impact on behaviour, especially where simple daily habits are concerned.

Impact on behaviour

2.6

15.4

28.2

53.8

daily

at least once a week

at least once a month

only when I visit my doctor

If yes, I now do so…

With weight checks by the doctor and a blood-sugar test once a month, most likely during a medical visit, there is still work to be done to get diabetic patients to take more responsibility for controlling their condition. This is the challenge of therapeutic education, whose impact has been proved in Europe and which should be more broadly developed in Africa.

Impact on behaviour

92.0

8.0

I eat fruit and/or vegetables more often than before

YES NO

Messages relating to nutrition are the most requested and best assimilated by patients. The traditional diet comprises little in the way of fruit and vegetables, so there is a need for information.

Impact on behaviour

22.2

62.2

15.6

at least one fruit or vegetable

at least two or three fruits or vegetables

more than four fruits or vegetables

If yes, my daily intake is now…

When one considers the high price of fruits and vegetables in Senegal as compared to grains and bananas, these results are very encouraging. BHBM’s “nutrition” module is intended to be shared with the entire adult population, diabetic and non-diabetic, and within schools.

Impact on behaviour

92.0

8.0 I eat fewer fatty foods than before

YES NO

While diabetes itself is the main subject of the m-Diabetes campaign, the associated risk factors – cholesterol, excess weight – are also a matter for awareness-building.

Impact on behaviour

35.6

13.3

13.3

37.8

Everyday

Often

Sometimes

Rarely

If yes, how often do you take more care?

Two opposing groups emerge: those who are aware and put their knowledge to effective use (35%), and those who are aware but do not really apply their knowledge (65%). The messages need to be repeated in order to reduce this inertia in the face of change.

Appreciation of the campaign Do you wish to continue receiving SMS texts this year?

Yes: 100%

The current format of the m-Diabetes campaigns, with simple SMS texts delivering essential information, is supported. It is important to impart the “base modules” and “nutrition module” to as many diabetics as possible, particularly those living far from medical centres or whose modest income limits their access to healthcare. Additional modules need to be made available to cater for specific situations.

Appreciation of the campaign Would you recommend the m-Diabetes programme to other health professionals?

Yes: 100%

This encouraging result represents a just reward for the efforts made by all those who, at different levels, have made a personal commitment to this innovative programme. While one might initially have doubted the ability of simple text messages to modify people’s behaviour, this survey has shown them to be a cost-effective means of sensitizing patients and making them more committed to controlling their condition.

34.5

45.5

16.4

1.8

1.8

Considerably

A lot

To a fair extent

A little

Not at all

Have these messages helped to increase your self-confidence when it comes to managing

your diabetes?

Controlling diabetes depends on the patient’s daily behaviour. His/her understanding of the different components of the treatment and degree of self-confidence in terms of making the right decisions between medical consulations are critical. The above result shows how the SMS texts can help.

Impact on self-confidence

Do you wish to continue receiving SMS texts this year?

Yes: 100%

The current format of the m-Diabetes campaigns, with simple SMS texts delivering essential information, is supported. It is important to impart the “base modules” and “nutrition module” to as many diabetics as possible, particularly those living far from medical centres or whose modest income limits their access to healthcare. Additional modules need to be made available to cater for specific situations.

Appreciation of the campaign