SMS to increase adherence in diabetes patients in India

The national prevalence of diabetes in India is over nine percent. At the same time, India has the second largest mobile market, following China. While technology has had minimal impact on consumer health overall in India, there is an opportunity to use SMS with diabetes patients. Agada Healthcare, a diabetes clinic located in Chennai, Tamil Nadu, India, faces the challenge of increasing patient adherence, which is estimated at about ten percent. Almost all their patients have a cell phone and Agada Healthcare wants to use SMS to increase adherence. To date we have worked with staff at Agada healthcare to learn about their self-pay patients: their health situation, knowledge and self-management skills, treatment plans, and family involvement in care. We have conducted a survey of attitudes of patients and their families towards cell phones and SMS, and their willingness to participate in a pilot. At the same time, we are investigating other SMS interventions to extrapolate from the applicable aspects of them even when the disease or location is different. We are especially interested in two-way SMS interventions, of which there are few (most are one-way messaging). While more costly to implement since more resources are needed, preliminary indications are that two-way SMS is more likely to engage patients. We are currently exploring cultural implications relevant to an SMS intervention, issues, in particular, the attitudes of patients and their families to diabetes. We are investigating how SMS is used by patients, which includes news and astrology, and any costs that may inhibit participation. We are also exploring health literacy to understand how to craft effective messaging as well as what type of training or assistance patients might require. A longer term goals is to explore use of SMS for prevention messaging on a broader scale in India.