title: Establishing an independent mobile health program for chronic disease self-management support in bolivia.
abstract: BACKGROUND
  Mobile health (m-health) work in low- and middle-income countries (LMICs) mainly consists of small pilot programs with an unclear path to scaling and dissemination. We describe the deployment and testing of an m-health platform for non-communicable disease (NCD) self-management support in Bolivia.
  
  
  METHODS
  Three hundred sixty-four primary care patients in La Paz with diabetes or hypertension completed surveys about their use of mobile phones, health and access to care. One hundred sixty-five of those patients then participated in a 12-week demonstration of automated telephone monitoring and self-management support. Weekly interactive voice response (IVR) calls were made from a platform established at a university in La Paz, under the direction of the regional health ministry.
  
  
  RESULTS
  Thirty-seven percent of survey respondents spoke indigenous languages at home and 38% had six or fewer years of education. Eighty-two percent had a mobile phone, 45% used text messaging with a standard phone, and 9% had a smartphone. Smartphones were least common among patients who were older, spoke indigenous languages, or had less education. IVR program participants completed 1007 self-management support calls with an overall response rate of 51%. IVR call completion was lower among older adults, but was not related to patients' ethnicity, health status, or healthcare access. IVR health and self-care reports were consistent with information reported during in-person baseline interviews. Patients' likelihood of reporting excellent, very good, or good health (versus fair or poor health) via IVR increased during program participation and was associated with better medication adherence. Patients completing follow-up interviews were satisfied with the program, with 19/20 (95%) reporting that they would recommend it to a friend.
  
  
  CONCLUSIONS
  By collaborating with LMICs, m-health programs can be transferred from higher-resource centers to LMICs and implemented in ways that improve access to self-management support among people with NCDs.
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System , Ann Arbor, MI , USA ; University of Michigan School of Public Health , Ann Arbor, MI , USA ; University of Michigan School of Medicine , Ann Arbor, MI , USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.affiliation: Servicio Departamental de Salud , La Paz , Bolivia.
authors.forename: Helen
authors.initials: H
authors.lastname: Valverde
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System , Ann Arbor, MI , USA ; University of Michigan School of Public Health , Ann Arbor, MI , USA ; University of Michigan School of Medicine , Ann Arbor, MI , USA.
authors.forename: Nicolle
authors.initials: N
authors.lastname: Marinec
authors.affiliation: University of Michigan School of Public Health , Ann Arbor, MI , USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jantz
authors.affiliation: University of Michigan School of Public Health , Ann Arbor, MI , USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Kamis
authors.affiliation: Universidad Católica Boliviana , La Paz , Bolivia.
authors.forename: Carlos Lazo
authors.initials: CL
authors.lastname: de la Vega
authors.affiliation: IEQ Technology, Inc. , Springfield, OR , USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Woolley
authors.affiliation: Universidad Católica Boliviana , La Paz , Bolivia.
authors.forename: Bismarck
authors.initials: B
authors.lastname: Pinto
keywords: Latin America; chronic illness; disease management; mobile health; vulnerable populations