title: mHealth Intervention to Improve Diabetes Risk Behaviors in India: A Prospective, Parallel Group Cohort Study.
abstract: In low/middle income countries like India, diabetes is prevalent and health care access limited. Most adults have a mobile phone, creating potential for mHealth interventions to improve public health. To examine the feasibility and initial evidence of effectiveness of mDiabetes, a text messaging program to improve diabetes risk behaviors, a global nonprofit organization (Arogya World) implemented mDiabetes among one million Indian adults.
  
  
  
  A prospective, parallel cohort design was applied to examine whether mDiabetes improved fruit, vegetable, and fat intakes and exercise.
  
  
  
  Intervention participants were randomly selected from the one million Nokia subscribers who elected to opt in to mDiabetes. Control group participants were randomly selected from non-Nokia mobile phone subscribers. mDiabetes participants received 56 text messages in their choice of 12 languages over 6 months; control participants received no contact. Messages were designed to motivate improvement in diabetes risk behaviors and increase awareness about the causes and complications of diabetes. Participant health behaviors (exercise and fruit, vegetable, and fat intake) were assessed between 2012 and 2013 via telephone surveys by blinded assessors at baseline and 6 months later. Data were cleaned and analyzed in 2014 and 2015.
  
  
  
  982 participants in the intervention group and 943 in the control group consented to take the phone survey at baselne. At the end of the 6-month period, 611 (62.22%) in the intervention and 632 (67.02%) in the control group completed the follow-up telephone survey. Participants receiving texts demonstrated greater improvement in a health behavior composite score over 6 months, compared with those who received no messages F(1, 1238) = 30.181, P<.001, 95% CI, 0.251-0.531. Fewer intervention participants demonstrated health behavior decline compared with controls. Improved fruit, vegetable, and fat consumption (P<.01) but not exercise were observed in those receiving messages, as compared with controls.
  
  
  
  A text messaging intervention was feasible and showed initial evidence of effectiveness in improving diabetes-related health behaviors, demonstrating the potential to facilitate population-level behavior change in a low/middle income country.
  
  
  
  Australian New Zealand Clinical Trials Registry (ACTRN): 12615000423516; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367946&isReview=true (Archived by WebCite at http://www.webcitation.org/6j5ptaJgF).
authors: Northwestern University Feinberg School of Medicine, Chicago, IL, United States. angela.pfammatter@northwestern.edu.
authors: Angela
authors: 0000-0003-0081-4090
authors: A
authors: Pfammatter
authors: Bonnie
authors: 0000-0003-0692-9868
authors: B
authors: Spring
authors: Nalini
authors: 0000-0001-7784-1236
authors: N
authors: Saligram
authors: Raj
authors: 0000-0003-4376-1064
authors: R
authors: Davé
authors: Arun
authors: 0000-0002-4871-9925
authors: A
authors: Gowda
authors: Linelle
authors: 0000-0003-1639-7826
authors: L
authors: Blais
authors: Monika
authors: 0000-0001-9987-3933
authors: M
authors: Arora
authors: Harish
authors: 0000-0002-1521-7398
authors: H
authors: Ranjani
authors: Om
authors: 0000-0002-4779-9273
authors: O
authors: Ganda
authors: Donald
authors: 0000-0001-8134-6094
authors: D
authors: Hedeker
authors: Sethu
authors: 0000-0003-2944-5436
authors: S
authors: Reddy
authors: Sandhya
authors: 0000-0001-6049-5154
authors: S
authors: Ramalingam
mesh_terms: D000328:Adult; D040421:Cell Phone; D003920:Diabetes Mellitus / Q000517:prevention & control*; D004035:Diet Therapy; D004041:Dietary Fats; D015444:Exercise; D005240:Feasibility Studies; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007194:India; D008297:Male; D009042:Motivation; D015995:Prevalence; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D017216:Telemedicine; D060145:Text Messaging; D014675:Vegetables; D055815:Young Adult
chemical_list: D004041:Dietary Fats
keywords: diabetes; health promotion; mHealth