A preliminary study of a cloud-computing model for chronic illness self-care support in an underdeveloped country

Am J Prev Med. 2011 Jun;40(6):629-32. doi: 10.1016/j.amepre.2011.02.014.


Background: Although interactive voice response (IVR) calls can be an effective tool for chronic disease management, many regions of the world lack the infrastructure to provide these services.

Purpose: This study evaluated the feasibility and potential impact of an IVR program using a cloud-computing model to improve diabetes management in Honduras.

Methods: A single-group, pre-post study was conducted between June and August 2010. The telecommunications infrastructure was maintained on a U.S. server, and calls were directed to patients' cell phones using VoIP. Eighty-five diabetes patients in Honduras received weekly IVR disease management calls for 6 weeks, with automated follow-up e-mails to clinicians, and voicemail reports to family caregivers. Patients completed interviews at enrollment and a 6-week follow-up. Other measures included patients' glycemic control (HbA1c) and data from the IVR calling system.

Results: A total of 53% of participants completed at least half of their IVR calls and 23% of participants completed 80% or more. Higher baseline blood pressures, greater diabetes burden, greater distance from the clinic, and better medication adherence were related to higher call completion rates. Nearly all participants (98%) reported that because of the program, they improved in aspects of diabetes management such as glycemic control (56%) or foot care (89%). Mean HbA1c's decreased from 10.0% at baseline to 8.9% at follow-up (p<0.01). Most participants (92%) said that if the service were available in their clinic they would use it again.

Conclusions: Cloud computing is a feasible strategy for providing IVR services globally. IVR self-care support may improve self-care and glycemic control for patients in underdeveloped countries.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Glucose
  • Cell Phone*
  • Chronic Disease
  • Developing Countries
  • Diabetes Mellitus / therapy*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin / metabolism
  • Honduras
  • Humans
  • Male
  • Medication Adherence
  • Middle Aged
  • Self Care / methods*
  • Telecommunications
  • United States
  • User-Computer Interface*


  • Blood Glucose
  • Glycated Hemoglobin A