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Randomized Controlled Trial
. 2016 Apr;22(4):261-8.
doi: 10.1089/tmj.2015.0099. Epub 2015 Sep 9.

Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country

Free PMC article
Randomized Controlled Trial

Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country

John D Piette et al. Telemed J E Health. .
Free PMC article


Background: Patients' engagement in mobile health (m-health) interventions using interactive voice response (IVR) calls is less in low- and middle-income countries (LMICs) than in industrialized ones. We conducted a study to determine whether automated telephone feedback to informal caregivers ("CarePartners") increased engagement in m-health support among diabetes and hypertension patients in Bolivia.

Materials and methods: Patients with diabetes and/or hypertension were identified through ambulatory clinics affiliated with four hospitals. All patients enrolled with a CarePartner. Patients were randomized to weekly IVR calls including self-management questions and self-care education either alone ("standard m-health") or with automated feedback about health and self-care needs sent to their CarePartner after each IVR call ("m-health+CP").

Results: The 72 participants included 39 with diabetes and 53 with hypertension, of whom 19 had ≤6 years of education. After 1,225 patient-weeks of attempted IVR assessments, the call completion rate was higher among patients randomized to m-health+CP compared with standard m-health (62.0% versus 44.9%; p < 0.047). CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy (p < 0.001 for both). M-health+CP patients were more likely to report excellent health via IVR (adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI], 1.07, 6.32) and less likely to report days in bed due to illness (AOR = 0.42; 95% CI, 0.19, 0.91).

Conclusions: In this study we found that caregiver feedback increased engagement in m-health and may improve patients' health status relative to standard approaches. M-health+CP represents a scalable strategy for increasing the reach of self-management support in LMICs.

Keywords: behavioral health; cardiology/cardiovascular disease; extreme environments; mobile health; telemedicine.


<b>Fig. 1.</b>
Fig. 1.
CONSORT diagram for participants in the trial. DM, diabetes mellitus; HTN, hypertension; IVR, interactive voice response; mHealth, mobile health; mHealth+CP, mobile health+CarePartner.
<b>Fig. 2.</b>
Fig. 2.
(A–D) Unadjusted comparisons of interactive voice response call completion rates among patients randomized to standard mobile health without caregiver feedback (white bars) or mobile health with caregiver feedback (black bars).

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