Development of a Smartphone‐Enabled Hypertension and Diabetes Mellitus Management Package to Facilitate Evidence‐Based Care Delivery in Primary Healthcare Facilities in India: The mPower Heart Project
Open accessAbstract
Background: The high burden of undetected and undertreated hypertension and diabetes mellitus is a major health challenge worldwide. The mP ower Heart Project aimed to develop and test a feasible and scalable intervention for hypertension and diabetes mellitus by task‐sharing with the use of a mobile phone–based clinical decision support system at Community Health Centers in Himachal Pradesh, India. Methods and Results: The development of the intervention and mobile phone–based clinical decision support system was carried out using mixed methods in five Community Health Centers. The intervention was subsequently evaluated using pre–post evaluation design. During intervention, a nurse care coordinator screened, examined, and entered patient parameters into mobile phone–based clinical decision support system to generate a prescription, which was vetted by a physician. The change in systolic blood pressure, diastolic blood pressure, and fasting plasma glucose ( FPG ) over 18 months of intervention was quantified using generalized estimating equations models. During intervention, 6797 participants were enrolled. Six thousand sixteen participants had hypertension (mean systolic blood pressure: 146.1 mm Hg, 95% CI : 145.7, 146.5; diastolic blood pressure: 89.52 mm Hg, 95% CI : 89.33, 89.72), of which 3152 (52%) subjects were newly detected. Similarly, 1516 participants had diabetes mellitus (mean FPG : 177.9 mg/dL, 95% CI : 175.8, 180.0), of which 450 (30%) subjects were newly detected. The changes in systolic blood pressure, diastolic blood pressure, and FPG observed at 18 months of follow‐up were −14.6 mm Hg (95% CI : −15.3, −13.8), −7.6 mm Hg ( CI : −8.0, −7.2), and −50.0 mg/dL (95% CI : −54.6, −45.5), respectively, and were statistically significant even after adjusting for age, sex, and Community Health Center. Conclusions: A nurse‐facilitated, mobile phone–based clinical decision support system‐enabled intervention in primary care was associated with improvements in blood pressure and blood glucose control and has the potential to scale‐up in resource poor settings. Clinical Trial Registration: URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 01794052. Clinical Trial Registry—India: CTRI /2013/02/003412.
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In the included studies, digital health interventions for individuals' behavioral outcomes showed positively inclined results, although mixed, especially when substantiated by behavioral science theories.
“For individuals’ behavioral outcomes, although still mixed, we consistently observed positively inclined results, especially when substantiated by behavioral science theories26,82.”
From Digital health interventions for non-communicable disease management in primary health care in low-and middle-income countries (2023) · cites this paper as [82]
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- Authors
- Ajay, V. S., Jindal, D., Roy, A., Venugopal, V., Sharma, R., Pawar, A., Kinra, S., Tandon, N., & Prabhakaran, D.
- Affiliations
- Centre for Chronic Disease Control (IN)
- All India Institute of Medical Sciences (IN)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Tandon, Nikhil
- Prabhakaran, Dorairaj
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2016-12
- Volume
- 5
- Issue
- 12
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC5210443
- OpenAlex
- W2562123090
- Cited by
- 90
- References
- 20
- Citations by year
- 2026: 8 · 2025: 1 · 2024: 12 · 2023: 12 · 2022: 15 · 2021: 9 · 2020: 9 · 2019: 10 · 2018: 9 · 2017: 5
- FWCI
- 14.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Kaiser Permanente
- Wellcome Trust
- Medtronic Foundation
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- hypertension, diabetes mellitus, task sharing, primary care, community health centers, blood pressure control, fasting blood glucose, newly diagnosed diabetes, Himachal Pradesh, resource-limited settings, scalable interventions, diabetes screening, blood glucose monitoring
- MeSH terms
- Smartphone, Adult, Blood Glucose, Blood Pressure, Diabetes Mellitus, Female, Follow-Up Studies, Humans, Hypertension, India, Male, Middle Aged, Morbidity, Primary Health Care, Retrospective Studies, Evidence-Based Medicine, Disease Management, Decision Support Systems, Clinical
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