Pilot Mobile Phone Intervention in Promoting Type 2 Diabetes Management in an Urban Area in Ghana: A Randomized Controlled Trial

Abstract

Purpose The purpose of the study was to evaluate the feasibility and effectiveness of a nurse-led mobile phone call intervention on glycemic management and adherence to self-management practices among patients with type 2 diabetes mellitus (T2DM) in Ghana. Methods This was a pilot randomized controlled trial to compare diabetes care as usual to a mobile phone call intervention delivered by nurses in addition to care as usual over a 12-week period in a tertiary referral hospital in Ghana. Sixty patients with T2DM were randomized to either the intervention or the control arm. The intervention group received up to 16 mobile phone calls (mean duration = 12 minutes) from a diabetes specialist nurse in addition to their care as usual. The control group received only care as usual. The primary outcome was the change in A1C over the 12-week period. The secondary outcomes were changes in self-reported adherence to medication and diabetes self-management measures over the 12-week period. Results Mean baseline A1C was comparable between the intervention and control groups (9.54%, SD = 2.00% vs 9.07%, SD = 1.72%, P = .334). After 12 weeks, A1C was significantly lower in the intervention group compared to the control group. The difference in mean A1C in the control group rose by +0.26 ± 1.30% ( P = .282; 95% CI, −0.23 to 0.75), whereas that of the intervention group reduced by −1.51 ± 2.67% ( P = .004; 95% CI, −2.51 to −0.51). No improvements in self-management were recorded in the control group. In the intervention group, however, the only significant improvement was recorded in the area of foot care practices. Participant recruitment and retention were 100% without any attrition. About 87% (n = 26) of the intervention group completed at least 70% (≥11) of the calls. At the end of the trial, participants who received the intervention rated their satisfaction as 89.3% on average. Conclusion A mobile phone follow-up call by nurses emphasizing adherence to self-management practices is feasible and can improve short- to medium-term glycemic management among patients with T2DM.

Diabetes self-management education interventions in the WHO African Region: A scoping review

“…Length of the interventions varied, ranging from 4 weeks [ 42 ] to 48 months [ 37 ]. The majority of the programs (63.2%) were delivered at tertiary care facilities [ 26 , 29 , 30 , 34 , 36 , 38 ] and clinics [ 28 , 35 , 37 , 41 – 43 ]. Five interventions [ 27 , 31 , 32 , 39 , 40 ] were delivered at health centers, and one at both tertiary and secondary care facilities [ 33 ].…”

“…Six interventions [ 26 , 33 , 34 , 38 , 41 , 42 ] were delivered by an interdisciplinary team of health professionals, such as doctors/physicians, nurses, dietitians/nutritionists, and medical social workers. Five interventions [ 28 – 30 , 36 , 37 ] were delivered by nurses, three [ 25 , 27 , 35 ] by peer educators, two [ 40 , 43 ] by diabetes health educators, two [ 32 , 39 ] by dietitians and one [ 31 ] by health promoters—paid non-medically trained professionals whose work is to promote public health.…”

“…Outcomes for diabetes-related behaviors reported in the included studies were: dietary practices, physical activity/exercise, foot care, blood glucose self-monitoring, smoking, alcohol consumption, and medication adherence. Dietary practices were reported in seven studies; four [ 23 , 30 , 39 , 40 ] demonstrated significant improvements, three [ 27 , 31 , 36 ] reported no significant changes. Physical activity or exercise was measured in six studies [ 25 , 30 , 31 , 36 , 41 , 42 ]; only two [ 25 , 42 ] demonstrated significant positive effects.…”

“…Dietary practices were reported in seven studies; four [ 23 , 30 , 39 , 40 ] demonstrated significant improvements, three [ 27 , 31 , 36 ] reported no significant changes. Physical activity or exercise was measured in six studies [ 25 , 30 , 31 , 36 , 41 , 42 ]; only two [ 25 , 42 ] demonstrated significant positive effects. Foot care practices were assessed in four studies; three [ 25 , 36 , 42 ] reported significant improvements, one [ 31 ] showed no significant positive change.…”

“…Physical activity or exercise was measured in six studies [ 25 , 30 , 31 , 36 , 41 , 42 ]; only two [ 25 , 42 ] demonstrated significant positive effects. Foot care practices were assessed in four studies; three [ 25 , 36 , 42 ] reported significant improvements, one [ 31 ] showed no significant positive change. Self-monitoring of blood glucose was an outcome measure in two studies [ 30 , 36 ]; all demonstrating no significant improvements.…”