bHealthybMobile initiative

1. Dr Line Kleinebreil
WHO consultant BHBM / UNFM
“Can mobiles save lives ?
WHO and ITU answered
YES in 2013

2. NCD are on the UN agenda
WHO-ITU
mHealth for NCDs

3. Be Healthy Be Mobile: Timeline
3
INSTITUTIONALISATION
2013
mCessation Toolkit
mDiabetes Toolkit
Launch services in Costa Rica
mWellness Toolkit
mCervical cancer Toolkit
Launch services in Senegal
Launch services in Zambia
Engagement discussions Norway, Philippines,
Russia, UK
mHypertension Toolkit
Launch services in Philippines
Launch services in all countries
Launch
30+ COUNTRIES
INTERESTED 2014
2015 / 2017
7 SIGNED COUNTRY
AGREEMENTS
8 NATIONAL mHEALTH
INITIATIVES
2018
knowledge & innovation
hubs

4. m-diabetes in practice
Local team
Target population
Draft SMS
Test by MOH
Registration ++++
SMS campaign
Evaluation
International team
Review by experts
Country Exchanges
Review, dissemination

5. mDiabète: lutter contre
l’explosion mondiale du
diabète grâce aux
nouvelles technologies
Une initiative conjointe
de l’OMS et ITU .
Une application de la “Santé
Mobile” aux Maladies Non
Transmissibles (MNT)
New:
Sénégal, mDiabetes laboratory

6. New : national content prepared by
national and international experts
(including patients), documented by WHO

8. Young diabetics
Promoting mDiabetes
Active role of the patient
association ASSAD

9. Official website
www.mdiabete.gouv.sn

10. One
SMS
+
One
Page
on the
web

11. First results
Political decision : november 2013
1st campaign : june 2014 “Diabetes & Ramadan”
1000 participants, 6 weeks
2nd campaign : november 2014,
3000 participants, basic diabetes module, 12 weeks
3rd campaign : april 2015,
3000 participants , healthy diet module, 6 weeks
4th campaign : june 2015, “Diabetes & Ramadan”
12 000 participants, 6 weeks
5th campaign : november 2015, “basic module ”
20 000 participants, 12 weeks
6th campaign : march 2016, healthy diet module
15 000 participants, 6 weeks
7th campaign : may 2016, “Diabetes & Ramadan”
51 000 participants, 6 weeks
WHO compiles the different steps, the content and evaluations. The
document will be shared with all members states

12. Take home messages
BHBM, is powerful, cheap, easy to scale-up,
well accepted by citizen and HCP
Opportunity for awareness, prevention,
continuous training of healthcare
professionals
Opportunity to improve health literacy

13. Thank you for your attention

14. impact on HCP

15. Profile of the sample
28.1
59.4
4.7
7.8
doctor
paramedic
pharmacist
other
Professions
“Other”: among those who registered as being in the “health
professional” category, a small number are in contact with patients
without being healthcare staff as such (medical secretary, educators
from the association, community workers, healthcare journalist).

16. Profile of the sample
84.8
6.1
9.1
Sector of activity
public
private (for profit)
private (business)
The public sector is strongly represented in this random sampling. The private-
sector HPs subsequently signed up for the next m-Diabetes campaigns by
means of the SMS registration system introduced by the operators as from May
2016.

17. Impact on awareness
65.8
21.9
5.5
5.5
1.4
Considerably
A lot
To a fair extent
A little
Not at all
Did these messages increase your
knowledge about diabetes?
These results confirm the need to provide continuous training on diabetes
and, more generally, on chronic illnesses. This simple format, in which the
message is progressively distilled into a clear and succinct text, is
appreciated by overloaded HPs who do not need to travel in order to
receive a basic training.

18. Impact on awareness
32.618.5
16.3
10.9
7.6
5.4
4.3
4.3
Nutrition
Monitoring
Diabetes and Ramadan
Physical activity
Medicines
Diagnosis
Gestational diabetes
Complications
Messages which provided you with
information that was new to you (themes)
This reflects the needs previously expressed by HPs with respect to better
nutritional information, which gave rise to the “nutrition” module and to
advice on fasting. Information relating to the management and
monitoring of complications is also highly appreciated.

19. Impact on self-confidence
57.4
32.8
8.2
1.6
0.0
Considerably
A lot
To a fair extent
A little
Not at all
Have these messages helped to increase
your self-confidence when it comes to
working with a patient suffering from
diabetes?
For 90% of the HPs interviewed: yes.
Obviously, for senior doctors and paramedics, these simple text messages
have not added to their knowledge of diabetes or to their self-
confidence in dealing with diabetics.

20. Impact on behaviour
19.6
17.4
10.9
10.9
10.9
8.7
Nutrition
Diagnosis
Complication
Diabetes and Ramadan
Medicines
Physical activity
Specify a message which changed the
way you handle your patients’ diabetes
(themes)
60% of the HPs interviewed cited at least one message which caught their
attention and influenced their working methods. While the SMSs on
nutrition were the most often cited, those relating to risk factors, diabetes
diagnostic criteria and monitoring of complications also helped to
improve working methods.

21. Impact sur les comportements
47.5
28.8
5.1
10.2
8.5
Considerably
A lot
To a fair extent
A little
Not at all
Have these messages changed the way
in which you monitor diabetic foot?
If there is one subject that is neglected by university training it is diabetic
foot, whereas in the field it is unfortunately a frequent complication that
leaves many HPs feeling powerless. The provision of simple guidance on
how to take early action to identify those at risk has had a significant
impact on working methods.

22. Appreciation of the campaign
Do you wish to continue receiving SMS texts
this year?
Yes: 100%
The current format of the m-Diabetes campaigns, with simple SMS texts
delivering essential information, is supported. Important is to impart the
“base modules” and “nutrition module” to as many HPs as possible at all
levels of the health pyramid, while also supplementing the programme with
specific SMS modules targeting situations such as gestational diabetes, child
diabetes, foot ulcers, recourse to insulin, …

23. Appreciation of the campaign
Would you recommend the m-Diabetes
programme to other health professionals?
Yes: 100%
This encouraging result represents a just reward for the efforts
made by all those who, at different levels, have made a
personal commitment to this innovative programme. While one
might initially have doubted the ability of simple text messages
to modify working methods, this survey has shown them to be a
cost-effective means of rapidly upgrading the skills needed by
HPs to handle both crisis situations and routine healthcare.

24. impact on patients

25. Profile of the sample
53.8
46.2
GENDER of the diabetics interviewed
MALE
FEMALE
The survey carried out in 2015 by ASSAD also found a slight male
predominance (men 51%, women 49%). It will be interesting to compare
these results with those from the STEPS survey recently conducted in Senegal
by the Ministry and WHO.

26. Profile of the sample
12.9
58.1
19.4
9.7
Age groups of the diabetics interviewed
20-30 years
30-50 years
50-60 years
over 60 years
70% of the diabetics interviewed were below 50 years of age, and 90%
were below 60. They were therefore, theoretically, still of working age. The
2015 survey revealed 17% of diabetics aged over 66. These two results
highlight a diabetes discovery age that is much earlier in Africa than in
Europe, with the corresponding impact on companies and economic
development.

27. Profile of the sample
15.4
26.2
40.0
18.5
Education level of the diabetics
interviewed
None
Primary
Secondary
University
41% have a minimum level of education (38% in the 2015 ASSAD survey).
The SMS texts have to be simply and clearly worded if they are to be
understood. The “one sentence at a time”, “only one topic per day”
approach has undoubtedly helped to bring people into the programme, in
addition to the wide variety of complex information provided during
consultations.

28. Profile of the sample
55.4
44.6
Occupational status of the diabetics
interviewed
Actively
employed
Unemployed
While 90% are of working age, 44% are without an occupation. Of
these,14% are “housewives”, while for the other 30% diabetes makes
it difficult to find or hold down a job. Making both employers and
employees aware of the need for early treatment of the disease in
the interests of employability is a direction to be pursued within m-
Diabetes.

29. Profile of the sample
36.9
44.6
18.5
Type of diabetes of the diabetics
interviewed
Type 1
Type 2
Don't know
Type of diabetes is a medical notion. For patients, there is often a confusion
between type 1 diabetes and insulin treatment. 18% are unaware of their
diabetes type, whereas the differences are important, particularly where the
work environment is concerned. This topic should be made more explicit in
the “base module” SMS texts.

30. Receipt of messages
84.6
15.4
Did you receive and read the SMS messages
sent within the framework of m-Diabetes?
YES
NO
Operator statistics show that, from the technical standpoint, 98% of the
thousands of SMS texts sent are delivered. The question was whether the
messages in question were actually read. Despite the low education level
of the sample and the written format (in French) of the texts, 84% were
able to read the messages and benefit from their content.

31. Impact on awareness
47.2
13.9
11.1
25.0
2.8
Nutrition
Physical activity
Monitoring
Diabetes and Ramadan
Diabetic foot
Messages which had an impact on you
(topics)
Messages that are immediately applicable to daily life, such as those
relating to the sugar content of certain foodstuffs that are consumed daily
or during the period of Ramadan, are those which have the greatest
impact on diabetics, helping them to alter their habits.

32. Impact on awareness
22.2
44.4
33.3
Nutrition
Diabetes and Ramadan
Others
Message which provided information that was
new to you (topics)
Despite the country having a large majority of practising Muslims, there is
little discussion of the topic of diabetes and Ramadan during consultations.
Simple SMS tips on how to remain hydrated and monitor one’s blood sugar
during fasting provide patients with useful information.

33. Impact on self-confidence
34.5
45.5
16.4
1.8
1.8
Considerably
A lot
To a fair extent
A little
Not at all
Have these messages helped to increase
your self-confidence when it comes to
managing your diabetes?
Controlling diabetes depends on the patient’s daily behaviour. His/her
understanding of the different components of the treatment and degree of
self-confidence in terms of making the right decisions between medical
consulations are critical. The above result shows how the SMS texts can help.

34. Impact on self-confidence
93.8
6.3
I check my blood sugar level more
regularly than before
YES
NO
Most of the time, diabetes is a silent disease. Checking one’s blood sugar
level is the only way to verify that the treatment as a whole (nutrition +
exercise + medicines) is working. One of the aims of the programme was to
make diabetics aware of the need to perform such checks.

35. Impact on behaviour
30.0
20.0
50.0
once a day
once a week
once a month
If yes, I now do so at least…
This frequency of blood-sugar monitoring is not sufficient for a patient
to maintain his/her diabetes within a balance that will protect him/her
from complications. While SMS texts can inform and aid awareness,
the problem of access to and the affordability of blood-sugar tests
should be a key strand of the national diabetes plan.

36. Impact on behaviour
78.0
22.0
I monitor my weight more regularly than
before
YES
NO
Here again, the m-Diabetes SMS campaign has shown that it can have a
positive impact on behaviour, especially where simple daily habits are
concerned.

37. Impact on behaviour
2.6
15.4
28.2
53.8
daily
at least once a week
at least once a month
only when I visit my doctor
If yes, I now do so…
With weight checks by the doctor and a blood-sugar test once a month,
most likely during a medical visit, there is still work to be done to get
diabetic patients to take more responsibility for controlling their condition.
This is the challenge of therapeutic education, whose impact has been
proved in Europe and which should be more broadly developed in Africa.

38. Impact on behaviour
92.0
8.0
I eat fruit and/or vegetables more often
than before
YES
NO
Messages relating to nutrition are the most requested and best assimilated
by patients. The traditional diet comprises little in the way of fruit and
vegetables, so there is a need for information.

39. Impact on behaviour
22.2
62.2
15.6
at least one fruit or
vegetable
at least two or three fruits
or vegetables
more than four fruits or
vegetables
If yes, my daily intake is now…
When one considers the high price of fruits and vegetables in Senegal as
compared to grains and bananas, these results are very encouraging.
BHBM’s “nutrition” module is intended to be shared with the entire adult
population, diabetic and non-diabetic, and within schools.

40. Impact on behaviour
92.0
8.0
I eat fewer fatty foods than before
YES
NO
While diabetes itself is the main subject of the m-Diabetes campaign, the
associated risk factors – cholesterol, excess weight – are also a matter for
awareness-building.

41. Impact on behaviour
35.6
13.3
13.3
37.8
Everyday
Often
Sometimes
Rarely
If yes, how often do you take more care?
Two opposing groups emerge: those who are aware and put their
knowledge to effective use (35%), and those who are aware but do not
really apply their knowledge (65%). The messages need to be repeated in
order to reduce this inertia in the face of change.

42. Appreciation of the campaign
Do you wish to continue receiving SMS texts
this year?
Yes: 100%
The current format of the m-Diabetes campaigns, with simple SMS texts
delivering essential information, is supported. It is important to impart the
“base modules” and “nutrition module” to as many diabetics as possible,
particularly those living far from medical centres or whose modest income
limits their access to healthcare.
Additional modules need to be made available to cater for specific
situations.

43. Appreciation of the campaign
Would you recommend the m-Diabetes
programme to other health professionals?
Yes: 100%
This encouraging result represents a just reward for the efforts
made by all those who, at different levels, have made a
personal commitment to this innovative programme. While one
might initially have doubted the ability of simple text messages
to modify people’s behaviour, this survey has shown them to be
a cost-effective means of sensitizing patients and making them
more committed to controlling their condition.

44. 34.5
45.5
16.4
1.8
1.8
Considerably
A lot
To a fair extent
A little
Not at all
Have these messages helped to increase your
self-confidence when it comes to managing
your diabetes?
Controlling diabetes depends on the patient’s daily behaviour. His/her
understanding of the different components of the treatment and degree
of self-confidence in terms of making the right decisions between
medical consulations are critical. The above result shows how the SMS
texts can help.
Impact on self-confidence

45. Do you wish to continue receiving SMS texts
this year?
Yes: 100%
The current format of the m-Diabetes campaigns, with simple SMS texts
delivering essential information, is supported. It is important to impart the
“base modules” and “nutrition module” to as many diabetics as possible,
particularly those living far from medical centres or whose modest income
limits their access to healthcare.
Additional modules need to be made available to cater for specific
situations.
Appreciation of the campaign