Saleh Shadi, Farah Angie, Dimassi Hani, El Arnaout Nour, Constantin Joanne, Osman Mona, El Morr Christo, Alameddine Mohamad
Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Global Health Institute, American University of Beirut, Beirut, Lebanon.
JMIR Mhealth Uhealth. 2018 Jul 13;6(7):e137. doi: 10.2196/mhealth.8146.
Rural areas and refugee camps are characterized by poor access of patients to needed noncommunicable disease (NCD)-related health services, including diabetes and hypertension. Employing low-cost innovative eHealth interventions, such as mobile health (mHealth), may help improve NCDs prevention and control among disadvantaged populations.
The aim of this study was to assess the effect of employing low-cost mHealth tools on the accessibility to health services and improvement of health indicators of individuals with NCDs in rural areas and refugee camps in Lebanon.
This is a randomized controlled trial study in which centers were allocated randomly into control and intervention sites. The effect of an employed mHealth intervention is assessed through selected quality indicators examined in both control and intervention groups. Sixteen primary health care centers (eight controls, eight interventions) located in rural areas and Palestinian refugee camps across Lebanon were included in this study. Data on diabetic and hypertensive patients-1433 in the intervention group and 926 in the control group-was extracted from patient files in the pre and postintervention periods. The intervention entailed weekly short message service messages, including medical information, importance of compliance, and reminders of appointments or regular physician follow-up. Internationally established care indicators were utilized in this study. Descriptive analysis of baseline characteristics of participants, bivariate analysis, logistic and linear regression were conducted using SPSS (IBM Corp).
Bivariate analysis of quality indicators indicated that the intervention group had a significant increase in blood pressure control (P=.03), as well as a significant decrease in the mean systolic blood pressure (P=.02), mean glycated hemoglobin (HbA; P<.01), and in the proportion of HbA poor control (P=.02). Separate regression models controlling for age, gender, and setting showed a 28% increase in the odds of blood pressure control (P=.05) and a 38% decrease in the odds of HbA poor control (P=.04) among the intervention group in the posttest period. Females were at lower odds of HbA poor control (P=.01), and age was statistically associated with annual HbA testing (P<.01). Regression models for mean systolic blood pressure, mean diastolic blood pressure, and mean HbA showed that a mean decrease in HbA of 0.87% (P<.01) pretest to posttest period was observed among the intervention group. Patients in rural areas belonging to the intervention group had a lower HbA score as compared with those in refugee camps (P<.01).
This study underlines the importance of employing integrative approaches of diseases prevention and control in which existing NCD programs in underserved communities (ie, rural and refugee camps settings) are coupled with innovative, low-cost approaches such as mHealth to provide an effective and amplified effect of traditional NCD-targeted care that can be reflected by improved NCD-related health indicators among the population.
ClinicalTrials.gov NCT03580330; https://clinicaltrials.gov/ct2/show/NCT03580330 (Archived by WebCite at http://www.webcitation.org/70mhVEUwQ).
农村地区和难民营的特点是患者难以获得所需的非传染性疾病（NCD）相关医疗服务，包括糖尿病和高血压。采用低成本的创新型电子健康干预措施，如移动健康（mHealth），可能有助于改善弱势群体中的非传染性疾病预防和控制情况。
本研究的目的是评估采用低成本移动健康工具对黎巴嫩农村地区和难民营中患有非传染性疾病的个人获得医疗服务的可及性以及健康指标改善情况的影响。
这是一项随机对照试验研究，各中心被随机分配到对照组和干预组。通过在对照组和干预组中检查选定的质量指标来评估所采用的移动健康干预措施的效果。本研究纳入了黎巴嫩农村地区和巴勒斯坦难民营中的16个初级卫生保健中心（8个对照组，8个干预组）。在干预前后期间，从患者档案中提取了糖尿病和高血压患者的数据——干预组有1433例，对照组有926例。干预措施包括每周发送短信服务消息，内容包括医疗信息、依从性的重要性以及预约提醒或定期医生随访提醒。本研究采用了国际公认的护理指标。使用SPSS（IBM公司）对参与者的基线特征进行描述性分析、双变量分析、逻辑回归和线性回归。
质量指标的双变量分析表明，干预组的血压控制有显著改善（P = 0.03），平均收缩压显著降低（P = 0.02），平均糖化血红蛋白（HbA；P < 0.01）以及HbA控制不佳的比例显著降低（P = 0.02）。在控制年龄、性别和环境的单独回归模型中，干预组在测试后期血压控制的几率增加了28%（P = 0.05），HbA控制不佳的几率降低了38%（P = 0.04）。女性HbA控制不佳的几率较低（P = 0.01），年龄与年度HbA检测在统计学上相关（P < 0.01）。平均收缩压、平均舒张压和平均HbA的回归模型表明，干预组在测试前到测试后期的HbA平均下降了0.87%（P < 0.01）。与难民营中的患者相比，干预组中农村地区的患者HbA得分较低（P < 0.01）。
本研究强调了采用疾病预防和控制综合方法的重要性，即在服务不足的社区（即农村和难民营环境）现有的非传染性疾病项目中，结合创新的低成本方法，如移动健康，以提供传统非传染性疾病针对性护理的有效和放大效果，这可以通过人群中与非传染性疾病相关的健康指标改善来体现。
ClinicalTrials.gov NCT03580330；https://clinicaltrials.gov/ct2/show/NCT03580330（由WebCite存档于http://www.webcitation.org/70mhVEUwQ）
