An Assessment of E-health Resources and Readiness in the Republic of the Marshall Islands: Implications for Non-communicable Disease Intervention Development.

The prevalence of non-communicable diseases (NCDs) is rapidly increasing in low and middle income countries (LMIC). The Republic of the Marshall Islands is an island country in the Pacific located near the equator and has the third highest prevalence of diabetes in the world, high rates of complications, and early mortality with limited or no resources for tertiary care of these complications. Given the limited resources of the country, there is a need for strategies which emphasize NCD prevention. E-health interventions are becoming more popular in LMICs. A rapid qualitative assessment, involving focus groups, site visits, and key informant interviews, was performed to ascertain community perceptions about the causes of NCDs including diabetes and potential solutions. An assessment of the technology infrastructure was conducted to assess capacity for potential e-health interventions. Thirty local participants were interviewed. Participants identified diabetes as the highest priority NCD with dietary shifts toward imported, processed foods and decrease in physical activity as the major causes. Text messaging and Facebook were found to be widely utilized for personal and public communication. Given the low-tech, low-cost communication mechanisms and widespread use of Facebook, a social media intervention could help support local NCD prevention communications initiatives.