mDiabetes – a Large Diabetes Prevention Text Messaging Initiative in India

Over 62 million individuals have been diagnosed with diabetes in India, creating a significant public health problem. India, a country with approximately 900 million mobile phone subscribers, is an optimal location to test effects of large-scale mHealth interventions to address burdensome chronic diseases. Arogya World’s mDiabetes program, a diabetes prevention text-messaging program among one million consumers from all over India, looked at the effectiveness of text messages in encouraging health behaviors known to prevent diabetes. The current study employs a non-randomized, prospective, parallel cohort design to test the impact of text messages on health behavior change. The study had two arms – Experimentals and Controls. Experimentals were about 900 Nokia mobile phone users who opted in to receive 56 diabetes prevention text messages in their choice of 12 languages, while Controls (N=900) received no text messages or contact during the 6 month intervention period. The frequency of text messages was as follows - one a day for the first 6 days, then twice a week for the rest of the weeks, up to 6 months. The content of the messages was different - some described how big a problem diabetes was in India, others that there were medical studies that showed that diabetes was preventable with lifestyle changes, that healthy living included increasing physical activity and improving diets. And the messages went on to cover how to incorporate physical activity into everyday lives, and also encouraged consumers to eat more fruits and vegetables and limit oily and sugary foods. All participants were surveyed by phone at baseline and 6 months to assess a selection of health behaviors. The study showed encouraging results - 35% of the experimental group compared to 21% in the control group reported positively changing more than one health behavior (p<.001). This study shows that large-scale text message based diabetes prevention interventions have the potential to be an effective option for population level health behavior change.