Development of a Smartphone-enabled hypertension and diabetes management package to facilitate evidence-based care delivery in primary healthcare facilities in India: A formative research to inform intervention design

Background. Hypertension and diabetes have become a major public health challenge in India. This research work aims to develop a feasible and scalable intervention for hypertension and diabetes, tailored to primary care settings in India.

Objectives. To conduct a healthcare facility assessment to inform the development of a Smartphone-enabled intervention package for hypertension and diabetes at primary healthcare facilities in India. To pilot the Smartphone-enabled hypertension and diabetes intervention package at primary healthcare facilities in India in order to identify the barriers, synergies and health system strengthening requirements for the feasibility and scalability of such an intervention.

Methodology. This research work was carried out in five Community Health Centres (CHCs) in Solan, Himachal Pradesh. The implementation and evaluation of the piloting, guided by a conceptual framework1, was carried out using mixed methods, following implementation science principles.

Results. In this research work, a six component intervention was developed comprising a Nurse Care Coordinator (NCC), a structured training programme, clinical management guidelines, a Smartphone-based clinical decision-support system, counselling services and follow-up plan for patients. During piloting, NCCs detected that 37% of the out-patient clinic attendees had hypertension/diabetes. At three months of follow-up, systolic blood pressure had a mean reduction of 10.9+/-13.1 mmHg (p<0.001) in 2974 participants while fasting glucose level had a mean reduction of 26.4+/-49.0 mg/dl (p<0.001) in 717 subjects.

Discussion. This research work demonstrated that a six component intervention for hypertension and diabetes care is feasible. However, barriers such as inadequate manpower, insufficient drug supply and inadequate lab facilities need to be addressed for optimal intervention delivery.

Conclusion. A Smartphone decision-support-enabled, NCC-facilitated intervention for hypertension and diabetes is feasible for primary care settings in India.