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mDiabetes initiative using text messages to improve lifestyle and health-seeking behaviour in India
  1. Ambady Ramachandran1,
  2. Rajeev Kumar2,
  3. Arun Nanditha1,
  4. Arun Raghavan1,
  5. Chamukuttan Snehalatha1,
  6. Satheesh Krishnamoorthy1,
  7. Pradeep Joshi3,
  8. Fikru Tesfaye3
  1. 1 India Diabetes Research Foundation and Dr A Ramachandran’s Diabetes Hospitals, Chennai, Tamil Nadu, India
  2. 2 Ministry of Health and Family Welfare, Government of India
  3. 3 World Health Organisation, India, New Delhi, India
  1. Correspondence to Professor Ambady Ramachandran, India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, Tamilnadu, India; ramachandran{at}


Background Data on the use of mobile technology in public health are sparse. Text messaging is cost-effective in disseminating information to large communities. The Ministry of Health and Family Welfare, Government of India, initiated and executed this mDiabetes programme.

Objectives The main objective of this commissioned study was to test the feasibility of using mobile technology to reach a large number of people to improve their lifestyle and health-seeking behaviour. Participants’ interest, acceptability and scope for improvement were assessed.

Methods This mDiabetes observational study was done in India between 2016 and 2017. Text messages inviting registrations were sent to 130 million people in the country, mostly to the working class. Respondents (n=107 548) were registered by dialling a given phone number (missed phone call) or through a website. Based on the response, participants were grouped into six categories: persons with diabetes, pregnant/lactating women, high-risk individuals, healthcare professionals, elderly and normal population. They received 90 messages on healthy living during the 6 months. The impact of intervention was assessed at the third and sixth months by feedback messages. Telephonic interviews were conducted at 1 year in a subpopulation (n=855).

Results The registered respondents, 31 725, were grouped into six categories. 21.4% had diabetes and 5.3% had multiple risk factors. 15.6% responded to feedback messages. Among them, 57.2% followed a healthy diet, 72.3% practised advice on physical activity, 51.9% screened for diabetes and 67.3% checked their glycaemic status. The telephonic interviews showed that the programme was feasible and acceptable. The participants suggested use of interactive voice response system for registration and motivation.

Discussion and conclusion The study demonstrated the feasibility and acceptability of mHealth in a large population to disseminate knowledge regarding diabetes and healthy lifestyle, and to improve health-seeking behaviour. It helped to identify the limitations and scope for future improvements.

  • mhealth
  • lifestyle
  • diabetes

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  • Contributors Conceived and designed the experiments: AmR, CS, SK, PJ, FT, RK. Trained the technical team to deliver the programme: SK, PJ. Performed the experiments: SK, PJ, FT, RK. Analysed the data: AmR, CS, SK. Wrote the first draft of the manuscript: AmR, CS, SK. Contributed to discussion, reviewed/edited the manuscript: AN, ArR, PJ, FT, RK. Agreed with the manuscript’s results and conclusions: all authors.

  • Funding The study was funded by the Ministry of Health and Family Welfare, Government of India. The evaluation study was funded by the WHO Country Office for India.

  • Competing interests AmR reports grant from the WHO for the study design and evaluation.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.