Mobile health (mHealth) work in low- and middle-income countries (LMICs) often is limited to small pilot programs with an unclear path to scaling and dissemination. CMCD is working on a number of projects in order to identify pathways for bringing promising interventions to scale.

In this project, 364 primary care patients with diabetes and hypertension living in and around La Paz, Bolivia completed surveys about their use of mobile phones, health, and access to care. One hundred sixty-five of those patients then participated in a 12-week demonstration of automated telephone monitoring and self-management support. Weekly interactive voice response (IVR) calls were made from a platform established at a local university, under the direction of the regional health ministry.

Despite limited education and resources, we found that 82% of potential participants had a mobile phone, 45% used text messaging with a standard phone, and 9% had a smartphone. Smartphones were least common among patients who were older, spoke indigenous languages, or had less education. IVR program participants completed 1007 self-management support calls. IVR call completion was lower among older adults, but was not related to patients’ ethnicity, health status, or healthcare access. IVR health and self-care reports were consistent with information reported during in-person baseline interviews. Patients’ likelihood of reporting excellent, very good, or good health (versus fair or poor health) via IVR increased during program participation and was associated with better medication adherence. Patients completing follow-up interviews were satisfied with the program, with nearly all reporting that they would recommend it to a friend.

By collaborating with LMICs, CMCD is learning that mHealth programs can be transferred from higher-resource centers to LMICs and implemented in ways that improve access to self-management support.

Learn more about the CarePartner Program.

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