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Interventional study to improve diabetic guidelines adherence using mobile health (m-Health) technology in Lahore, Pakistan
  1. Noreen Rahat Hashmi1,2,
  2. Shazad Ali Khan1
  1. 1 Health Services Academy, Islamabad, Pakistan
  2. 2 Department of Community Medicine, Rahbar Medical and Dental College, Lahore, Pakistan
  1. Correspondence to Dr Noreen Rahat Hashmi; drnoreen2{at}


Objective To check if mobile health (m-Health) short message service (SMS) can improve the knowledge and practice of the American Diabetic Association preventive care guidelines (ADA guidelines) recommendations among physicians.

Methodology Quasi-experimental pre–post study design with a control group.

Participants The participants of the study were 62 medical officers/medical postgraduate trainees from two hospitals in Lahore, Pakistan. Pretested questionnaire was used to collect baseline information about physicians’ knowledge and adherence according to the ADA guidelines. All the respondents attended 1-day workshop about the guidelines. The intervention group received regular reminders by SMS about the ADA guidelines for the next 5 months. Postintervention knowledge and practice scores of 13 variables were checked again using the same questionnaire. Statistical analysis included χ2 and McNemar’s tests for categorical variables and t-test for continuous variables. Pearson’s correlation analysis was done to check correlation between knowledge and practice scores in the intervention group. P values of <0.05 were considered statistically significant.

Results The total number of participating physicians was 62. Fifty-three (85.5%) respondents completed the study. Composite scores within the intervention group showed statistically significant improvement in knowledge (p<0.001) and practice (p<0.001) postintervention. The overall composite scores preintervention and postintervention also showed statistically significant difference of improvement in knowledge (p=0.002) and practice (p=0.001) between non-intervention and intervention groups. Adherence to individual 13 ADA preventive care guidelines level was noted to be suboptimal at baseline. Statistically significant improvement in the intervention group was seen in the following individual variables: review of symptoms of hypoglycaemia and hyperglycaemia, eye examination, neurological examination, lipid examination, referral to ophthalmologist, and counselling about non-smoking.

Conclusion m-Health technology can be a useful educational tool to help with improving knowledge and practice of diabetic guidelines. Future multicentre trials will help to scale this intervention for wider use in resource-limited countries.

  • diabetes mellitus
  • guidelines
  • adherence
  • patients

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was obtained from the Institutional Ethical Review Committee of Health Services Academy, Islamabad. Permission was also taken from the administration of the Jinnah Hospital, Lahore, where data collection was undertaken. The administration in the Lahore General Hospital said since our study was an educational intervention, it did not require formal ethical approval.

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

  • Data sharing statement The data are not freely available; however, specific enquiries can be submitted to

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