SMARTHealth Diabetes in China Using Lay Family Health Promoters
Condition: Diabetes Mellitus, Type 2; Hypertension; Dyslipidemias
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2; Dyslipidemias
Study type: Interventional

Summary: 
      It's a community-based parallel-arm cluster Randomized Controlled Trial (RCT). An interactive
      mobile health management system will be developed to support lay family health promoters and
      healthcare staff to improve clinical outcomes for family members with Type 2 Diabetes
      Mellitus (T2DM). 2,000 participants from 80 sites will be chosen from urban (40 communities)
      and rural (40 villages) settings in Shijiazhuang City, Hebei Province.
    

Detailed description: 
      Study design and Settings:

      Cluster randomised controlled trial involving 80 sites (40 communities in urban Shijiazhuang
      and 40 villages in rural Shijiazhuang) and 2,000 people with T2DM.

      Hypothesis:

      An interactive mobile health management system can support lay family health promoters (FHP)
      and healthcare staff to improve clinical outcomes for family members with T2DM

      Intervention:

      SMARTHealth Diabetes is an interactive mobile health platform to promote improved
      self-management for people with T2DM. It comprises the following core features:

        -  Management support based on best practice clinical guidelines

        -  Self-management tools and resources for family members

        -  Password protected registration of patients and their nominated FHP to access this
           information

        -  Population of key clinical information into a desktop application used by health care
           providers when applicable

      Community eligibility:

        -  40 urban communities and 40 rural villages from geographically dispersed regions will be
           selected

        -  Each community/ village must have at least one community health station providing
           services to ≥1,000 adult residents

        -  Staff at the community health station must be willing to participate in the intervention

      Statistical power:

      80 clusters and a mean community cluster size of 25 participants (2,000 total) will provide
      90% power to detect an absolute improvement of 10% in the primary outcome. This assumes 20%
      of people in the control arm will achieve ≥2 'ABC' diabetes goals ((HbA1C<7%; Blood Pressure
      <140/80 mmHg, LDL cholesterol <100mg/dl or 2.6mmol/L) at end of study; an intra-class
      correlation coefficient of 0.05, a 20% loss to follow-up, and a 2-sided significance level of
      0.05. This translates to a mean reduction of 0.35% for HbA1C, 0.14 mmol/L for LDL cholesterol
      and 3.4mmHg for systolic BP. Primary analyses will be conducted at the patient level.
      Secondary analyses will be conducted at the cluster level. Sub-group analyses will be
      conducted at the community level (based on size and health service characteristics) and
      patient level (based on demographic factors (co-habitation with FHP) and clinical factors
      (control rate of 'ABC' risk factors at baseline).

      Significance:

      The Chinese government has placed prevention and treatment of diabetes as one of 11 National
      Basic Public Health Services. Despite great promise for mobile health (mHealth) interventions
      to improve access to effective healthcare, there remains uncertainty about how this can be
      successfully achieved. These uncertainties pose substantial dilemmas for health system
      planners. The findings are likely to inform policy on a scalable strategy to overcome
      sub-optimal access to effective health care in China.
    

Intervention name(s): SMARTHealth Diabetes
Intervention type(s): Behavioral
Intervention description(s): SMARTHealth Diabetes is an interactive mobile health platform to promote improved self-management for people with T2DM.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Telemedicine; Diabetes Mellitus, Type 2; Decision Support Systems, Clinical; Family Health Promoter; Primary Health Care