About DiabeTEXTs

About DiabeTEXTs

Site: K-Net Meeting Place
Meeting Place: DiabeTEXTs
Book: About DiabeTEXTs
Printed by: Guest User
Date: Friday, 22 November 2024, 03:43 PM

Table of Contents

Introduction to DiabeTEXTs

Project Overview:

Living with diabetes makes great educational demands on a family – for children, parental support and involvement play a central role in management of the disease. However, this also creates special challenges relating to independence and opposition when children move into adolescence. Information and communication technology could provide the means for greater flexibility and independence. Diabetic patients also have to be active participants in their treatment, because they are inevitably responsible for their day to day care.

As the availability of mobile access advances rapidly, mobile phones are now widely available at a low cost. The potential in using mobile phones for supporting and educating diabetes patients is increasingly being recognized. However, this proposed service has not yet been explored in a Canadian First Nations community context, especially when First Nations people in Canada experience a disproportionate burden of type 2 diabetes mellitus. With the establishment of Keewaytinook Mobile (KM) and Dryden Mobility (DMTS), local cellular and data services are becoming readily available to more First Nations communities across Northern Ontario. This provides a great opportunity to see if utilizing cell phones to provide educational information for First Nations diabetes patients and their caregivers can be an effective and long-term health care support strategy.

About the Developer

Michael Mak

Michael Mak is a Bachelor of Health Science Student in the Global Health Specialization from McMaster University.  With the growing introduction of cellular services in KO communities, Michael developed the idea of DiabeTEXTs and is now working with K-NET and KO Health to improve diabetes education and health dissemination in First Nations communities.  He is also the creator of the ELDER project (www.elderproject.knet.ca) and a member of the One Laptop Per Child Community.   

Project Details

Project Details

Goals:

· To create an active, effective and long-term diabetes education project through cellular SMS texting and other information avenues to promote healthy living habits, carbohydrate counting, medication information, reminders for blood-glucose testing and other related information or community diabetes events

· Perform research on the effectiveness of the above service in a remote and rural First Nations context

· Explore and develop the necessary infrastructure within existing mobile networks of KM and DMTS to send diabetes-information texts to a greater number of First Nations patients and caregivers

· Explore and develop a software interface for health-care providers to send both texts and emails through a computer terminal

Objectives of the Pilot

· Create a pilot project in interested communities where community wellness workers can send educational diabetes texts to a group of patients (2010/2011)

· Conduct research with KORI to evaluate the effectiveness of the pilot and diabetes text messaging (2010/2011)

Methods

Because there is no existing mass SMS texting from internet service implemented for both DMTS and KM, the pilot will be utilizing a cell phone with a computer software interface so that community wellness workers can send SMS Texts to a large number of recipients.

Methods

Community Wellness workers will broadcast scheduled and appropriately tailored messages, including a weekly reminder of the goal set in clinic, and a daily message providing tips, information or reminders to reinforce this goal. Community Wellness Workers must also keep track of which messages were sent when, for research and redundancy purposes. Examples of these messages include the following categories:

Message Categories

Example Messages

Insulin Injections

Don’t 4get 2 inject!

Blood Glucose Testing

Why not try another BG meter-check out with the team next time ur in clinic

Healthy eating

Fruit, celery or carrot sticks, pretzels, plain popcorn make healthy snax

Carbohydrate counting

Do you have any “carb counting” questions for the DiabTs doctors or dietician? Stp by da clinic!

Events

New recipes avilble at clinic – stp by to rcve FREE pkage!

People can sign up for the service through the following:

· Invitations made to existing diabetes patients and their caregivers who have a cell phone to subscribe

· Individuals purchasing a new cell phone can be asked if they wish to sign up for the service

· Other: emailing, calling, or speaking to the community wellness worker to subscribe for the service

Privacy:

All subscription forms will be held confidential by the community wellness worker. Mailing Lists will not be disclosed or utilized for purposes other than diabetes education and information.

Equipment

Equipment:

For one community wellness worker:

· Nokia 5310 Cell Phone with PC Suite installation software disc

· SIM card

· Calling card

· Prepaid text plan

· Available Computer able to run the software

· Delivery Cost

Instructional sessions can be hosted over videoconferencing, providing the training on how to use the software.

Phone/Software Interface

Nokia Set up

The Nokia 5310 cell phone was chosen in particular for this pilot because it is compatible with Nokia PC Suite Interface, a software application for desktop/laptop computers that comes with the Nokia phone that allows users to perform a number of functions, including the ability to composer and send SMS texts to contacts. This allows Community Wellness workers to send multiple texts easily from their computer, without having to send texts from their phone one patient at a time.

Suggested Research Methodology

Suggested Pilot Research Evaluation Methodology

For the pilot, qualitative data can be gathered through semi-structured phone interviews covering the following topics: SMS for diabetes education; communication with health personnel and with the child; and control. Interviews can be recorded transcribed verbatim and analysed through a general systematic text condensation procedure, where repeated or similar statements in the transcripts will be coded according to general meaning and subsequently grouped into themes. In addition, the responses to specific evaluation questions such as whether the respondent would like to continue using the system can be counted.

After primary evaluation, on-going research can also be performed on the long-term benefits of diabetes education through mobile text. This research can hopefully justify the establishment of a mass SMS texting via email system dedicated to diabetes education, as well as the creation of a dedicated website where patients can view other information online and a new online software interface for community wellness workers, diabetes workers, and other health care professionals.

Conclusion

Conclusion:

The use of mobile technology as a diabetes education dissemination tool is extremely valuable to the First Nations communities in North-Western Ontario. Not only can it potentially improve self-efficacy and adherence to healthy lifestyle choices and medications, it reaches out to youth which has been classically a difficult-to-reach patient group. With the success of this pilot, other avenues for dissemination such as addictions and mental health, can be established and explored.

Sample Text Message List

This list is continually updated, edited, and reconstructed. Diabetes workers and other health professionals are invited to add, edit, and create their own "message list" to match their community.

Physical Activity

Managing Blood Glucose

Staying Healthy

Smoking

Clinic examples
  • Did u know? Regular physical activity improves the body’s sensitivity to insulin and can help manage blood glucose lvls!
  • Avoid injecting insulin into the body part that will be exercising!
  • If your pre-meal blood glucose level is >14.0 mmol/L and urine ketone level is >8.0 mmol/L or blood ketone level is >3.0 mmol/L, exercise should not be performed as it could cause high blood glucose and more ketone production. Wait until your blood glucose is back in the normal range before exercising
  • Estimate how much carbohydrate and insulin you need to keep your blood glucose levels stable. You may need to work with your healthcare team to learn how to do this. A general rule of thumb for most moderate-intensity exercise is 15 to 30 g of carbohydrate every 30 to 60 minutes of exercise.
  • Keep some form of fast-acting carbohydrate with you at all times in case you need to treat a low blood glucose.
  • Listen to your body. While exercising will probably cause some muscle fatigue or even slight discomfort, it should not cause pain before or after.
  • When you are sick, drink plenty of extra sugar-free fluids or water; try to avoid coffee, tea and colas as they contain caffeine, which may cause you to lose more fluids.
  • When you are sick, replace solid food with fluids that contain glucose, if you can’t eat according to your usual meal plan;
  • When you are sick, if you are on insulin, be sure to continue taking it while you are sick. Check with your healthcare team about guidelines for insulin adjustment during an illness.
  • If you have a cold or flu and are considering using a cold remedy or cough syrup, ask your pharmacist to help you make a good choice. Since many cold remedies and cough syrups contain sugar, try to pick a sugar-free product.
  • You and your healthcare team should set goals for your blood glucose levels. It is important to recognize that you may need to add pills and/or insulin to your lifestyle changes (meal planning and increased activity), to achieve your blood glucose targets.
  • High blood pressure can lead to eye disease, heart disease, stroke and kidney disease. You may need to change your eating and exercise habits and/or take pills to keep your blood pressure below 130/80 mm Hg.
  • Both aerobic and resistance exercise are important for people living with diabetes. If you have diabetes, you should do at least 150 minutes of moderate- to vigorous-intensity aerobic exercise per week. You may need to start with as little as 5 to 10 minutes per day of brisk walking. In addition, resistance exercise (such as weight training) should be performed 3 times per week. If you are just starting to be active, check with your doctor first.
  • High cholesterol and other fats in the blood can lead to heart disease and stroke. You may need to change your eating and exercise habits and/or take pills to keep your blood fats at healthy levels.
  • Reaching and maintaining a healthy weight will help you control your blood glucose, blood pressure and blood fat levels.
  • You need to be seen by an eye care specialist who will dilate your pupils and check for signs of eye disease. Your regular doctor cannot do this special test in his or her office. Ask for a referral to an eye care specialist.
  • Take off your shoes and socks at every visit (even if your doctor or healthcare team forget to ask you). Ingrown toenails, cuts and sores on the feet can lead to serious infections. Learn about proper foot care.
  • The earlier you catch signs of kidney disease the better. You must have your urine tested regularly for early signs of kidney disease. Your doctor may prescribe pills to delay more damage to your kidneys.
  • Monitoring your blood glucose is important. Review your home glucose monitoring record with your doctor regularly. And make sure that your meter is providing accurate results by checking against the results of a blood test at the lab at least once a year.
  • Quitting smoking is one of the most important things individuals living with diabetes can do to help prevent or delay the onset of complications.
  • People with diabetes are already at increased risk for heart disease; however, if they smoke, they face three times the risk for heart attack of a person with diabetes who does not smoke.
  • Come to the clinic to learn how you can get a new glucometer!
  • Have questions about

    • 　

    Want to quit? Come to the clinic tonite to learn how!

    　

    Towards the Future

    Heading towards the future

    The current design for DiabeTEXTs is to utilize a Nokia 5310 phone and the Nokia PC Suite interface in order to send and collect SMS texts. Although the interface on the Nokia PC Suite is a simple one, the question persists: is there an interface that can do more, such as store patient records, and send out questionnaires via SMS texting? Is there an interface that could work with almost any phone? What can we envision for the future of mobile health care in Northern Ontario?

    Frontline SMS

    FrontlineSMS is award-winning free, open source software that turns a laptop and a mobile phone into a central communications hub. Once installed, the program enables users to send and receive text messages with groups of people through mobile phones. What you communicate is up to you, making FrontlineSMS useful in many different ways.

    · It does not require an Internet connection.

    · Attach a phone and SIM card, and pay your local operator per SMS as usual.

    · It stores all phone numbers and records all incoming and outgoing messages.

    · All data lives on your computer, not on servers controlled by someone else.

    · You can send messages to individuals or large groups, and reply individually – useful for fieldwork or during surveys.

    · It is easy to install and requires little or no training to use.

    · Developers can freely take the source code and add their own features.

    · It can be used anywhere in the world simply by switching the SIM card.

    To learn more go to: http://www.frontlinesms.com/

    *Note*: I have tested Frontline SMS with the Nokia 5310 XpressMusic, and it does NOT work. The compatibility list of which phones work and which don’t can be found here: http://www.frontlinesms.com/resources/requirements/ According to the developers, it is actually preferable to use a GSM modem for the software.

    Frontline SMS MEDIC

    We’re focusing on local ownership and appropriate technology.

    In the developing world, lack of infrastructure prevents health workers from delivering efficient healthcare to rural areas. As health workers travel from clinics to reach isolated patients, they are often as disconnected from central clinics as the patients they are trying to serve. The mission of FrontlineSMS:Medic is to advance healthcare networks in under served communities using innovative, appropriate mobile technologies. The centerpiece of our system is FrontlineSMS, a free, open-source software platform that enables large-scale, two-way text messaging using only a laptop, a GSM modem, and inexpensive cell phones. We are also extending the FrontlineSMS platform to enable better patient management, electronic medical records via the cell phone, cheap mobile diagnostics, and mapping of health services.

    To learn more: http://medic.frontlinesms.com/

    *NOTE*: Frontline SMS MEDIC is a plugin for Frontline SMS. You will need to have a working phone or GSM modem to utilize this plugin, just like for Frontline SMS.

    Open MRS

    OpenMRS is a software platform and a reference application which enables design of a customized medical records system with no programming knowledge (although medical and systems analysis knowledge is required). It is a common platform upon which medical informatics efforts in developing countries can be built. The system is based on a conceptual database structure which is not dependent on the actual types of medical information required to be collected or on particular data collection forms and so can be customized for different uses.

    OpenMRS is based on the principle that information should be stored in a way which makes it easy to summarize and analyze, i.e., minimal use of free text and maximum use of coded information. At its core is a concept dictionary which stores all diagnosis, tests, procedures, drugs and other general questions and potential answers. OpenMRS is a client-server application, which means it is designed to work in an environment where many client computers access the same information on a server.

    Please visit their site at: http://openmrs.org/about/

    DMTS Text Messaging to Landline

    Don’t have a mobile phone? Text messages can now be sent to home phones, according to Dryden Mobility.

    Features:

    To learn more, go to: http://www.dmts.biz/?p=3880