Perceived Facilitators and Barriers to Implementing a Technology Supported Primary Care Program for the Management of Type 2 Diabetes and Kidney Disease in India
Background: Low-income countries often face the challenge of being incapable to
prevent, treat, and manage diseases that are becoming increasingly prevalent over recent years.
An example of this is the rise of chronic kidney disease (CKD) primarily due to type 2 diabetes
in rural settings in India. Research concerning preventive CKD and diabetes care in India
therefore needs to be conducted. Mobile-health has shown to be an effective tool for
supplementing the efficiency and outreach of health care in low-income settings.
Methods: This study aimed to 1) understand current practices and preparedness of staff
related to CKD and diabetes management in rural settings in India 2) identify barriers and
facilitators for quality CKD management and care in rural settings 3) assess the perceived
usefulness and barriers to the mHealth mobile-clinical decision support system (mCDSS)
approach with respect to CKD in limited resource settings. Qualitative in-depth interviews were
conducted with 13 stakeholders comprised of health workers, government officials, and
patients with CKD and diabetes to accomplish these objectives. Thematic analysis of these
interviews yielded four primary themes.
Results: These themes consisted of 1) shortages of CKD and diabetes health services 2)
low awareness of CKD and diabetes 3) high familiarity with and suggestions for mobile-based
device use 4) supported use of Accredited Social Health Activists (ASHA)s for implementation
and utilization of a mobile-based device to manage CKD and diabetes in rural India. Generally,
stakeholders reported an insufficiency of health care services to combat CKD and diabetes, as
well as reportedly being in favor of a mobile-based device to mitigate this shortage.
Stakeholders also underscored the high plausibility of Accredited Social Health Activists
(ASHA)s successfully implementing and utilizing the device for CKD and diabetes services.
Conclusions: This analysis will inform creation and implementation of this device in
order to increase CKD and diabetes health care in rural settings in India. Specifically,
components of this device may be created to address opinions reported by stakeholders. For
example, an awareness component can be designed for this device to address the reported low
awareness for CKD and diabetes. Additionally, a referral system may be incorporated from
ASHA to physician to mitigate the high portion of CKD and diabetic patients undiagnosed.
Incorporating these components into this device may effectively address the input of
stakeholders and work towards increasing CKD and diabetes health care in rural India.
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.
Rights for Collection: Masters Theses
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info