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.