Abstract:
BACKGROUND : Developing countries are experiencing a shift from infectious diseases such as HIV and tuberculosis to
noncommunicable diseases (NCDs) such as diabetes. Diabetes accounts for more disability-adjusted life years than any other
NCD in South Africa, and research has identified a number of preventable risk factors; however, there is not enough evidence
from lower resource settings as to how best to disseminate this information to the population. Today, 90% of the world’s population
lives in mobile phone coverage areas, and this provides a unique opportunity to reach large populations with health information.
OBJECTIVE : This study aimed to investigate how potential mobile health (mHealth) platforms should be paired with diabetes
risk factor education so that at-risk communities are empowered with information to prevent and manage diabetes.
METHODS : A Likert-style survey was distributed to commuters in the City of Johannesburg in July 2018 that explored participants’
background characteristics as well as their knowledge and awareness surrounding diabetic risk factors (such as exercise, smoking,
and hypertension) and their comfort level with various information delivery methods (such as WhatsApp, short message service,
and email). The grouped variables from diabetic risk factors and information delivery methods were described with mean Likert
scores and then investigated for relationships with Spearman Rho correlation coefficients.
RESULTS : Background characteristics revealed that the self-reported prevalence of diabetes was twice as high in this studied
commuter population than the national average. WhatsApp was the most favorable mHealth information delivery method and
had a moderate correlation coefficient with diet and nutrition (0.338; P<.001) as well as a weaker correlation with physical activity
(0.243; P<.001). Although not as robust as the WhatsApp correlations, each of the other information delivery methods also
showed weaker, yet statistically significant, relationships with one or more of the risk factors.
CONCLUSIONS : The elevated self-reported diabetes prevalence reinforces the need for diabetes risk factor education in the studied
commuter population of Johannesburg. The most feasible mHealth intervention for diabetic risk factor education should focus
on WhatsApp messaging while also offering content across other mHealth and traditional platforms to remove barriers to access
and enhance the user experience. The content should emphasize diet and nutrition as well as physical activity while also
incorporating information on secondary risk factors.
