Pilot Testing and Implementation of a mHealth tool for Non-communicable Diseases in a Humanitarian Setting

INTRODUCTION. Given the protracted nature of the crisis in Syria, national and international assistance agencies face immense challenges in providing for the needs of refugees and the host Lebanese due to the high burden of noncommunicable diseases (NCDs) among both populations. These are complex conditions to manage, and the resources for refugee care limited, having dramatic implications for Lebanon’s health system. METHODS. A longitudinal cohort study was implemented from January 2015 through August 2016 to evaluate the effectiveness of treatment guidelines and an mHealth application on quality of care and health outcomes for patients in primary health care facilities in Lebanon serving Syrian refugees and host communities. RESULTS. Overall, reporting in clinic medical records remained low, however, during the mHealth phase recording of BMI and blood pressure were significantly greater in the mHealth application as compared to clinic medical records. Patient exit interviews reported a much more frequent measurement of weight, height, blood pressure, and blood glucose, suggesting these may be assessed more often than they are recorded. Satisfaction with the clinic visit improved significantly during implementation of the mHealth application as compared to both baseline and guidelines implementation in all measures. Despite positive changes, provider uptake of the application was low; patients indicated that the mHealth application was used in a minority (21.7%) of consultations. Provider perspectives on how the application changed patient interactions were mixed. DISCUSSION. Similar to previous evidence, this study further demonstrates the need to incorporate new interventions with existing practices and reporting requirements to minimize duplication of efforts and, consequently, strengthen provider usage. Additional research is needed to identify organizational and provider-side factors associated with uptake of similar applications, particularly in complex settings, to optimize the benefit of such tools.