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How ICF Uses Technology to Improve Health in the Border Region
Written by Sarah Beauchemin
San Diego is a central part of the unique Southern California – Baja California mega-region: one large community with shared ecosystems, natural resources, and the desire to improve quality of life for residents on the U.S. – Mexico border.
That is why The International Community Foundation (ICF) – an international nonprofit organization that seeks to inspire international charitable giving by U.S. donors, with an emphasis on Northwest Mexico – launched an innovative mobile app-based project called Dulce Wireless Tijuana (DWT).
DWT aims to drastically reduce the number of people – currently 1.5 million – who suffer from Type 2 diabetes in the Tijuana border region. Users install the free app on their smartphone to get a wealth of information on how to manage diabetes, connect with local community health workers (“promotoras”) and nurses, and attend classes.
“DWT is a prime example of the type of interventions that ICF supports to improve health in the border region and elsewhere in Mexico,” said Alana Ortez, ICF’s Senior Health Program Officer. “At the start of this program, we identified the health need – high rates of uncontrolled diabetes in Tijuana – and sought out key multi-sector partners to work together on a solution.”
Donate to ICF’s Border Health Fund to support critical public health interventions like DWT in the border region.
Some of these partners include Qualcomm® Wireless Reach™, the Mexican nonprofit Fronteras Unidas Pro Salud, and Scripps Whittier Diabetes Institute. These thought leaders pooled their knowledge and resources to address this critical public health issue, and DWT began as a clinical research study at Tijuana’s Mexican Institute of Social Security (IMSS) Family Health Clinic #27 in collaboration with the School of Medicine and Psychology of the Autonomous University of Baja California (UABC).
How DWT’s Comprehensive Program Enhances Lives
After five years of dedicated research, clinical study, and technological development from all the project’s partners, a full-scale implementation of DWT is now taking place at Fronteras Unidas Pro Salud’s nonprofit clinic in Tijuana.
DWT has three main components – clinical, educational, and technological. When a new patient enrolls in the program, clinic staff create a patient profile in the DWT electronic record system. Patients then schedule their first clinical visit with a family physician and enroll in diabetes management classes taught by community health workers.
From there, DWT’s exciting technological feature comes into play – the patient can download the free DWT mobile app, which gives them full access to critical resources to get their diabetes under control. The app also connects DWT patients to the program’s physicians, nurses, and promotoras, who offer ongoing personalized support and medical consults. In other words, the app serves as an interactive and on-the-go “hub” for the patients’ clinical records, educational materials, and communication with healthcare providers.
“Thanks to the technology and the people behind it, I felt there were people that were truly interested in my health,” said one DWT patient.
Other DWT patients agree, saying that the DWT mobile app both educated them and held them accountable for their health. “In my experience, the DWT app forced me to truly take care of myself and to know how to take care of myself,” said another patient.
This successfully tackles issues of both equity and access, giving those that struggle with diabetes in marginalized communities an easy, free way to manage and learn about their illness.
“The main users of the mobile app are the patients and the promotoras,” said Oscar Olivares, lead technical consultant on DWT, who worked closely with the project’s software developers. “Once the patients set up their profile, they have access to videos, handouts, and other resources. The system sends push notifications to the mobile app with reminders of appointments, classes, laboratory studies, and also motivational messages.”
The patients also participate in interactive surveys that allow the medical staff to follow up on the patient’s adherence to the project – meaning they get an accurate picture of the patient’s level of exercise, medications, and how informed they are about vital aspects of their diabetes management, like glucose readings and carbohydrates intake.
“In this way, the app itself becomes a strong ally for the concepts taught during the classes that all the patients attend,” said Olivares. “The videos reinforce the key topics covered during training sessions. The patients are even able to send their glucose readings from their glucose meter to the mobile app, and the data is stored there with the rest of the information in their electronic health record.”
An International Model for Health Management
But DWT is more than just a diabetes management system for those who suffer from the illness. The toolkit, being launched online in early 2018, will provide open-source, cutting-edge technology to any health professional or clinic worldwide who is interested in formulating a comprehensive approach to helping an adult patient with Type 2 diabetes.
“Its purpose is to be a dynamic guide for replicating the successful best practices used in the DWT study,” said Dr. Adriana Vargas, UABC researcher and co-author of the DWT study. “It can help health professionals, health educators, dieticians, health administrators, and government agencies who wish to implement a strategy to effectively combat the epidemic of Type 2 diabetes, using a model with proven clinical results.”
Vargas says that the positive outcomes of the DWT project, published in full detail online, are extremely promising. For example, in the study DWT patients achieved a significant reduction in glycosylated hemoglobin, or blood sugar level, by 3%; while publications on other similar interventions have only reported a decrease of 1%, and a maximum of 2%.
Equally as important, patients participating in the program improved their quality of life by effectively changing their thought processes and lifestyles – factors that are integral for lifelong management of diabetes.
“Above all, having created DWT by sharing the bi-national experience of working harmoniously with private, governmental, and educational organizations to achieve a common goal was very gratifying,” said Vargas.
Ortez agrees that a united bi-national approach plays a large role in the success of border health studies like DWT, and believes it is why DWT stands out among similar programs that have been implemented worldwide.
“ICF embraces the philosophy ‘don’t do anything about me, without me,’” she said. “We take this to heart as we design health interventions in the border region, and as we work with our partners, making sure that we are not making decisions for others, but are consulting and including everyone as we go through the process.”
Thanks to the cohesive efforts of ICF and its many committed DWT partners, there is now an innovative, viable option to support patients with diabetes to control their disease and live healthier, happier lives.