The COVID-19 pandemic has put enormous pressure on the health services to find ways to provide ongoing care for patients with chronic conditions, such as diabetes. The Faculty of Medicine and Health Sciences (FMHS) at Stellenbosch University (SU) recently launched a pilot project called GREAT4Diabetes that hopes to help solve this problem in the Western Cape.
On 8 March 2021 SU's Division of Family Medicine and Primary Care, together with the Metro Health Services, and Aviro, a design-focused health company aiming to improve healthcare experiences, launched a WhatsApp Chat Bot that sends out educational diabetes messaging aimed at helping patients to improve their glycaemic control.
A quarter of South Africans over the age of 45 have diabetes, and in Cape Town the numbers are even higher, according to the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA).
People with diabetes at high risk of Covid-19 complications
People with diabetes, especially if it is poorly controlled, are at high risk of hospitalisation if they test positive with Covid-19 – in fact, approximately 42% of diabetics in the Western Cape who tested positive for COVID-19, were hospitalised and many died, according to the Western Cape Department of Health.
"The effective treatment of chronic diseases during a pandemic is a worldwide problem, and it is an even greater problem in a low-resource setting," says Dr Darcelle Schouw, biokineticist at the Division of Family Medicine and Primary Care. "How does one provide ongoing care for people with chronic conditions for whom it might be dangerous to come to a health facility, and risk infection with COVID-19?"
On a practical level this means that support groups aren't meeting, and that normal services, such as individual patient education and counselling have been interrupted.
The GREAT4Diabetes project is aimed at addressing these gaps, while still maintaining the necessary physical distance to prevent infections. The project involves a WhatsApp Chat Bot, which sends out educational diabetes messaging, aimed at helping patients to improve their levels of glycaemic control in the absence of the usual support structures.
GREAT4Diabetes is being offered to people with diabetes at health centres in Bishop Lavis, Symphony Way, Elsies River and Kraaifontein. Community health workers will also offer the service to people with diabetes when they deliver medication at home.
"This is a solution for a low-resource setting. We know that cellphone coverage is good in poor communities, and that people can afford to pay for small amounts of data. Small audio files use minimal amounts of data and should be a feasible solution to providing support for self-management of diabetes," says Schouw.
WhatsApp messages aimed at improving glycaemic control
The Division of Family Medicine and Primary Care provided the following description of how this process works:
"The intervention consists of 16 three-to-four minute audio messages, which are sometimes supported by a picture. Once a person with diabetes sends the message 'Hi' to the designated WhatsApp number, they are registered for the programme, after they have accepted the standard terms and conditions of AVIRO, and shared key information, such as sex, age and language preference. They will then automatically receive an audio message every day for 16 days. They must reply to a question after each audio message as to whether it was useful (yes or no), in order to continue receiving messages."
The content of the audio messages was derived from the Group Empowerment and Training (GREAT) programme, which was being rolled out nationally prior to the start of the COVID-19 pandemic. The audio messages were recorded in three languages, namely English, Afrikaans and Xhosa.
"The project only went live in March, so it is a bit early for feedback on the success rate of this project, but nevertheless, there are promising signs," says Schouw.
"Numbers are picking up as the community health workers start to inform people about it in the community, particularly when they deliver medication. Only people with urgent medical problems are attending the primary care facilities and there are no routine appointments, so numbers at the facilities are few. We do not have specific numbers as yet as the users vary each day."
Also involved in the GREAT4Diabetes project are family physicians at these health centres, as well as the Comprehensive Health Manager from the Northern Tygerberg Sub-Structure.
If this project is successful, Schouw foresees that this kind of WhatsApp Chat Bot could be expanded for use in helping to treat other chronic diseases, not just in the Western Cape, but across the rest if South Africa. She mentions that the National Department of Health has already expressed interest in the project.
Photo credit: PIXABAY
