Collaborative management of Type 2 Diabetes Mellitus in informal settings in Port-Harcourt, Nigeria using technology

Introduction

Type 2 Diabetes Mellitus (T2DM) is one of the most prevalent diseases in Nigeria, and like other chronic diseases would require long-term care in informal contexts. The need for collaborative healthcare in chronic diseases like T2DM has been established by several researchers as it offers a plethora of benefits. However, the importance of technology in facilitating this process cannot be overemphasized. A lot of tech options have been explored such as the creation of mobile apps or the utilization of AI, however, there are still limited options available that consider the lived experiences of persons in non-Western contexts. The gaps observed in literature and available interventions, have contributed to the objectives of this study, which is centred on understanding the relationship between community pharmacists, persons living with T2DM and caregivers, within the Nigerian context and how this relationship could contribute to tech co-creation and tech-adoption for the improvement of health outcomes.

Objectives

PHASE 1: The objectives of this phase are to investigate the role of community pharmacists in promoting self-care using technology, to explore the types of technologies available and how they are being used. Other objectives include understanding collaborative care using technology within this context and identifying tech needs for this demographic.

PHASE 2: The objective of this phase is to focus on the co-design/creation of a prototype or relevant artefact.

PHASE 3: This phase would be focused on evaluating the artefact in the wild.

PLAN FOR PHASE 1

The purpose of this phase is to achieve the major objectives of the study using qualitative and quantitative research methods.

Data collection

Data collection would be conducted in two stages at the city of Port-Harcourt, Rivers State in Nigeria. The questions for the interviews and questionnaires would be designed to achieve the research objectives. In the first stage, interviews would be conducted via WhatsApp, with the intention of collecting different forms of data. The aim is to identify scenarios in which they either used some sort of technology or they wish they had some sort of technology. Interviews would also be conducted with several participants who may want to communicate physically, or via telephone calls or online calls. The second stage involves the dissemination of questionnaires which would have been prescreened and validated. The questionnaires would be distributed to as many persons living with T2DM, but with the aim of getting at least 59 responses which is the baseline sample size. The target group would be assessed in informal locations, and all ethical guidelines would be considered before the administration of the questionnaires.

Data analysis

The qualitative data from the first stage would be analyzed using reflexive thematic analytical methods, while quantitative data would be analyzed using descriptive statistics and cluster analysis. The results would be used to create a report and a journey map, through which an artefact can be designed.

Expected contributions

There are multiple possible contributions from this phase of the study and they could generate viable research papers which could include:

1. An assessment of WhatsApp as a tool for data collection in qualitative research (Possible methodological contribution)

2. An understanding of the use of WhatsApp in the collaborative healthcare management of T2DM in informal settings

3. Characterization of how tech is adopted by relevant stakeholders in the low resource setting of Port-Harcourt, Nigeria

PHASE 2

The themes from the first phase would serve as guidelines for the co-creation of an artefact, and/or the creation of frameworks or regulatory documents.

PHASE 3

The last phase would involve the deployment of the tech tool and evaluation of its performance in the wild.

Impact on Health and Care
The CDT primarily addresses the most pressing needs of nations such as the UK - namely the growth of expenditure on long term health conditions. These conditions (e.g. diabetes, depression, arthritis) cost the NHS over £70Bn a year (~70% of its budget). As our populations continue to age these illnesses threaten the nation's health and its finances.

Digital technologies transforming our world - from transport to relationships, from entertainment to finance - and there is consensus that digital solutions will have a huge role to play in health and care. Through the CDT's emphasis on multidisciplinarity, teamwork, design and responsible innovation, it will produce future leaders positioned to seize that opportunity.

Impact on the Economy
The UK has Europe's 2nd largest medical technology industry and a hugely strong track record in health, technology and societal research. It is very well-placed to develop digital health and care solutions that meet the needs of society through the creation of new businesses.

Achieving economic impact is more than a matter of technology. The CDT has therefore been designed to ensure that its graduates are team players with deep understanding of health and social care systems, good design and the social context within which a new technology is introduced.

Many multinationals have been keen to engage the CDT (e.g. Microsoft, AstraZeneca, Lilly, Biogen, Arm, Huawei ) and part of the Director's role will be to position the UK as a destination for inwards investment in Digital Health. CDT partners collectively employ nearly 1,000,000 people worldwide and are easily in a position to create thousands of jobs in the UK.

The connection to CDT research will strongly benefit UK enterprises such as System C and Babylon, along with smaller companies such as Ayuda Heuristics and Evolyst.

Impact on the Public
When new technologies are proposed to collect and analyse highly personal health data, and are potentially involved in life or death decisions, it is vital that the public are given a voice. The team's experience is that listening to the public makes research better, however involving a full spectrum of the community in research also has benefits to those communities; it can be empowering, it can support the personal development of individuals within communities who may have little awareness of higher education and it can catalyse community groups to come together around key health and care issues.

Policy Makers
From the team's conversations with the senior leadership of the NHS, local leaders of health and social care transformation (see letters from NHS and Bristol City Council) and national reports, it is very apparent that digital solutions are seen as vital to the delivery of health and care. The research of the CDT can inform policy makers about the likely impact of new technology on future services.

Partner organisation Care & Repair will disseminate research findings around independent living and have a track record of translating academic research into changes in practice and policy.

Carers UK represent the role of informal carers, such as family members, in health and social care. They have a strong voice in policy development in the UK and are well-placed to disseminate the CDTs research to policy makers.

STEM Education
It has been shown that outreach for school age children around STEM topics can improve engagement in STEM topics at school. However female entry into STEM at University level remains dramatically lower than males; the reverse being true for health and life sciences. The CDT outreach leverages this fact to focus STEM outreach activities on digital health and care, which can encourage young women into computer science and impact on the next generation of women in higher education.

For academic impact see "Academic Beneficiaries" section.