The World Health Organization (WHO) describes non-communicable diseases (NCDs) as chronic ailments of the long term as a consequence of an interplay of genetic, behavioral, physiological, and environmental factors.
India faces a huge burden of NCDs as it has undergone demographic and epidemiological shifts, leading to a transition from infectious diseases to NCDs. Consumption of tobacco and alcohol, sedentary lifestyle, overweight and obesity, increased intake of fat and sodium intake, and low intake of fruits and vegetables, are the various behavioral and biological risk factors of NCDs. Other factors such as individuals’ job profile and the workplace environment play a role in the development of NCDs. The WHO acknowledges the capability of digital health interventions for ensuring high-quality care to people. Information and Communication Technologies (ICTs) have the potential to offer affordable and high-quality services.
To address this rising burden of chronic NCDs, I discuss here one of our innovative digital health interventions, Swasthya Pahal (Health for All) (SP) launched in April 2012. Swasthya Pahal (Health for all) is an innovative community-based program, facilitated through an interactive, multi-lingual, standalone, and internet-enabled touch screen computer-based program that aims to enhance self-management of NCDs including diabetes, hypertension, and obesity among individuals living across diverse community settings.
This community program facilitates the collection of individual subjective and objective data using the Population Health Informatics (PopHI) framework called SMAART (Sustainable Multisector Accessible Affordable Reimbursable Tailored). Data gathered includes subjective data and objective data.
Subjective data comprised responses to a sequence of multiple-choice questions, including (I) location of residence, (II) socio-demographic variables such as age (years), gender, the highest level of education attained (III) health behavior variables such as smoking, alcohol consumption, and physical activity patterns, (IV) clinical status assessments such as ever been told by a doctor about high blood sugar and high blood pressure and if currently being treated for their health conditions. Information related to Knowledge, Attitude, and Practices (KAP) about diabetes and hypertension self-management was also gathered. Objective data was collected using multiple physiological sensors which captured participants’ height, weight, blood sugar, and blood pressure levels. Algorithms (“if and then” rules applied to problem-solving) were applied to the garnered data to generate an electronic evidence-based report called a SMAART health card.
The program has been successfully implemented in diverse community settings including urban, urban slum, rural and geographically inaccessible settings such as hilly regions. The program has so far been covered in eight states of India over 400 health camps and screened more than 10,000 individuals across diverse geographic settings. In February 2016, we launched Swasthya Pahal initiative as a pilot program to address burden of chronic NCDs among police personnel of Delhi. Since then, more than 142 SP events have been conducted screening more than 5000 police personnel and providing them lifestyle intervention to support their good health and well-being. Nearly 75% of the Delhi police stations have been covered so far under this initiative. In 2018, the platform won the Digital Commonwealth Award. In 2020, we expanded the program to police personnel in the state of Uttarakhand.
Swasthya program implemented using the SMAART informatics framework can be utilized to screen obesity, diabetes, and hypertension for improved disease prevention, monitoring, and self-management of NCDs in a geographically inaccessible, underserved, under resourced environments in a cost-effective manner.
The next article will cover the cost of the Swasthya Pahal program implementation and program delivery. Contact Ashish Joshi for more information on Swasthya Pahal digital intervention.
