Preliminary effectiveness and feasibility of ASHA-led mobile health intervention for diabetes care in Indian primary health care settings

Abstract

Abstract Diabetes management in resource-limited settings faces challenges in screening, guideline-based treatment, and healthcare access. The IMPACT Diabetes study evaluated a community-based, technology-enabled task-shifting intervention for diabetes care in India. A cluster randomized controlled trial was conducted in 16 villages/peri-urban areas across 8 primary health centers (PHCs) in two states in India. Accredited Social Health Activists (ASHAs) screened 1,785 community participants, identifying 418 individuals with diabetes. The intervention group received nine months of CDSS-supported care delivered by ASHAs under physician supervision, while the control group received usual care. The primary outcome was the proportion of participants achieving ≥ 0·5% reduction in glycated haemoglobin (HbA1c) from baseline. Secondary outcomes included healthcare utilization and medication adherence. A significantly higher proportion of intervention participants achieved HbA1c reduction ≥ 0·5% compared to the control group (21.8% vs. 10.3%, p < 0.05). Intervention participants had more frequent physician visits (85·0% vs. 29·8%), higher glucose-lowering medication adherence (63·0% vs. 43·1%, p < 0·05), and better engagement with diabetes management practices. Qualitative findings demonstrated that the intervention was acceptable and feasible for patients, ASHAs, and physicians, empowering ASHAs in chronic disease care. This study demonstrates that task-shifting and digital health tools can improve diabetes outcomes in low-resource settings. Future research should explore long-term sustainability and cost-effectiveness.