Health messaging with Viber application on risk factors of non-communicable diseases among the rural population: community-based quasi-experimental study

Swe Mar Myint Lwin, Khaing Lay Mon, Aung Soe Htet


Background: Mobile health and mobile phone technology have become increasingly noticed as favorable communication channels for the prevention of non-communicable diseases (NCDs) by reducing the unhealthy behaviors of NCDs. The study was carried out to assess the effect of the health messaging with the Viber application on modifiable risk factors of NCDs.

Methods: A community-based quasi-experimental study was conducted among a total of 240 community members who were 30 to 60 years old selected from two villages in Twantay township with a one year intervention. Face-to-face interviews with all participants using the WHO STEP survey questionnaire and measurements of behavioral and metabolic risk factors of NCDs were carried out at baseline and after 12 months follow up. Changes in behavior and metabolic risk factors between the intervention and control group were analyzed using mixed-effects random-intercept linear regression modeling with propensity score adjustment. Because of the small sample in smoking, smokeless tobacco and alcohol users, the Wilcoxon rank-sum (Mann-Whitney) test was used to compare the changes between the two groups.

Results: The amount of smoking and smokeless tobacco use among current users in the intervention group was reduced after the intervention (p<0.05). Of metabolic risk factors, participants in the intervention group had a significant net reduction in fasting blood sugar with a mean change relative to controls of -18.7 mg/dl 95% CI (-32.83, -4.56, p=0.010). No significant mean reduction was seen in other behavioral or metabolic risk factors.

Conclusions: The study results showed that intervention affected a reduction in some behavioral and metabolic risk factors of NCDs.


Health messaging, Viber application, Risk factors of NCDs

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Islam SMS, Purnat TD, Phuong NTA, Mwingira U, Schacht K, Fröschl G. Non-communicable diseases (NCDs) in developing countries: a symposium report. Global Health. 2014;10:81.

Robinson HM, Hort K. Non-communicable diseases and health systems reform in low and-middle-income countries. Pac Health Dialog. 2012;18(1):179-90.

Kassa M, Grace J. The global burden and perspectives on non-communicable diseases (ncds) and the prevention, data availability and systems approach of NCDs in low-resource countries. Pub Health Develop Count Challeng Opport. 2019.

Htet AS, Bjertness MB, Sherpa LY, Kjøllesdal MK, Oo WM, Meyer HE. The prevalence of selected risk factor for non-communicable diseases among 25-74 year old urban citizens of Yangon Region, Myanmar. BMC Public Health. 2016;16(1):1225.

Park VS, Molesworth K, Karimova G, Matthys B, Obris B. Health Promotion and Health Literacy: Toward transformative action for non-communicable diseases. Medicus Mundi Schweiz. 2018.

Shrestha A, Singh SB, Khanal VK, Bhattarai S, Maskey R, Pokharel PK. Health Literacy and Knowledge of Chronic Diseases in Nepal. Health Liter Res Pract. 2018;2(4):221-30.

Oo WM, Khaing W, Mya KS, Moh MM. Health literacy-is it useful in prevention of behavioral risk factors of NCDs? Int J R Med Sci. 2015;3(9):2331-6.

Ministry of Health. Fact sheet: Report on national survey of diabetes mellitus and risk factors for non-communicable diseases in Myanmar, 2014. Available at: surveillance/steps/Myanmar_2014_STEPS_Report.pdf. Accessed on 14 May 2021.

Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev. 2010;32(1):56-69.

Müller AM, Alley S, Schoeppe S, Vandelanotte C. The effectiveness of e- and mHealth interventions to promote physical activity and healthy diets in developing countries: A systematic review. International J Behav Nutr Phys Activ. 2016;13(1):109.

Gary LK. The relevance of health literacy to mHealth. IOS Press. 2017;37(2):123-30.

Amdie FZ, Woo K. The use of mHealth technology for chronic disease management: the challenges and opportunities for practical application. Wounds Int. 2020;11(2).

Sharma M, Banerjee B, Ingle GK, Garg S. Effect of mHealth on modifying behavioural risk-factors of non-communicable diseases in an adult, rural population in Delhi, India. Mhealth. 2017;3:42.

Data Reportal. Fact sheet: Digital 2020: Myanmar, 2020. Available at: reports/digital-2020-myanmar. Accessed on 14 May 2021.

WHO. Fact sheet: WHO STEP surveillane manual, 2017. Available at: surveillance/steps/STEPS_Manual.pdf. Accessed on 14 May 2021.

Kruse C, Betancourt J, Ortiz S, Luna SMV, Bamrah IK, Segovia N. Barriers to the use of mobile health in improving health outcomes in developing countries: systematic review. J Med Internet Res. 2019;21(10):13263.

Kyaw OO. Effectiveness of e-Health promotion programme for major non-communicable diseases among sailors of Ayeyarwady Naval Regional Command, Myanmar Navy in 2017. Def Serv Med Acad. 2018.

Saleh S, Farah A, Dimassi H, ElArnaout N, Constantin J, Osman M, et al. Using mobile health to enhance outcomes of noncommunicable diseases care in rural settings and refugee camps: Randomized controlled trial. JMIR Mhealth Uhealth. 2018;6(7):137.

Rubinstein A, Miranda JJ, Beratarrechea A, Diez-Canseco F, Kanter R, Gutierrez L, et al. Effectiveness of an mHealth intervention to improve the cardiometabolic profile of people with prehypertension in low-resource urban settings in Latin America: a randomised controlled trial. Lancet Diabetes Endocrinol. 2016;4(1):52-63.

Ramachandran A, Snehalatha C, Ram J, Selvam S, Simon M, Nanditha A, et al. Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2013;1(3):191-8.

Pfammatter A, Spring B, Saligram N, Davé R, Gowda A, Blais L, et al. mHealth intervention to improve diabetes risk behaviors in India: a prospective, parallel group cohort study. J Med Internet Res. 2016;18(8):207.

Golshahi J, Ahmadzadeh H, Sadeghi M, Mohammadifd N, Pourmoghaddas A. Effect of self‑care education on lifestyle modification, medication adherence and blood pressure in hypertensive adults: randomized controlled clinical trial. Adv Biomed Res. 2015;4:204.