ABSTRACT
BACKGROUND: Type 2 diabetes mellitus (T2DM) is one of the leading noncommunicable diseases that require diabetes self-management (DSM) practices. This study proposes to develop a customized mobile health (mHealth) app integrated with a hospital information system (HIS) to enable real-time, two-way transfer of information between the patient and physician. The captured information in the electronic health record will facilitate physicians to have a chronological account of the patient's diabetes history and enable tweaking of the treatment. OBJECTIVE: The objectives of the study are (1) to develop the HIS-integrated Electronic Diabetes Diary (EDDy) per the end-user expectations at a tertiary care hospital in a south Indian state with a high prevalence of T2DM and (2) to evaluate and test adherence to EDDy in the management of T2DM. METHODS: The study will be carried out in 3 phases. Phase 1 involved in-depth interviews with primary end users to gather information regarding their expectations from the hospital-based EDDy. Phase 2 will use this information to develop a customized mHealth app using an iterative model of software development. Phase 3 will involve a pre- and posttest design; the developed app will be tested among consenting patients, where physicians will receive the patients' data through the HIS-integrated mHealth app. The pre- and posttest values will be analyzed for adherence leading to improvement in patients' self-management of blood glucose, user experience, glycemic control, and clinical utility. RESULTS: Phase 1 was completed on November 28, 2023. Phase 2 commenced in December 2023 and will end in May 2025. Phase 3 will follow afterward. CONCLUSIONS: The proposed app will include a convenient and simple alert system that enables the patient to test glucose values at self-selected intervals, provide grading options to enter diabetic-related complications, enhance patients' knowledge of tracking and managing the complications of diabetes, and help in maintaining the visual representation of glucose values and complications. The simplicity and usability of the modules are its novelty, which may motivate the patients to keep track of their glucose values and help them attain better health outcomes. TRIAL REGISTRATION: Clinical Trial Registry India CTRI/2023/03/051077; http://tinyurl.com/4tau4ndb. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/50732.
ABSTRACT
BACKGROUND: Child marriage is a breach of the basic fundamental rights of a child and is a major concern for policy makers in many countries. OBJECTIVE: The present study intended to identify the direct and indirect socio-demographic factors associated with child marriage among 15-17 years old girls in India. PARTICIPANTS AND SETTING: The study used National Family Health Survey-4 data. The sample comprised of 1459 married girls and an equal number of unmarried girls aged 15-17 years at the time of the survey. METHODS: Multivariable logistic regression was performed to identify the factors associated with child marriage. A hypothetical path model was constructed and tested. The path models were refitted after removing the insignificant path coefficients, and finally, the significance of direct as well as indirect effects were obtained. RESULTS: Path analysis revealed that mother's education was the only factor that had both significant direct and indirect effects on child marriage (p < 0.001). Religion had only significant indirect effect (p = 0.047) through girls' education. Besides mother's education, the factors that showed significant direct effects on child marriage were wealth index (p = 0.012), caste (p = 0.009) and education of the girl (p = 0.009). CONCLUSIONS: Education of both mothers and the girls, wealth index and caste had significant direct effects on child marriage whereas significant indirect effect was exerted by mothers' education and religion. Therefore, these factors should be given primary focus while formulating strategies to curb child marriage in countries like India.
