Emphasizing Better Self-Care And Patient Adherence With Cell Phone Videos

Author(s): 
Kshitij Shankhdhar, MBBS, Dip Diab, FICN

Fifty million people in India have diabetes.1 This is nearly double the estimated 26 million in the United States who have the disease.2 Although 8 percent of the global diabetes population live in the U.S., America’s diabetes care spending totals more than 50 percent of total world expenditures on the disease.3 In contrast, only 10 percent of the 1.3 billion people in India have healthcare insurance.4

   Podiatric medicine is one of the most neglected aspects of diabetes care in India. The United States has 10 schools of podiatric medicine and reportedly over 13,000 podiatrists. The Indian subcontinent does not have a single practicing podiatrist with a foot and ankle qualification.

   Every 30 seconds, a patient somewhere in the world undergoes an amputation due to diabetes yet 85 percent of diabetic foot amputations are preventable.5 Education plays an important role in amputation prevention. Diabetes self-management education is associated with improved diabetes knowledge and self-care behavior, as well as improved clinical outcomes such as lower HbA1c, lower self-reported weight, improved quality of life and lower costs.

   Rendering effective diabetes education to all becomes quite challenging. Different people with diabetes require different types of education. Someone with neuropathic symptoms in feet should receive special education regarding diabetic foot care while someone with gestational diabetes needs different education. Conventional education methods like group lectures and printed literature distribution are often boring and less effective.

   The result is that we have a significant number of people with diabetes who have myths and misconceptions about diabetes, and related issues like diet, exercise, insulin, etc. An ideal method for diabetes education should be simple, economical, effective and require no special training.

Enhancing Connections Between Doctors And Patients

Keeping these principles in mind, our team at the L.K. Diabetes Centre in Lucknow, India, discovered a solution in 2001. We call it the Samadhan System of Diabetes Education (SSDE). The word “samadhan” means “solution” in Hindi. With this system, we use mobi-films (videos made with mobile phones) for diabetes education. We have mobi-films focused on doctor to doctor communication, doctor to patient communication, patient to doctor communication and patient to patient communication.

   The mobi-films from doctors to doctors focus on clinical diabetes care and demonstrate foot examination and procedures such as debridement of foot lesions, etc. The mobi-films from doctors to patients focus on transferring knowledge and skill to patients regarding self care, such as foot care or self insulin administration.

   The mobi-films from patients to doctors are simple video clips recorded by patients at home. In these clips, patients try to record their day-to-day diabetes-related activities like the exercise they do at home, their diet, how they dress their lesions at home or how they administer insulin to themselves. The video can also include any other activity recorded by them either on their own or on request by the treating medical professionals (diabetologist, medical nutrition therapist, diabetes educator, etc). When the patients visit the diabetes center, they show these video clips to the medical professionals, who in turn point out mistakes and suggest corrections.

   The fourth group of mobi-films from patients to patients has inspirational messages or lessons from one patient to the other. One mobi-film may feature a kid with type 1 diabetes explaining that doing insulin administration yourself is not as scary as it appears on first instance. Another video could show a person who lost his foot explaining how he neglected his foot lesions since they were painless and how smoking added fuel to fire. Another video could be how an obese person lost significant weight because he diligently followed recommended diet and exercise prescriptions.

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nice job

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