Impact Of An Interactive Smartphone Application On Glycaemic And Blood Pressure Control Among Diabetes And Hypertension Patients In Ghana: A Quasi-Experimental Study

Abstract

Background: Mobile technology has the potential to improve cardiometabolic disease management in sub-Saharan Africa, but data on its effec tiveness are limited. In this quasi-experimental study, we investigated the impact of an interactive smartphone application (app) on glycated he moglobin (HbA1c) and blood pressure in individuals with type 2 diabetes or hypertension in Ghana. Methods: Individuals with type 2 diabetes or hypertension in Greater Accra public clinics were randomly assigned to an intervention or control group. The intervention group received smartphones with a health app providing alerts, medication reminders, and progress monitoring. The control group received standard care. The study assessed changes in HbA1c, glycaemic control (HbA1c < 48 mmol/mol), blood pressure (BP), and BP control (<140/90 mmHg) over six months. Multivariable linear, Cox, and Poisson regression analyses adjusted for demographics, lifestyle, comorbidities, baseline HBA1c, BP and medications were used to evaluate the outcomes. Clustering effects were accounted for using generalized estimating equations and frailty models. Results: The study included 874 participants (mean age 58 years, 64.6% female). Over the six-month period, the proportion of individuals with optimal glycaemic control increased by 11.5% in the intervention group compared to 3.0% in the control group. In the fully adjusted model, the intervention was significantly associated with improved glycaemic control at the final visit (Relative Risk [RR] = 1.06, 95% CI: 1.01–1.10), though no significant association was observed for quarterly glycaemic control (Hazard Ratio [HR] = 0.93, 95% CI: 0.78–1.12). For BP control, the intervention group improved by 15.2%, compared to 9.8% in the control group. In the fully adjusted model, the intervention was significantly associated with improved BP control at the final visit (RR = 1.19, 95% CI: 1.03–1.36) and for quarterly BP control (HR = 1.46, 95% CI: 1.17–1.83). Conclusion: This study demonstrates that interactive smartphone application is associated with improvement in BP and glycaemic control among Ghanaian patients and highlight the potential of digital health solutions in chronic disease management. Future research should identify strategies to optimize the integration of interactive smartphone applications into standard care in Ghana.