July/Aug

Improving Health Outcomes

By Deepanjali Kakati An interdisciplinary team of Baylor University researchers and physicians from Bangalore Baptist Hospital has developed a diabetes mobile health app with culturally tailored resources.

Culturally appropriate health education materials are a key component in helping raise awareness among people. While smartphones and Internet connectivity are widely accessible among health providers in India, most technological educational resources are developed in the West and do not effectively translate to the Indian context. An interdisciplinary team of researchers from Baylor University, Texas, and physicians from Bangalore Baptist Hospital (BBH) was awarded a U.S.-India 21st Century Knowledge

Initiative grant in 2018 to address this issue. The team has developed a diabetes mobile health app to boost awareness and educate people who are most at risk of getting the disease.

Project team leader Shelby Garner is an associate professor at the Baylor University Louise Herrington School of Nursing and a Fulbright-Nehru scholar. She teaches leadership in the university’s graduate program and research in the undergraduate program. Her primary research interest involves building the nursing and health system capacity in India through the adaptation, design and testing of innovative technologies to transform health education and improve patient care.

Excerpts from an interview.

You have worked in India for several years. Please tell us briefly about some of these projects.

It has been a joy to collaborate with my colleagues at Bangalore Baptist Hospital and Baylor University on several projects, including: ‣ A United States Agency for International Development (USAID) American Schools and Hospitals Abroad (ASHA) project to build a Simulation, Education and Research Centre for Nursing Excellence, from 2015 to 2019. ‣ A Fulbright-Nehru program-funded project to study the impact of nursing simulation on teaching and learning outcomes in India, from 2016 to 2018. ‣ A USAID ASHA project to build a women’s and children’s health care and research center at BBH, from 2017 to 2022. ‣ A USAID ASHA project to build a living and learning center with smart classrooms for nurses at BBH, from 2018 to 2023.

‣ A 21st Century Knowledge Initiative project of the United States-India Educational Foundation (USIEF) to build health care simulation and mobile health capacity in India, from 2018 to 2020.

What was the driving idea behind the proposal for the U.S.-India 21st Century Knowledge Initiative grant? How has it been implemented?

When I was in India, working on the Fulbright-Nehru simulation project, I was invited to a symposium on digital health initiatives at BBH. During the symposium, it was discussed that culturally tailored digital resources were desperately needed to educate vulnerable populations in India about non-communicable diseases like hypertension and diabetes, which greatly contribute to mortality. It takes nurses and doctors a lot of time and energy to educate patients, many of whom live in remote areas with limited face-to-face interaction with medical personnel, making digital resources an efficient option.

While India is a digital powerhouse with excellent wireless capability, many of the available health educational resources were developed in the West, where diet and lifestyle are different from India. So, these resources do not

translate well to the Indian context. We decided to submit an application for a 21st Century Knowledge Initiative grant, and propose building some mobile health or virtual reality simulation resources to address this need.

The grant concurrently included training for nurses and physicians in India to travel to the U.S. to receive additional education in simulation and mobile health utilization.

The guiding framework for implementing this project was social innovation collaboration, which requires partnerships and a multidisciplinary approach to address problems that a single stakeholder cannot solve. We brought together researchers from public and private sectors of medicine, nursing, business, information technology, art and computer sciences to design an app focused on diabetes prevention and treatment in India.

Could you please describe how the diabetes mobile app will help Indian users and its current status?

The name of our app is, I Feel Great India. It was designed to be educational, entertaining and engaging while appealing to a wide audience of users in India. It includes four 2- to 3-minute 3D animations to teach the user about diabetes prevention and treatment, including segments on “What is diabetes?,” “What can happen if I have diabetes?,” “How can I prevent and manage diabetes?” and “What do I do now?”

After each section, a touch screen game or question is included to engage the user and help them practice what they have learned. For example, after the “How can I prevent and manage diabetes?� section, a game starts and the user can drag and drop various food items and portion sizes into a plate to help reinforce healthy eating. If the user makes a wrong choice, the app shows the mistake and gives the user another try.

The app is available in Kannada, Hindi and English. All of the text has an audio function, in case the user has low or no literacy. We tested the app among users and found it was significantly effective in improving diabetes health literacy. We are currently finalizing the app and it should be available after October 1, 2020.

Please describe the collaboration with Bangalore Baptist Hospital for the project, how it worked on the ground and some of the key takeaways.

Bangalore Baptist Hospital was instrumental in the planning, implementation and evaluation of this project. The physicians and nurses there have expertise in working with local vulnerable populations and are well versed in the health needs of the people. They helped write the script for the 3D animations and facilitated the on-the-ground research in

Bengaluru. Community Health Department Director Dr. Carolin Elizabeth George facilitated a partnership between our team and the Department of Social Work at Kristu Jayanti College in Bengaluru. Master of Social Work students and faculty helped our team test the app with residents of the Devarjeevanahalli area in Bengaluru over two weeks.

Are you planning any other projects in India?

I recently applied for the Fulbright IIE [Institute of International Education] Centennial Fellowship for the purpose of “Building and sustaining the nursing workforce in India during the COVID-19 crisis.” If funded, this grant will provide valuable resources to keep the nursing program at BBH going via a supplemental online platform, during and after the pandemic, increasing the nursing workforce.

Additionally, I am part of a team that received the Baylor University Dr. Benjamin F. Brown IV Fund for Interdisciplinary and Collaborative Scholarship. This project will focus on starting a specialized pediatric and neonatal palliative care program at BBH. The overarching objective for this project is to develop, implement and evaluate effectiveness of a comprehensive, interprofessional, culturally appropriate, evidence-based palliative care program for children and their families in India. This program will be initiated through the new USAID ASHA-funded women’s and children’s health care and research center at BBH, which will open in 2021.

In what ways do you think collaborations between U.S. and Indian universities can benefit both countries?

I cannot emphasize enough how collaborations between U.S. and Indian universities are mutually beneficial. First, the collaboration has fostered cultural humility in all our team members. Cultural humility includes the process of self-reflection to understand personal and systemic biases, ultimately resulting in mutually respectful relationships and partnerships based on trust. This process helps us understand how we can never be competent in another’s culture, but instead we should take a humble approach as learners when it comes to understanding each other. Second,

these types of collaborations give all members of the team experience in combating issues of global importance, working on projects bigger than ourselves, bigger than our individual universities or even countries.