This document summarizes an mHealth initiative in India called mDiabetes that aims to prevent diabetes through lifestyle changes promoted via mobile phones. It provides an overview of the program development, message refinement process involving consumer insights, planned effectiveness testing of the program reaching 1 million consumers, and future evaluation and expansion goals. The program leverages the Nokia Life mobile platform and partnerships to deliver culturally relevant diabetes prevention content to consumers in 12 Indian languages. Initial consumer insights from pre-testing and a first rollout indicate high message recall and perceived usefulness among recipients.

1. Changing the Course of Chronic Disease,
One Community at a Time
mDiabetes: Leveraging Mobile Technology
for Diabetes Prevention in India
Nalini Saligram, Ph.D.
19 April 2012
Geneva Health Forum PL03 Innovation & Inclusion:
Opportunities & Challenges for Chronic Diseases
Arogya World is a U.S. based non-profit 501 © 3 organization. The name of the organization is simply an articulation of
our mission: Arogya in Sanskrit means good health. More literally it means to live a life without disease.

2. Non-Communicable Diseases (NCDs):
An Urgent Issue
 UN High Level Meeting on NCDs* Sep 19/20 2011
• NCDs: one of the leading health and development challenges of the century
• Political Declaration: “whole of government” and “whole of society” approach
 Nearly 2 out of every 3 deaths in the world due to NCDs
• 80% of NCD deaths occur in low- and middle-income countries
• But, only 3% of overall global development assistance for NCDs.
 Cost of inaction > cost of action
• Economic Burden of NCDs: World Economic Forum/ Harvard** : NCDs (+ mental health) have
cumulative loss of economic output = $ 47 trillion.
• Action: WHO Best Buys*** cost $11 billion per year in LMICs , roughly 1$ per person per year
 Prevalence of NCDs alarmingly high
• >20% of population in India**** has at least one chronic disease; >10% more than one
* NCDs = Cardiovascular diseases, diabetes, cancers + chronic respiratory disease
**WEF/Harvard Global Economic Burden of NCDs Sep 2011;
***WEF / WHO Report – From Burden to Best Buys 2011
****The Lancet series January 12, 2011 © 2010 Arogya World. All Rights Reserved. 2

3. Prevention: The Holy Grail for Tackling NCDs
 WHO: a healthy diet, exercise and avoiding tobacco can prevent
• 80% of premature heart disease
• 80% type II diabetes
• 40% of cancers
Compelling Clinical Proof Exists that Diabetes Can Be Prevented
 Landmark Trial - Diabetes Prevention Program (DPP)
• 3234 high-risk adults in the US. 30 min physical activity/ day + low-fat diet reduced
chance of getting diabetes by 58%, ( metformin: 31%) NEJM Feb 7, 2002.
• The Lancet (2009) …diabetes prevention through lifestyle changes sustained 10 years.
 Finnish Diabetes Prevention Study
 NEJM May 3, 2001.
 Indian Diabetes Prevention Programme
 Diabetologia. 2006 Feb;49(2):289-97.
© 2010 Arogya World. All Rights Reserved. 3

4. The Arogya World Approach to the NCD Crisis
Two-fold mission
Galvanize global action to address Implement Diabetes Prevention
non-communicable diseases (NCDs) through Lifestyle Changes in India
► Leverage UN NCD Summit Sep 2011
► Op-ed, blog and social media campaign ► Multipronged Approach in
► Case studies schools, workplaces and the community
► Women and NCDs ► mDiabetes: leverage mhealth and
► Women for a Healthy Future Petition partnerships. Culturally relevant.
► 10,000 Women “Perspectives on NCDs” ► Science based work
Global Survey ► Measure effectiveness and impact
© 2010 Arogya World. All Rights Reserved. 4

5. mHealth (Nokia Life):Scalable Development Platform
Encourage Micro
Entrepreneurship MDG 8: Global Partnership for
Life Skills and Development
Financial Literacy
Hygiene, sanitation,
Functional tobacco control and
English Skills fitness
MDG 2: Universal Prevent Non-
Primary Education Communicable
Diseases
MDG 3: Gender MDG 6: Combat
Equality and Women’s HIV, Malaria and
Empowerment other diseases
MDG 4: Reduce MDG 5: Improve
Child Mortality Maternal Health
The Promise of mHealth: Increasing Access to Healthcare.
5.9 billion people (87% global population) have access to mobile phones.

6. The Case for mDiabetes in India
Prevention Arogya World
Program mDiabetes
Nokia Life broad reach in rural,
Accessible urban India
53% population have mobile phones
Scalable (2011 Census)
mHealth success in maternal health +
HIV. Arogya applying to diabetes
Persuasive prevention. Expert + consumer
insights.
12 languages. Cultural relevance.
Adaptable Content, frequency adaptable from
research + tech advances
Future: integrate with workplace +
Integrated rural health worker programs

7. Nokia Life: Livelihood & Life Improvement Services
High appeal and daily relevance in the lives of the Next Billion users
Know more, Live more.
Built for Emerging Markets
High appeal and daily relevance in the lives of the Next Billion users

8. Nokia Life, Arogya World mDiabetes Offering
Main Menu Health Topics Menu
Healthcare Menu

9. Arogya World mDiabetes Program At A Glance
ProgramDevelopment MessageRefinement EffectivenessTesting Evaluation and
Expansion
(2nd Half-2011) (2011 - 1stHalf-2012) (2012-2013)
 2011 Clinton Global  56 Messages -  Full Roll-Out 1  Comprehensive
Initiative Emory million evaluation of
Commitment  Pre-Tested with  Multiphased
outcomes
 Nokia Life Platform consumers evaluation  Extending free
 9 Jan 2012 roll-out content to 1 year
 1,000,000 Consumers  30,000 recipients Mar  Effectiveness Eval
insights from 1,000  Content, Sequencing
 Free for 6 months  mDiabetes name Improvement
consumers, phone
 25 messages x 30
 2x/wk; 12 languages  Interactive
consumers = 750  Village Testing: face-
 Accuracy, Cultural to-face in-depth Technology
consumer insights.
Relevance - Behavior feedback Incorporation
 Telephone feedback
Change Task Force
 Data analysis and  Sustainability and
 Real-world Scalability
Current Partners Publication
consumer insights to
 Nokia, Emory, Ipsos refine messages
 Aetna, J&J, Biocon
© PharmARC Analytic Solutions Pvt. Ltd., 2009 Slide 9

10. mDiabetes
Initial Consumer Insights

11. mDiabetes – Adaptation of Content
 Pretesting
 Nov/Dec 2011. Consumers. Simulated situations.
 Part I N= 44, N + S India (Hindi + Kannada); Telephone interviews
 Part II – N=8 Semi-Urban Tamil Nadu; face to face interviews
KEY TAKEAWAYS
 Overall messages liked and found to be useful
 Simple short sentence with one concept will improve ease of reading
 Direct call to action is desirable compared to indirect persuasive messages
 Messages with no specific action scored low on likability and usefulness
 Link messages to diabetes
 Message should communicate whether it is primarily for control or prevention of diabetes
 Message frequency could be increased in the beginning
ACTION TAKEN
 Messages were modified per consumer feedback obtained
 Frequency of messages was increased to 6 messages for the 1st week and then 2 messages
per week

12. mDiabetes
First Real World Consumer Insights

13. Message Recall Message Usefulness
100 100
80 80
60 60
90 86 88 81
40 80 40 80
67 70 70 70
20 20
0 0
1 2 3 4 5
1 2 3 4 5
Recalled receiving and reading the message Perceived message to be useful or very useful
Ease of Understanding Willing to share
100 100
80 80
60 60
92 95 96 100
40 87 85 88 40 88 88 85
20 20
0 0
1 2 3 4 5 1 2 3 4 5
Perceived message to be easy or very easy to understand Yes, willing to share
Y axis = % consumers. X axis represents messages.

14. Critical Success Factors
 Compelling messages: science + behavior change
 Consumer-testing and local adaptation
 Behavior Change Task Force: Medical & non-medical experts =
technical accuracy + cultural relevancy
 Comprehensive measurement and evaluation
 In-house expertise + external evaluation partner
 Multisector partnership: Industry (mobile phone, pharma,
health insurance), academia, civil society
 Unifying purpose: Make meaningful public health impact,
improve outcomes
 Scalability, sustainability
 Innovation; leverage technology advances

15. Back-Up

16. Arogya World Network of Influencers
Board*
Dr. Nalini Saligram – Arogya World; Dr. Pamela Yih, Treasurer – Pamela Y-F Yih Inc.; Kathryn Graves – Emory Univ
Rollins School of Public Health; Dr. MeryleMelnicoff– formerly at WISTAR Institute
Indo-US Scientific Steering Committee*
 Based in India - Dr K. Srinath Reddy – President, Public Health Foundation of India, Dr V. Mohan – Madras Diabetes
Research Foundation, Dr Ashok K. Das – Additional Director General Health Services, Dr Prabhakaran – Centre for
Chronic Disease Control, and PHFI, Dr Nikhil Tandon – All India Institute of Medical Sciences, Dr. Prasanna Kumar –
Bangalore Diabetes Hospital
 Based in the US - Dr K.M. VenkatNarayan – Emory University, Dr Sreekumar Nair – Mayo Clinic, Dr Francine
Kaufman – Medtronic, Dr KarmeenKulkarni – Abbott Diabetes Care, Dr Sethu Reddy – Merck, Dr. Om Ganda -Joslin
Advisors*
Dr A Ramachandran - India Diabetes Research Foundation, Chennai; Dr SubhankarChowdhury-IPGME&R and SSKM
Hospital, Kolkata; Monika AroraHriday-Shan; C.V. MadhukarPRS Legislative Research; Deanna M. HoelscherMichael
and Susan Dell Center for Advancement of Healthy Living; Dr Sudeep Singh Gadok, International Health and
Development Expert; Raj Dave ARE Consulting, Dr. ArunChockalingamWorld Hypertension League, Dr. David C
U’PrichardDruid Consulting
Behavior Change Task Force*
 Based in the US - Dr. Fran Kaufman, Medtronic, Dr. LinelleBlais, Emory University, Andrea Falls, Edelman
 Based in the UK – Zoe Hellman, Weight Watchers
 Based in India – Dr. Ranjani Harish, Dr. Mohan’s Diabetes Specialities Centre, Dr. Monika Arora, Hriday-Shan,
SukantiGhosh, APCO Worldwide, Dr. KanavKahol– PHFI
*all working pro-bono
+
Consultants
TheaJoselow (Washington DC – digital media expert), Dr. S Kumar (Bangalore - senior consultant India), Dr.
SandhyaRamalingam (Bangalore – market research expert), Beau Young (Philadelphia- accountant)

17. Our Track Record
• Feb 2009 – Workshop with 66 stakeholders in Delhi to gather input on priorities.
• World Diabetes Day 2009; 40 community walks in Delhi; 6,000 children asked MrsGursharanKaur, wife of Prime Minister
of India, for help in making policy changes
•Formalized as US-based non-profit organization March 2010.
•New Diabetes Friendly Recipe Created for Arogya World by celebrated Manhattan chef from Devi Nov 2010
•Initiated Schools diabetes education program in India 2011; completed year 1 program, encouraging results
•Clinton Global Initiative Commitment 2011 – 1 million consumers diabetes mHealth campaign in India; 30,000 consumers
received messages through March 2012.
• Healthy Workplace Stakeholder Input Session in India Bangalore, Feb 24, 2012
•Women for a Healthy Future – 2011 petition;