Previously submitted to: JMIR Formative Research (no longer under consideration since Oct 23, 2019)
Date Submitted: Sep 3, 2018
Open Peer Review Period: Sep 9, 2018 - Nov 4, 2018
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Use of a non-invasive NCD risk monitoring device among Pakistani families for Stroke Prevention in LMIC Settings: A Proof of Concept Study
Background:
Pakistan has an estimated 7 million stroke survivors. It is estimated that around 80% of these events can be prevented by early detection of clinically silent risk factors and conditions like hypertension (HTN), diabetes (DM), atrial fibrillation (Afib) and abnormal cholesterol metabolism.
Objective:
We proposed to develop an intelligent device that enables noninvasive detection of blood pressure, Electrocardiography (EKG) and blood glucose levels accompanied with interactive feedback based software that runs on android based cell phones, that interprets these values. We tested the feasibility of use in Pakistani families. Our rationale is to use this technology to enable early risk detection and prevent strokes.
Methods:
A pragmatic prototype testing along with qualitative interviews was conducted. Four families living in Karachi, Pakistan were identified through convenience sampling. The study participants included apparent healthy as well as those who have known NCD risks factors like Hypertension, Diabetes Mellitus, atrial fibrillation and others. Each family member received a detailed teaching session on how to use the device. Each participant was instructed to record the minimal periodic measurements required for the study.
Results:
The study was conducted from August to September 2015. A total of 4 families were approached and total of 12 participants with 5 males and 7 females were recruited. The mean age of the participants was 51±14.97 years. The participants were instructed to perform at least 3-4 observations daily by their device for period of four weeks. In total 90 observations were made over a period of 4 weeks. During the study period the device detected, hypertension in 9 readings, hypotension in 18, abnormal hyperglycemia was detected 7 times, low glucose values in 13, tachycardia 5 times, bradycardia 2 times and atrial fibrillation was identified in one user. In order to verify abnormal readings identified by the device repeated observations and validated tests were performed. All medically important observations identified by device also received physician consultation. Qualitative in-depth interviews were performed for user feedback which further informed refinement of device for use in diverse settings and users in future testing.
Conclusions:
The proof of concept demonstrated the real time feasibility of the use of the device in an LMIC setting. It repeatedly identified modifiable risk factors within the study participants over four weeks. Wi-Fi networks with their bandwidths currently operating within Pakistan were able to support the remote detection of abnormalities and transmit the data for recording and interpretation.
ClinicalTrial:
Not Applicable. This is not a trial.
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