Effectiveness and sustainability of mhealth interventions for improving diabetes management: combined analysis of cluster-randomised crossover trial in Western Rajasthan

Diabetes mellitus requires sustained self-management and lifestyle modification, which can be strengthened through digital health interventions. Mobile-based technologies, including short message services (SMS) and Android applications, offer a cost-effective approach to improving diabetes care, particularly in community and primary healthcare settings. This study aimed to evaluate the effectiveness and sustainability of an mHealth intervention on glycaemic control among adults with type 2 diabetes in a primary healthcare setting. A cluster-randomised crossover trial was conducted among 280 adults with type 2 diabetes across two Primary Health Centres (PHC-I and PHC-II; n = 140 each). During Phase I (baseline to six months), PHC-I received an mHealth intervention in addition to usual care, while PHC-II received usual care alone. In Phase II (six to twelve months), the groups were crossed over. Clinical outcomes, including HbA1c, body mass index (BMI), blood pressure (BP), waist circumference, and quality of life (QoL), were assessed at baseline, six months, and twelve months. Message engagement and changes in diabetes-related knowledge, attitudes, and practices were also evaluated. Data were analysed using descriptive statistics, paired t-tests, and independent t-tests. A p-value < 0.05 was considered statistically significant. In Phase I, participants receiving the mHealth intervention demonstrated significant improvements in HbA1c, BMI, BP, and QoL, whereas the control group showed a reduction in HbA1c alone, accompanied by a decline in QoL ( p = 0.001). Following crossover, participants receiving the intervention demonstrated a reduction in HbA1c from 7.70% to 7.56% ( p = 0.488), while quality-of-life scores improved significantly from 0.87 ± 0.15 to 0.94 ± 0.11 ( p = 0.001). Conversely, withdrawal of the intervention was associated with an increase in HbA1c from 8.33% to 8.83% ( p = 0.007) and a decline in quality of life ( p = 0.001). The findings support the potential effectiveness of sustained mHealth interventions in improving diabetes self-management, quality of life, and glycaemic outcomes in primary healthcare settings. This highlights the importance of continuous mHealth support and supports the integration of mHealth interventions into routine primary healthcare to promote sustainable diabetes self-management in resource-constrained settings.