Prevention of chronic non-communicable diseases in primary care is the key to preventing premature mortality and reducing disability. However, health systems face a shortage of human and time resources in providing preventive care to the population, especially those living in remote rural areas, warranting the need for new organizational forms and expanding their accessibility. In this setting, nursing staff can be an important resource to provide high-quality and accessible preventive interventions.
OBJECTIVE
To study the comparative effectiveness of a comprehensive prophylactic technology for reducing excess body weight, including personalized counseling on behavioral risk factors and remote monitoring using a smartphone application with medical support by a doctor and nursing staff.
MATERIAL AND METHODS
A multicenter open-label randomized study was conducted in primary healthcare organizations of five constituent entities of the Russian Federation. Five hundred forty-six subjects were monitored: males and females aged 18—60 years with overweight and obesity, randomized to intensive intervention and self-control groups. Physicians provided medical support to 364 subjects and nursing staff to 182 subjects. The intervention included in-person individual in-depth preventive counseling with different frequencies in the comparison groups and subsequent remote support using the Doctor PM mobile application.
RESULTS
During 6 months of the study, a statistically significant decrease in monitored anthropometric parameters (body weight, body mass index, and waist circumference) was noted in study groups, regardless of the intervention intensity. The percentage of subjects who achieved the target level of weight loss (5% from baseline) was 39.3% when observed by a doctor and is comparable to that when observed by nurses (40.1%; χ2=0.034, p=0.853). The adjustment of dietary habits successfully reduced the consumption of foods with excess fat and simple carbohydrates but had a multidirectional trend in the consumption of foods rich in fiber (vegetables, fruits, cereals). The physical activity in the intervention groups was high; however, there were periods of decrease in the average number of steps per day.
CONCLUSION
A comprehensive preventive intervention, including in-person, in-depth preventive counseling and subsequent remote monitoring using a mobile application (mHealth technology), demonstrated similar effectiveness regardless of the type of medical support (by a physician or nursing staff) in overweight patients living in both urban and rural areas. The change features of behavioral risk factors (eating habits and level of physical activity) in patients can be related to the place of residence and traditional preferences, which must be considered when introducing remote technologies into medical prevention practice at the primary health care level.
