Effect of Digital Tools on the Knowledge and Performance of Frontline Health Workers For Diabetes Control in Myanmar: Cost-Effective Analysis and Quasi Experimental Study

Abstract

Background: Diabetes has become a significant global health issue, particularly imposing a deep economic burden on low-income countries. Innovative and integrated digital solutions can reduce the impact of diabetes and enhance the quality of care. However, digital solutions have not been utilized before in Myanmar.

Objective: This study aimed to demonstrate the novel integrated effect of diabetes knowledge and registry tools on the performance of front-line health workers in primary health care settings.

Methods: A quasi-experimental study with an intervention and a control group was conducted in two townships from October 2022 to April 2023. For the first time, researchers trained the intervention group to use digital tools for diabetes control and performed monthly follow-ups. The study employed multiple linear regression models to explore the novel impact of digital tools on knowledge and performance scores, their correlations, and their association with covariates. Additionally, it assessed the cost-effectiveness of the intervention by using self-administered questionnaires as measurement tools formulated based on the National Diabetes Guidelines.

Results: A total of 96 participants were enrolled in the study, divided evenly into the two groups. The intervention group exhibited a significant increase in the mean knowledge scores from 85.81 to 99.25 (P<.001) and performance scores from 71.22 to 107.16 (P<.001). The intervention accounted for 43.2% of the variance in knowledge scores and 62.5% in performance scores (P<.001). A positive correlation was found between knowledge and performance scores (r=0.45, P<.001). The intervention was also cost-effective, with a cost-effectiveness analysis value of 0.711 and an incremental cost-effectiveness ratio of 10127.04 Kyats (US$ 4.83).

Conclusions: As the new integrated intervention yields significant economic gains and positive effects, researchers suggest policy makers replicate this intervention as a nationwide program and recommend scaling up the use of digital tools to improve knowledge and performance for diabetes control in frontline health workers.

Keywords: Myanmar; cost-effectiveness analysis; diabetes mellitus; digital tools; health personnel.

Figure 1.. Flow chart for quasi-experimental design.

Figure 2.. Comparison of mean outcomes between the intervention and control: (A) mean knowledge scoring, (B) mean performance scoring.

Figure 3.. Correlation between mean knowledge and performance scoring (n=95). (A) Total scoring, (B) health promotion, (C) screening and diagnosis, (D) care and treatment, (E) referral, (F) registry and reporting.

Figure 4.. Cost-effectiveness between the intervention and control.