An intersectoral innovative solution involving DIGItal tools, empowering families and integrating community CARE services for the prevention and management of type 2 diabetes and hypertension

Project Information

DigiCare4You

Grant agreement ID: 945246

DOI

10.3030/945246

EC signature date 29 January 2021

Start date 1 April 2021

End date 30 June 2026

Funded under

• SOCIETAL CHALLENGES - Health, demographic change and well-being

Total cost

€ 4 408 368,75

EU contribution

€ 3 972 161,25

Coordinated by

CHAROKOPEIO PANEPISTIMIO
Greece

Periodic Reporting for period 2 - DigiCare4You (An intersectoral innovative solution involving DIGItal tools, empowering families and integrating community CARE services for the prevention and management of type 2 diabetes and hypertension)

Reporting period: 2022-10-01 to 2024-03-31

Summary of the context and overall objectives of the project

Type 2 diabetes (T2D) and hypertension (HTN) represent a major health, financial and psychological burden on individuals, their families and society and cause important challenges to public health systems. Although T2D and HTN can be prevented through lifestyle changes, their prevalence is increasing in Europe with overweight and obesity being major risk factors. Given the association between parents’ and children’s weight status, targeting families and promoting a supportive environment could have multiple benefits on lifestyle and health for both high-risk parents and their offspring.
The currently hospital- and disease-centred healthcare systems need to be shifted into people-centred integrated care models focusing on health promotion and disease prevention. Digitalization of healthcare along with organizational and policy innovations could achieve the anticipated impact. Finally, T2D and HTN are strongly associated with socioeconomic disadvantages, suggesting a health inequality dimension that needs to be considered when planning public health initiatives for their prevention and management.
Considering all the above, DigiCare4You Consortium jointly works with local stakeholders to strengthen primary health systems and deliver an intersectoral innovation, involving digital tools, for early screening, prevention and management of T2D and HTN in an effective, efficient and equitable way. DigiCare4You solution consists of a two-stage screening procedure to identify families at high risk for T2D and/or HTN, followed by an intervention combining the use of digital tools and activities supporting families’ well-being in schools and communities. DigiCare4You project conducts an implementation study targeting more than 10,000 families in 2 middle-income countries (MICs, Albania & Bulgaria) and 2 high-income countries (HICs, Greece & Spain). Specifically, DigiCare4You project aims to:
• Study and understand the local needs & contextual factors
• Adapt the innovative solution & develop the evaluation tools for its implementation
• Implement the innovative solution, using existing facilities, personnel and processes to foster a low-cost and sustainable approach & evaluate its process, impact, outcome, cost-effectiveness, scalability and transferability
• Apply regular monitoring to refine protocols and ensure adaptability, equity and effective uptake
• Develop a roadmap to help policy makers across Europe adopt Digicare4You solution and promote people-centred care and integrated health services

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

During the 1st and 2nd periods of the project, the following tasks were completed:
• Establishment of two local Stakeholder Advisory Boards (SABs) (one with implementers and one with end-users) in each implementation country to contribute to the effective embedment of the solution to the local systems
• Establishment of an External Ethics Advisory Board to support ethics and legal compliance of the project
• A comprehensive review of the contextual factors related to the healthcare services in each country
• Two focus groups and two conjoint web surveys (one with implementers and one with end-users) in each country to identify potential barriers and facilitators for the implementation of the solution, and to explore the determinants of its acceptance and use
• Two systematic literature reviews to synthesise evidence on the clinical and cost-effectiveness of mHealth and community-based interventions for the prevention and management of T2D and HTN
• Identification of the strategies to guide the adaptation and implementation of the DigiCare4You solution in each country
• Adaptation and testing of the digital tools for the two-stage screening and the mHealth intervention and further refinement
• Adaptation of the school intervention material to the needs of each country
• Development of the 1st and 2nd version of the DigiCare4You Social Collaboration Platform for the promotion of healthy and active lifestyle for all residents/families
• Development of the tools and plan for the process, impact, outcome and cost-effectiveness evaluation of the DigiCare4You solution
• Development and further refinement of the DigiCare4You Digital Platform and Secure Cloud-based Repository, as well as the Visual Analytics component of the digital platform
• Development and further refinement of the AI-empowered Virtual Assistant and the Decision Support System to guide the implementers in monitoring and evaluating study participants through the use of the digital platform and facilitate decision-making
• Development of the DigiCare4You implementation study protocol and obtaining of approvals from Ethics Committees and/or relevant regulatory authorities in each country
• Central and local trainings in each country for the research teams and local implementers
• Establishment of an International SAB and analytical communication, dissemination and exploitation plan to support the development of a scalable DigiCare4You solution
• Workshops with local stakeholders in each country to identify scalability causal pathways
• Transferability analysis plan with the methods to study the contextual and implementation factors that might contribute to cross-country scalability outcomes
• Two-stage screening procedure completed, reaching >30,000 families in the four countries:
o >19,000 parents completed the 1st stage screening
o >2,500 parents completed the 2nd stage screening
• 841 parents with pre-diabetes and 365 parents with T2D participate in the DigiCare4You mHealth self-management intervention, including data from 1,325 children

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

During the 1st and 2nd periods, the following progress beyond the state of the art was made:
• Adaptation and digitalisation of a two-stage screening procedure for the early identification of individuals at risk of T2D: DigiCare4You built on the school and community-based population screening applied in the H2020 Feel4Diabetes-study and further adapted it, considering the contextual factors in each country. Digital tools were developed to identify parents/caregivers at risk of T2D.
• Customization of the mHealth applications to the needs of users and their carers: An in-depth situational analysis and needs assessment was conducted in each implementation country that guided the contextual and cultural adaptation of the mHealth applications, using the MetaClinic and MetaDieta digital health solutions as a basis.
• Engagement of key local stakeholders from the beginning of the project: Following a community-based participatory research approach, two SABs consisted of key local stakeholders were established in each country and were actively involved in the adaptation of the DigiCare4You solution to the local needs and contextual factors.
• Focus on families and consideration of vulnerable groups: The DigiCare4You solution targets families instead of individuals; the screening procedure is combined with children’s growth assessment and the intervention was developed to support healthy and active living for the entire family. Moreover, the innovative solution is implemented in both MICs and HICs across Europe aiming to improve access to healthcare for all families, including the most vulnerable.

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