IMPACT: Innovations using Mhealth for People with dementiA and Co-morbidiTies

Background: Health systems in LMICs are poorly equipped to care for chronic mental and physical disease, which are rapidly increasing with aging populations. Cognitive impairment challenges health systems on multiple fronts, incurring huge human and financial costs. Latin America has the highest projected increase in dementia incidence globally, and in Peru there are ~300,000 people with dementia (PWD).

Many are undiagnosed and lack basic support. Care is often provided exclusively by family members. PWD have twice as many co-morbidities as those without dementia which, despite being treatable, are often missed, poorly managed and reduce quality of life for PWD and their carers.

Aims and objectives: Project IMPACT will use dementia as a tracer condition to strengthen health systems in Latin America through sustainable, integrated, person-centred, community-delivered, technology-enabled innovation. Our specific objectives are to i) evaluate health systems readiness to provide support for PWD; ii) develop and implement an mHealth application for diagnosis of dementia by community health workers (CHWs) in Peru; iii) determine the feasibility of an mHealth-delivered, CHW-supported intervention to improve health-related quality of life for PWD and their carers; iv) assess the socioeconomic burden of dementia in Peru.

Through these objectives, and in combination with our Outreach, Capacity Building and Engagement activities, we will identify barriers to and facilitators for high-quality health systems.

Methods: Our strongly interdisciplinary team includes researchers, policymakers and community representatives working together across 5 interrelated work packages (WPs). WP1 (Health System Readiness) will assess the needs of PWD and their carers and the readiness of the Peruvian health system to meet those needs. The tools developed will also be applied in 3 other Latin American countries.

WP2 (Diagnosis) will co-produce an mHealth app for CHWs to find cases of dementia and record co-morbidities. We will evaluate the acceptability and accuracy of this app in 1600 PWD and controls from four distinct regions of Peru: the capital city (Lima), a coastal semi-urban region, the Andes mountains and the Amazon jungle. We will test integration of the app into primary health care.

WP3 (Intervention) will adapt an existing mHealth intervention, developed in the US, to the Peruvian context. The intervention will include co-morbidity management help, motivation for physical exercise and group-based activities and carer support. Its implementation will be assessed in a feasibility study.

WP4 (Health Economics) will estimate the economic burden and impact on quality of life of dementia and co-morbidities using questionnaires administered to the PWD and controls identified in WP2. WP5 will oversee all project management activities and engage stakeholders and the wider community to increase awareness and tackle sigma.

Anticipated impact and dissemination: We will work with patients, carers, health care workers, not-for-profit organisations, academics and policy makers to co-design our research and ensure maximum impact for PWD in Peru and beyond. We envisage: i) the diagnostic app being implemented nationwide within the health service; ii) preparing for a full trial of the complex intervention; iii) informing the design of a National Dementia Plan in Peru; iv) adaptation and application of health system readiness tools in other Latin American countries.