Implementation of mobile-health technology is associated with five-year survival among individuals in rural areas of Indonesia

There is an urgent need to focus on implementing cost-effective health interventions and policies to reduce the burden of cardiovascular disease in Indonesia. This study aims to evaluate whether a mobile technology–supported primary health care intervention, compared with usual care, would reduce the risk of all-cause mortality among people in rural Indonesia. Data were collected from 11,098 participants in four intervention villages and 10,981 participants in four control villages in Malang district, Indonesia. The baseline data were collected in 2016. All the participants were followed for five years, and the mortality data were recorded. Cox proportional hazard model was used to examine the association between the intervention and the risk of all-cause mortality, adjusted for the covariates, including age, gender, educational attainment, employment and marital status, obesity and the presence of diabetes mellitus. During the five-year follow-up, 275 participants died in intervention villages, compared with 362 in control villages. Participants residing in intervention villages were at 18% (95%CI = 4 to 30) lower risk of all-cause mortality. Higher education attainment and being married are associated with lower risks of all-cause mortality among respondents who lived in the control villages, but not among those living in the intervention villages. A mobile technology–supported primary health care intervention had the potential to improve the five-year survival among people living in villages in an upper-middle income country.Author summary: Mobile technology in healthcare has been widely used in Indonesia. SMARThealth (Systematic Medical Appraisal Referral Treatment) is among them, and it has been piloted and implemented in the Malang district of East Java province, Indonesia, since 2016. SMARThealth is a mobile device-based clinical decision support system (CDSS) to help primary healthcare workers improve optimal preventive treatment in primary healthcare. This paper evaluates whether this intervention would reduce the risk of death among people in Malang district. During the five-year follow-up, we found that participants residing in intervention villages had a lower risk of death than control villages. The findings highlight the potential of a mobile technology-based primary care intervention to empower primary healthcare workers to increase the population’s survival in Malang district, Indonesia.