# Health Diaries to Empower Marginalized Communities Through Self-Tracking: A Study in an Urban Slum and Rural Area of Bhopal District, Madhya Pradesh

## TL;DR

This study shows that health diaries can help marginalized communities in India track their health, improve health literacy, and reduce medical costs.

## Contribution

The study demonstrates the feasibility and benefits of using self-maintained health diaries in urban slums and rural areas for health surveillance.

## Key findings

- Diary compliance was high, with increased illness reporting in urban slums and reduced health expenditures in both settings.
- Health diaries enabled early detection of conditions like anemia, pre-hypertension, and pre-diabetes.
- The diaries captured a wide range of health issues, from common symptoms to serious conditions like stroke.

## Abstract

Background and objective: Health equity requires reliable, community-level data to inform policy and service delivery. In resource-constrained settings such as urban slums and rural areas of India, formal health data systems are often inadequate. This study aimed to assess the acceptability and use of self-maintained health diaries for community-based health surveillance.

Methods: A cross-sectional study was conducted in two demographically distinct underserved blocks in Bhopal district, Madhya Pradesh, India, covering 1132 urban slum and 1162 rural residents. Households were provided monthly health diaries to self-record illness episodes, healthcare utilization, and basic health parameters with support from home health guides (HHGs). Baseline and follow-up data were collected over multiple months using structured surveys and biometric screenings. Baseline data were collected initially by the respective HHG, study staff, and local health volunteers. The baseline data included sociodemographic characteristics, anthropometric measurements, blood pressure, screening for common illnesses and disorders, health needs, availability and cost of care, affordability of health care services, population distribution, health services distribution, health-seeking behavior of the community via their preferences and reasons, diary acceptability, availability and utilization of existing health care facilities, and knowledge of the community. Data was entered and analyzed in Microsoft Excel (Microsoft Corp., Redmond, WA, USA).

Results: Diary compliance was high across both settings. In the urban slum, illness reporting rose from 122 (10.4%) to 142 (12.5%), while in the rural area, it declined from 89 (7.6%) to 19 (1.6%). Significant reductions in health expenditures were observed post-intervention, with urban lab test costs dropping from 418 (36.9%) to four (0.3%) and rural costs from 235 (20.2%) to two (0.2%). The use of the health diary also enhanced early detection of anemia, pre-hypertension, and pre-diabetes. Diaries enabled the reporting of diverse conditions, from headaches and menstrual disorders to otitis media and stroke, highlighting their value in capturing a wide disease burden.

Conclusion: Self-maintained health diaries are feasible, acceptable, and cost-effective tools for improving health literacy, surveillance, and health-seeking behavior in underserved populations. Integration into national health programs and digital platforms could amplify their impact.