Text-Message Reminders To Help People With Diabetes Manage Their Health

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In Southern California, diabetes plagues the Latino population. But due to language, culture, and other barriers, these patients may not manage their disease optimally. Elizabeth Burner, MD, MPH, a research fellow at Department of Emergency Medicine at LAC and USC, tested the use of a program that used mobile phones to text educational and motivational messages to diabetes patients to improve their understanding of the disease and encourage meaningful lifestyle changes. During the SC CTSI-supported study, researchers texted reminders about nutrition, medications, and exercise, prompting some participants to adopt healthier behaviors.

Read the full story: http://sc-ctsi.org/index.php/news-dev/researchers-share-how-they-work-with-community-members-to-address-critica

Learn more about SC CTSI at USC and CHLA: http://sc-ctsi.org/

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  • 30 % of the world’s mobile users live in India and China Extremely high penetrance in developing countries
  • Text-Message Reminders To Help People With Diabetes Manage Their Health

    1. 1. Qualitative Analysis of TExT-MED:How does an mHealth interventionwork among low-income LatinosElizabeth Burner, MD, MPH, Co-Primary InvestigatorMichael Menchine, MD, MPH, Co-InvestigatorSanjay Arora, MD, Primary InvestigatorApril 24, 2013
    2. 2. • Mobile Health (mHealth): an emergingfield using patients cell phone to improvehealth knowledge and behavior• Consistent behavior and lifestyle change isdifficult to achieve• The optimal design of mHealthinterventions and the behaviors mostimpacted by mHealth have yet to bedeterminedBackground & Significance:2
    3. 3. • Mobile phones are can be seen asextension of self, very persuasive• 88% of US adults have a mobile phone,72% of US adults text, 53% use mobileweb, 50% use “apps”• Area of interest to CDC and NIH forfurther development and research• High potential for scalable, affordableprogramsWhy mHealth?3
    4. 4. • To explore the most impactful aspects ofan mHealth intervention for ED patientswith diabetes (TExT-MED) via aqualitative analysis of focus groups.Objective of this study:4
    5. 5. • Available in English and Spanish• 2 daily text-messages for 6 months• Educational and motivational texts• Medication reminders• Challenges to perform healthy behaviors (e.g.read a food label today)• Follow up at 3 and 6 monthsWhat is TExT-MED?5
    6. 6. Sample messages6“Challenge!Look at foodlabels andfind a snackthat has lessthan 100calories”“MedicationReminder!Don’t leavehomewithout yourmedications”
    7. 7. Health Belief Model7Proposed interactions of TExT-MED with the Health Belief ModelTExT-MEDTExT-MEDTExT-MED
    8. 8. • Is it changing knowledge or self-efficacy?• Or just cueing people to do the things theyalready know they should do?How is it working?8
    9. 9. • Series of 5 focus groups with 24 participants• Patients who had completed the 6 monthmHealth intervention• Stratified by language and genderMethods9
    10. 10. • Verbatim transcripts, analyzed inlanguage• Modified Ground theory analysis• Multiple rounds of co-coding untilconsensus on codes achieved, κ>0.7Methods10
    11. 11. • Cues to action were most impactfulmessages to patients:• Medication reminders• Challenge Messages• Patients’ desired more personalization• Delivery of messages (timing, names)• Content of messages (stage of disease, specificcomplications)Results11
    12. 12. • Before you go to bed it [the TExT-MEDmessage] told me, like, dont forget yourmedications and dont eat nothing heavybefore you go to bed. And that was good.Exemplary Quotes – Cues to behavior12
    13. 13. • The challenges are good. The challenges yousend us. One imagines that, I see the message,and when I read the challenge, those are mychallenges for the day. The challenges. Its noteveryday but when they send challenges, theyhelped me a lot. I dont answer them but I readthem, and I say, I have to do this. I motivatemyself like it Im going to go walk. Or as ifIm going to go eat a salad plate.Exemplary Quotes – Cues to behavior13
    14. 14. • Can we ask for something more personal? Like‘Hi, [states her own name],’…Computers cando so much now, nowadays; if you just said,‘oh [own name]…just texting about yourdiabetes’… You see that its a text from youguys and say ‘Hi, [own name], how are youdoing today?’Exemplary Quotes - Personalization14
    15. 15. • Well this is very personal, but the thing is we have todifferentiate the levels of diabetes … For example in mycase: when they took my, they cut my foot off. So then Ihad to look for, on my own, what types of exercises Ihave to do to help me to manage my diabetes and alsolearn how to live without my foot. So little things likethat, like I say, everything is in general terms, becauseits a pilot program. But as it becomes morepersonalized, well maybe, we know that certain thingsaffect this man and we can send him specificinformation for him—Exemplary Quotes - Personalization15
    16. 16. • Messages that cued action rather thanincreasing knowledge or self-efficacy wereperceived as most effective.• Patients felt personalization wouldincrease effectiveness, but must beweighed against increased cost associatedwith more complicated programs.Conclusions16
    17. 17. • Addition of a family member or friend asa supporter (KL2 project)• Med-Txt: focusing on medicationadherence only using behavior cues• Appointment reminders with patientspecific greetings• …..Future Directions17

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