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/

1. Qualitative Analysis of TExT-MED:
How does an mHealth intervention
work among low-income Latinos
Elizabeth Burner, MD, MPH, Co-Primary Investigator
Michael Menchine, MD, MPH, Co-Investigator
Sanjay Arora, MD, Primary Investigator
April 24, 2013

2. • Mobile Health (mHealth): an emerging
field using patients cell phone to improve
health knowledge and behavior
• Consistent behavior and lifestyle change is
difficult to achieve
• The optimal design of mHealth
interventions and the behaviors most
impacted by mHealth have yet to be
determined
Background & Significance:
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3. • Mobile phones are can be seen as
extension of self, very persuasive
• 88% of US adults have a mobile phone,
72% of US adults text, 53% use mobile
web, 50% use “apps”
• Area of interest to CDC and NIH for
further development and research
• High potential for scalable, affordable
programs
Why mHealth?
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4. • To explore the most impactful aspects of
an mHealth intervention for ED patients
with diabetes (TExT-MED) via a
qualitative analysis of focus groups.
Objective of this study:
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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 months
What is TExT-MED?
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6. Sample messages
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“Challenge!
Look at food
labels and
find a snack
that has less
than 100
calories”
“Medication
Reminder!
Don’t leave
home
without your
medications”

7. Health Belief Model
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Proposed interactions of TExT-MED with the Health Belief Model
TExT-MED
TExT-MED
TExT-MED

8. • Is it changing knowledge or self-efficacy?
• Or just cueing people to do the things they
already know they should do?
How is it working?
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9. • Series of 5 focus groups with 24 participants
• Patients who had completed the 6 month
mHealth intervention
• Stratified by language and gender
Methods
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10. • Verbatim transcripts, analyzed in
language
• Modified Ground theory analysis
• Multiple rounds of co-coding until
consensus on codes achieved, κ>0.7
Methods
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11. • Cues to action were most impactful
messages to patients:
• Medication reminders
• Challenge Messages
• Patients’ desired more personalization
• Delivery of messages (timing, names)
• Content of messages (stage of disease, specific
complications)
Results
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12. • Before you go to bed it [the TExT-MED
message] told me, like, don't forget your
medications and don't eat nothing heavy
before you go to bed. And that was good.
Exemplary Quotes – Cues to behavior
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13. • The challenges are good. The challenges you
send us. One imagines that, I see the message,
and when I read the challenge, those are my
challenges for the day. The challenges. It's not
everyday but when they send challenges, they
helped me a lot. I don't answer them but I read
them, and I say, I have to do this. I motivate
myself like it I'm going to go walk. Or as if
I'm going to go eat a salad plate.
Exemplary Quotes – Cues to behavior
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14. • Can we ask for something more personal? Like
‘Hi, [states her own name],’…Computers can
do so much now, nowadays; if you just said,
‘oh [own name]…just texting about your
diabetes’… You see that it's a text from you
guys and say ‘Hi, [own name], how are you
doing today?’
Exemplary Quotes - Personalization
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15. • Well this is very personal, but the thing is we have to
differentiate the levels of diabetes … For example in my
case: when they took my, they cut my foot off. So then I
had to look for, on my own, what types of exercises I
have to do to help me to manage my diabetes and also
learn how to live without my foot. So little things like
that, like I say, everything is in general terms, because
it's a pilot program. But as it becomes more
personalized, well maybe, we know that certain things
affect this man and we can send him specific
information for him—
Exemplary Quotes - Personalization
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16. • Messages that cued action rather than
increasing knowledge or self-efficacy were
perceived as most effective.
• Patients felt personalization would
increase effectiveness, but must be
weighed against increased cost associated
with more complicated programs.
Conclusions
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17. • Addition of a family member or friend as
a supporter (KL2 project)
• Med-Txt: focusing on medication
adherence only using behavior cues
• Appointment reminders with patient
specific greetings
• …..
Future Directions
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