Sweet Talk was associated with improved self-efficacy and adherence; engaging a classically difficult to reach group of young people. While Sweet Talk alone did not improve glycaemic control, it may have had a role in supporting the introduction of intensive insulin therapy. Scheduled, tailored text messaging offers an innovative means of supporting adolescents with diabetes and could be adapted for other health-care settings and chronic diseases.

Background Guidelines for optimizing type 1 diabetes in young people advocate intensive insulin therapy coupled with personal support from the health care team. “Sweet Talk” is a novel intervention designed to support patients between clinic visits using text messages sent to a mobile phone. Scheduled messages are tailored to patient profiles and diabetes self-management goals, and generic messages include topical “newsletters” and anonymized tips from other participants. The system also allows patients to submit data and questions to the diabetes care team.Objectives The aim was to explore how patients with type 1 diabetes interact with the Sweet Talk system in order to understand its utility to this user group.Methods Subjects were 64 young people with diabetes who were participating in the intervention arms of a randomized controlled trial. All text messages submitted to Sweet Talk during a 12-month period were recorded. Messaging patterns and content were analyzed using mixed quantitative and qualitative methods.Results Patients submitted 1180 messages during the observation period (mean 18.4, median 6). Messaging frequency ranged widely between participants (0-240) with a subset of 5 high users contributing 52% of the total. Patients’ clinical and sociodemographic characteristics were not associated with total messaging frequency, although girls sent significantly more messages unrelated to diabetes than did boys (P = .002). The content of patients’ messages fell into 8 main categories: blood glucose readings, diabetes questions, diabetes information, personal health administration, social messages, technical messages, message errors, and message responses. Unprompted submission of blood glucose values was the most frequent incoming message type (35% of total). Responses to requests for personal experiences and tips generated 40% of all the incoming messages, while topical news items also generated good responses. Patients also used the service to ask questions, submit information about their self-management, and order supplies. No patients nominated supporters to receive text messages about their self-management goals. Another option that was not used was the birthday reminder service.Conclusions Automated, scheduled text messaging successfully engaged young people with diabetes. While the system was primarily designed to provide “push” support to patients, submission of clinical data and queries illustrates that it was seen as a trusted medium for communicating with care providers. Responses to the newsletters and submission of personal experiences and tips for circulation to other participants also illustrate the potential value of such interventions for establishing a sense of community. Although participants submitted relatively few messages, positive responses to the system suggest that most derived passive support from reading the messages. The Sweet Talk system could be readily adapted to suit other chronic disease models and age groups, and the results of this study may help to inform the design of ...

Optimal diabetes management involves considerable behavioural modification, while nonadherence contributes significantly to poor glycaemia. Extensive research on psychological interventions aiming to improve glycaemia suggests that current strategies are costly and time-consuming and in our experience do not appeal to young people with Type 1 diabetes. Text messaging has rapidly become a socially popular form of communication. It is personal, highly transportable, and widely used, particularly in the adolescent population. However, text messaging coupled with specific behavioural health strategies has yet to be utilised effectively. We have developed a novel support network ("Sweet Talk"), based on a unique text-messaging system designed to deliver individually targeted messages and general diabetes information. Individualised motivation strategies--based on social cognition theory, the health belief model, and goal setting--form the theoretical basis of the message content. Intensifying insulin therapy and increasing contact with the diabetes team can improve control, but are difficult to provide within existing resources. Our support system offers a means of contact and support between clinic visits and aims to increase adherence with intensive insulin regimens and to improve clinical outcome.

Effective self-management of diabetes requires considerable behavioural change and continuous support from health professionals, which can be expensive. Information technology has the potential to offer cost-effective patient support, but internet use mostly relies on the active seeking of information. Text messaging offers an ideal channel for delivering 'push' support and facilitating reciprocal communication between patient and health professional. This paper describes a participatory design methodology to develop a text message scheduling system for supporting young people with diabetes. The project illustrates how this familiar design approach can be used in a short-term project to deliver a successful medical application. Close working between clinician and software developer led to successive user-informed iterations as the clinician became more aware of the system's potential and identified barriers. The result was a reliable, functional, acceptable and usable system that was effectively implemented in its intended setting.

In this article we argue for an interdisciplinary approach to designing interactive technology for young children on the Autistic Spectrum. We believe it key for the design process to embrace perspectives from diverse fields to arrive at a methodology, and consequently technology, that delivers satisfactory outcomes for all stakeholders involved. The ECHOES project has provided us with the opportunity to work on a technology-enhanced learning environment that supports acquisition and exploration of social skills by typically developing children and children with high-functioning autism and Asperger Syndrome. ECHOES' research methodology and the learning environment relies crucially on multi-disciplinary expertise including developmental and clinical psychology, visual arts, human-computer interaction, artificial intelligence, education and many other cognate disciplines. In this article, we reflect on the methods needed to develop a technology-enhanced learning environment for young users with Autism Spectrum Disorder. We identify key benefits, challenges and limitations of this approach. Although the context of ECHOES is very specific, we believe that there are a number of guidelines for the desing of technology-enhanced intervention for autism that can benefit a wider community of researchers in this emerging discipline.