Objective. Patients with type 2 diabetes often fail to achieve self-management goals. This study tested the impact on glycemic control of a two-way text messaging program that provided behavioral coaching, education, and testing reminders to enrolled individuals with type 2 diabetes in the context of a clinic-based quality improvement initiative. The secondary aim examined patient interaction and satisfaction with the program.Methods. Ninety-three adult patients with poorly controlled type 2 diabetes (A1C >8%) were recruited from 18 primary care clinics in three counties for a 6-month study. Patients were randomized by a computer to one of two arms. Patients in both groups continued with their usual care; patients assigned to the intervention arm also received from one to seven diabetes-related text messages per day depending on the choices they made at enrollment. At 90 and 180 days, A1C data were obtained from the electronic health record and analyzed to determine changes from baseline for both groups. An exit survey was used to assess satisfaction. Enrollment behavior and interaction data were pulled from a Web-based administrative portal maintained by the technology vendor.Results. Patients used the program in a variety of ways. Twenty-nine percent of program users demonstrated frequent engagement (texting responses at least three times per week) for a period of ≥90 days. Survey results indicate very high satisfaction with the program. Both groups’ average A1C decreased from baseline, possibly reflecting a broader quality improvement effort underway in participating clinics. At 90 and 180 days, there was no statistically significant difference between the intervention and control groups in terms of change in A1C (P >0.05).Conclusions. This study demonstrated a practical approach to implementing and monitoring a mobile health intervention for self-management support across a wide range of independent clinic practices.

Mobile health (mHealth) is gaining widespread attention for its potential to engage patients in their health and health care in their daily lives. Emerging evidence suggests that mHealth interventions can be used effectively to support behavior change, but numerous challenges remain when implementing these programs at the community level. This paper provides an overview of considerations when implementing community-based mHealth initiatives, based on the experiences of three Beacon Communities across the United States that have launched text messaging (short message service, SMS) pilot programs aimed at diabetes risk reduction and disease management. The paper addresses lessons learned and suggests strategies to overcome challenges related to developing text message content, conducting marketing and outreach, enrolling participants, engaging providers, evaluating program effectiveness, and sustaining and scaling the programs.

Background: The impact of pediatric atopic dermatitis (AD) on families is largely hidden from view, and AD is commonly misunderstood as a minor skin condition. Few studies have examined the full burden of AD from the family perspective. Objective: The aim of the study was to assess the burden of AD on children and families using a caregiver-centered survey. Methods: A 72-item anonymous online survey was posted on social media sites targeted to or composed of parents of children with AD. It explored the following 9 domains of impact: sleep, social isolation, time requirements, life decisions, family relationship dynamics, energy/fatigue, mental health impacts, and unmet treatment needs. Atopic dermatitis severity was reported by respondents using the Patient-Oriented Eczema Measure. Statistical analyses were conducted using R 3.6.0. Results: Two hundred thirty-five individuals completed the survey during the 1-month period that it was promoted via social media. Caregivers reported frequent sleep disturbance, exhaustion, worry, and social isolation related to their child's AD. Conclusions: Results highlight the need for psychosocial support and respite care for caregivers of children with AD.

In our international cohort of 103 patients with AD, 78% reported concomitant pain and itch. The greatest pain burden occurred on the hands (odds ratio [OR], 0.77), perioral region (OR, 0.74), and toes (OR, 0.7), corresponding to regions with the greatest sensory nerve density. Pain was most commonly described as "burning" and "stinging," particularly when lesions were red, cracked, and dry. Its presence significantly interfered with sleep, leisure activities, and activities of daily living. Among the clinic cohort, we observed a strong Spearman correlation between objective Eczema Area and Severity Index score and subjective skin pain. It is imperative that clinicians understand patients' unique pain burden to best evaluate clinical severity and quality-of-life interference.

Background Though adherence is low among caregivers of children with atopic dermatitis (AD), the reasons for it are poorly understood. This study aims to assess the self‐reported prevalence of non‐adherence and reasons for changing prescription regimens among parents of children with AD. Methods A link to a 15‐question online survey was posted to social media sites engaging parents of children with eczema, worldwide. Items included a scale related to physician trust. Results were analyzed using R 3.4 and summarized using normal and nonparametric descriptive statistics as appropriate for each item. Results Eighty‐six eligible parents responded to the survey and provided information about medication adherence. The mean age of respondents' children was 6.2 years (SD 4.4 years), and the majority were children with moderate or severe eczema (40.5% moderate and 42.9% severe). Just over half (54.7%) reported taking or applying eczema medications as directed by their physician. Of those that did not, 30.2% took or applied less medications, and 12.8% stopped taking or applying medications altogether. The top reasons for deviating from directions were as follows: (a) worry about side effects, (b) symptom resolution, and (c) perception that the medication was not working. Trust toward physician was significantly associated with taking medication as directed. Conclusions Decisions about adherence to medications are made in the context of perceived benefits versus anticipated side effects. Findings highlight opportunities for improving adherence, and thereby improving outcomes for children with moderate‐severe AD.