Mobile Phone Support for Diabetes Self-Care Among Diverse Adults: Protocol for a Three-Arm Randomized Controlled Trial

Nelson, Lyndsay A.; Wallston, Kenneth A.; Greevy, Robert A.; Elasy, Tom A.; Bergner, Erin M.; Gentry, Chad; Mayberry, Lindsay S.

doi:10.2196/resprot.9443

Cited by 34 publications

(30 citation statements)

References 63 publications

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“…Using these patient-reported barriers identified in the literature, we developed a barrier assessment [35] in which each barrier is written as a first-person statement (e.g., “Seeing no immediate benefit from taking medication” was modified to read “I’m disappointed when my medicine doesn’t improve my diabetes right away”). We enrolled adults with type 2 diabetes in a randomized controlled trial (RCT) [36] to evaluate a text messaging intervention which uses participants’ barriers identified with this assessment to tailor text message content. For the present analysis, we examine baseline data from the larger trial to understand if this assessment performs as stipulated by the IMB model.…”

Section: Methodsmentioning

confidence: 99%

Assessing barriers to diabetes medication adherence using the Information-Motivation-Behavioral skills model

Nelson

Wallston

LeStourgeon

et al. 2018

Diabetes Research and Clinical Practice

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Aims: Medication nonadherence is a prevalent and costly problem among patients with type 2 diabetes. Applications of theory can inform and improve adherence promotion interventions. We used a new assessment based on the Information-Motivation-Behavioral skills (IMB) model of adherence to assess patient-reported barriers and test the theoretical model. Methods: Participants (N = 237) completed a card sorting task to identify barriers to adherence, a survey, and a hemoglobin A1c (HbA1c) test. We identified the most commonly reported adherence barriers and examined associations between patient characteristics and barriers mapped onto each of the IMB constructs. We used structural equation modeling to test the IMB model and determine if barriers as reported on this measure predict patients’ self-reported diabetes medication adherence and, in turn, HbA1c levels. Results: The most frequently reported barriers were forgetting doses, thinking brand name medicine works better than generic medicine, not seeing immediate benefit, and feeling burned out with taking diabetes medicine. Younger age and lower health literacy were associated with higher barrier scores for all IMB model constructs. Information and social motivation barriers affected adherence via behavioral skills barriers (indirect effects −0.19, CI [−0.33, −0.09] and −0.24, CI [−0.37, −0.14], respectively). The IMB barrier constructs explained 44% of the variance in diabetes medication adherence which, in turn, was significantly associated with and explained 8% of the variance in HbA1c (both p<.001). Conclusions: Results suggest this assessment task can identify patient-specific barriers to diabetes medication adherence. Interventions targeting patient-specific barriers using this assessment could improve adherence and HbA1c.

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Section: Methodsmentioning

confidence: 99%

Assessing barriers to diabetes medication adherence using the Information-Motivation-Behavioral skills model

Nelson

Wallston

LeStourgeon

et al. 2018

Diabetes Research and Clinical Practice

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“…This research was conducted as part of a larger randomized controlled trial (RCT), evaluating the effects of mobile phone–based support on diabetes self-care and hemoglobin A 1c (HbA 1c ) [ 27 ]. The trial and intervention details have been previously described in our development and protocol papers [ 27 - 29 ]. For this study, we analyzed data for participants who were randomly assigned to the intervention.…”

Section: Methodsmentioning

confidence: 99%

“…We used mixed methods to examine user engagement in a 12-month text message–delivered intervention designed to support diabetes self-care, called REACH (Rapid Education/Encouragement And Communications for Health) [ 27 , 28 ]. We sought to explore how engagement changed over the course of the intervention, patient characteristics associated with engagement, whether the addition of a human component or letting participants choose their text frequency affected engagement, and patients’ reasons for their preferred text message frequency.…”

Section: Introductionmentioning

confidence: 99%

User Engagement Among Diverse Adults in a 12-Month Text Message–Delivered Diabetes Support Intervention: Results from a Randomized Controlled Trial

Nelson¹,

Spieker²,

Greevy³

et al. 2020

JMIR Mhealth Uhealth

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Background Text message–delivered interventions are a feasible and scalable approach for improving chronic disease self-care and reducing health disparities; however, information on long-term user engagement with these interventions is limited. Objective The aim of this study is to examine user engagement in a 12-month text message–delivered intervention supporting diabetes self-care, called REACH (Rapid Education/Encouragement And Communications for Health), among racially and socioeconomically diverse patients with type 2 diabetes (T2D). We explored time trends in engagement, associations between patient characteristics and engagement, and whether the addition of a human component or allowing patients to change their text frequency affected engagement. Qualitative data informed patients’ subjective experience of their engagement. Methods We recruited patients with T2D for a randomized trial evaluating mobile phone support relative to enhanced treatment as usual. This analysis was limited to participants assigned to the intervention. Participants completed a survey and hemoglobin A1c (HbA1c) test and received REACH text messages, including self-care promotion texts, interactive texts asking about medication adherence, and adherence feedback texts. For the first 6 months, texts were sent daily, and half of the participants also received monthly phone coaching. After 6 months, coaching stopped, and participants had the option to receive fewer texts for the subsequent 6 months. We defined engagement via responses to the interactive texts and responses to a follow-up interview. We used regression models to analyze associations with response rate and thematic and structural analysis to understand participants’ reasons for responding to the texts and their preferred text frequency. Results The participants were, on average, aged 55.8 (SD 9.8) years, 55.2% (137/248) female, and 52.0% (129/248) non-White; 40.7% (101/248) had ≤ a high school education, and 40.7% (101/248) had an annual household income <US $25,000. The median response rate to interactive texts was 91% (IQR 75%-97%) over 12 months. Engagement gradually declined throughout the intervention but remained high. Engagement did not differ by age, gender, education, income, diabetes duration, insulin status, health literacy, or numeracy. Black race and worse baseline medication adherence and HbA1c were each associated with lower engagement, although the effects were small. Nearly half of the participants chose to continue receiving daily texts for the last 6 months of the intervention. Participants who continued daily text messages said they wanted to continue experiencing benefits to their health, whereas those who chose fewer texts said that the daily texts had helped them create routines and they no longer needed them as often. Engagement was not impacted by receiving coaching or by participants’ chosen text frequency. Conclusions Well-designed interactive text messages can engage diverse patients in a self-care intervention for at least 1 year. Variation in and reasons for frequency preference suggest that offering a frequency choice may be important to users’ engagement.

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“…Por otro lado, algunos de los artículos identificados no pudieron incluirse en la revisión ya que trataban de protocolos de ensayos clínicos (Desveaux et al, 2016;Dobson et al, 2016;Moreira et al, 2017;Nelson et al, 2018). Gran parte de los ensayos clínicos identificados no presentaron una calidad metodológica óptima.…”

Section: Discusión Y Conclusionesunclassified

“…La tecnología móvil básica, que incluye los mensajes de texto y las llamadas telefónicas, ofrece facilidades para mejorar la adherencia terapéutica y el control glucémico en los pacientes con DMT2 (Sarabi, Sadoughi, Orak & Bahaadinbeigy, 2016;Thakkar et al, 2016). Los mensajes de texto permiten elaborar un contenido personalizado y asincrónico orientado al autocuidado de la diabetes (Holcomb, 2015;Nelson et al, 2018). La sociedad actual emplea el uso del teléfono, especialmente los mensajes de texto, en su rutina diaria (Holcomb, 2015), por lo que se podría considerar una herramienta factible de comunicación entre el profesional sanitario y el paciente (Islam et al, 2016).…”

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Adherencia terapéutica en pacientes con diabetes mellitus tipo II y el uso de la tecnología móvil básica: una revisión sistemática = Therapeutic adherence in patients with diabetes mellitus type II and use of basic mobile technology: a systematic review

Martínez-Mateo

García-Herrera

2019

recs

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ResumenAdherencia terapéutica en pacientes con diabetes mellitus tipo II y el uso de la tecnología móvil básica: una revisión sistemática Abstract Revisiones Objetivo: Revisar la literatura científica respecto a la efectividad de la tecnología móvil básica en la adherencia terapéutica, en los pacientes diagnosticados de diabetes mellitus tipo II (DMT2). Metodología: Revisión cuasi-sistemática, cuyos criterios de inclusión fueron: 2.012-2.018, inglés y/o español, ensayos clínicos aleatorizados y controlados, sujetos diagnosticados de DMT2, tecnología móvil básica y resultados relacionados con la adherencia terapéutica. Los estudios identificados fueron evaluados por la escala de Jadad. Resultados: Seis estudios fueron incluidos: 4 emplearon mensajes de texto y 2, llamadas telefónicas. La duración de la intervención oscilaba entre 3 y 18 meses. 1.690 sujetos diagnosticados de DMT2 fueron reclutados, de los cuales sólo 810 finalizaron los estudios. Limitaciones: Escasez de ensayos clínicos controlados y/o aleatorizados de calidad. No se han realizado estudios que incluyan los diferentes componentes de la adherencia terapéutica en relación al uso de la tecnología móvil básica. Conclusiones: El uso de la tecnología móvil básica, junto a una educación sanitaria, puede mejorar la implicación en los diferentes componentes de la adherencia terapéutica en los pacientes diagnosticados de DMT2. Implicaciones de los hallazgos principales: El uso de la tecnología móvil básica refuerza los conceptos y el seguimiento de las personas por parte de los profesionales sanitarios.Palabras clave: cumplimiento y adherencia al tratamiento; mensaje de texto; teléfono; dieta; ejercicio.Objective: To review the scientific literature regarding the effectiveness of basic mobile technology in therapeutic adherence in patients diagnosed with diabetes mellitus type II (DMT2). Methodology: Quasi-systematic review, whose inclusion criteria were: 2.012-2.018, English and/ or Spanish, randomized and controlled clinical trials, subjects diagnosed with DMT2, basic mobile technology and results related to therapeutic adherence. The identified studies were evaluated by the Jadad's scale. Results: Six studies were included: 4 used text messages and 2, phone calls. The duration of the intervention ranged from 3 to 18 months. 1.690 subjects diagnosed with DMT2 were recruited, of whom only 810 completed the studies. Limitations: Shortage of quality controlled and/or randomized clinical trials. There have been no studies that include the different components of therapeutic adherence in relation to the use of basic mobile technology. Conclusions: The use of basic mobile technology, together with health education, can improve the implication in the different components of therapeutic adherence in patients diagnosed with DMT2. Implications of the main findings: The use of basic mobile technology reinforces the concepts and the monitoring of people by health professionals.

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Mobile Phone Support for Diabetes Self-Care Among Diverse Adults: Protocol for a Three-Arm Randomized Controlled Trial

Cited by 34 publications

References 63 publications

Assessing barriers to diabetes medication adherence using the Information-Motivation-Behavioral skills model

Assessing barriers to diabetes medication adherence using the Information-Motivation-Behavioral skills model

User Engagement Among Diverse Adults in a 12-Month Text Message–Delivered Diabetes Support Intervention: Results from a Randomized Controlled Trial

Adherencia terapéutica en pacientes con diabetes mellitus tipo II y el uso de la tecnología móvil básica: una revisión sistemática = Therapeutic adherence in patients with diabetes mellitus type II and use of basic mobile technology: a systematic review

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