Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part II): Assessment of Participants' Perceptions on Efficacy

Abstract

BackgroundAlthough there is great enthusiasm in both the public and private sector for the further development and use of large-scale consumer-facing public health applications for mobile platforms, little is known about user experience and satisfaction with this type of approach. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing, mobile phone-based health information service targeting type 2 diabetes, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. This program was marketed via large public health campaigns and drew many users within the respective communities.ObjectiveThe purpose of this investigation was to use the RE-AIM framework to document txt4health efficacy by focusing on perceptions of satisfaction, usage, and behavior change among individuals who used txt4health in pilot studies in Southeast Michigan and Greater Cincinnati.MethodsWe conducted a multimodal user survey with txt4health users recruited via text message through the program to understand participant perceptions of program use and satisfaction, as well as self-reported perceptions of behavior change as a result of using txt4health.ResultsTxt4health users reported very high levels of program satisfaction, with 67.1% (108/161) reporting satisfaction scores of ≥8 on a 10-point scale, with 10 equivalent to most satisfied (mean 8.2, SD 1.6). All survey participants agreed/strongly agreed that the messages included in txt4health were clear and easy to understand (100.0%, 160/160), and most found txt4health made them knowledgeable about their risk for type 2 diabetes (88.1%, 140/159) and made them conscious of their diet and physical activity (88.8%, 142/160). Most participants reported that txt4health helped them to make behavior changes related to diet; after having completed txt4health, most agreed/strongly agreed that they are more likely to replace sugary drinks, such as juice or soda, with water (78.0%, 124/159), have a piece of fresh fruit instead of dessert (74.2%, 118/159), substitute a small salad for chips or fries when dining out (76.1%, 121/159), buy healthier foods when grocery shopping (79.7%, 126/158), and eat more grilled, baked, or broiled foods instead of fried (75.5%, 120/159).ConclusionsResults from this study suggest that participants in txt4health, a large-scale, public health–focused text message program targeting type 2 diabetes, have positive perceptions of the program and that participation has led to positive behavior change.

Cell phone–based health education messaging improves health literacy

“…These findings were similar to other research finding, that texting was easily accepted by subjects. 24 SMS was found to affect the promotion of health awareness, 25 health knowledge, [26][27][28] and changing unhealthy behavior or improving therapy. [29][30][31][32][33][34] SMS was more effective than pamphlets in improving knowledge, attitude, and practices, especially in promoting physical activity.…”

Using Digital Technology to Engage and Communicate with Patients: A Survey of Patient Attitudes

“…23 Consumer e-health tools-electronic tools and services, including secure messaging between patients and providers, mobile health (mHealth) apps, and existing technologies used in novel ways-offer unique opportunities to improve patient-provider communication and facilitate patient engagement. [24][25][26] A growing body of evidence suggests that patient use of new technologies such as text messaging [27][28][29][30] or email 31 to communicate with healthcare providers can lead to behavior change and improved health outcomes for select patient populations. Novel digital technology tools for engaging a wider group of patients are rapidly emerging.…”

The Re-Aim Model From the Perspective of Telephone-Based Educational Programs on Diabetes

“…Patients with long-duration diabetes are less interested and motivated to maintain self-care actions, to adhere to pharmacological treatment, or to implement changes in their lifestyles compared to recently diagnosed patients. 21 Other outcomes, such as quality of life and patient satisfaction, also show the efficacy of telephone-based educational interventions. One study conducted in the United States in 2013 adopted the RE-AIM model to assess the efficacy of a health information service provided via mobile phone.…”

“…The study shows that health information provided via mobile phone was positive and promoted positive behavioral changes, especially in terms of eating habits and exercises. 21 One observational study conducted in the interior of São Paulo, Brazil, assessed the expectations and satisfaction of patients who received telephone-based diabetes follow-up and showed that 77.8% of the patients were satisfied with the information provided. 12 Assessing the efficacy of telephone-based educational interventions may represent advancement for health services.…”