Automated text-messaging holds promise for diabetes management

Results of two new studies published in Health Affairs and the Journal of Medical Internet Research indicate that text-based mHealth interventions are potentially effective in helping diabetics manage their conditions. 

At the University of Chicago Medicine, researchers evaluated a disease management program that is based on the use of mobile phones for members of the employee health plan. Called CareSmarts, the program uses automated text-messaging software to engage patients in self-care and to facilitate care coordination between nurses at the health plan and physicians at the medical center.

Their study, conducted between May 2012 and February 2013, included participant and nonparticipant adults with diabetes. Clinical outcomes, utilization and costs were all taken into consideration. Researchers observed a net cost savings of 8.8 percent, suggest that mHealth programs can support healthcare organizations' pursuit of the triple aim of improving patients' experiences with care, improving population health, and reducing the per capita cost of healthcare.

"University of Chicago Medicine's experience with a mobile health diabetes program suggests that connected health solutions hold promise for supporting chronic disease self-care, improving clinical outcomes, and reducing costs," concludes the article's authors. "Our study offers early evidence that mHealth can enable health care organizations to effectively support patients beyond the traditional healthcare setting and achieve the triple aim of better health, better health care, and lower costs."

A separate study published in JMIR found that low-income Latino diabetes patients will accept text messages as a behavioral intervention. Called TExT-MED (Trial to Examine Text Messaging for Emergency Department patient with Diabetes), it is a fully-automated, text message-based program designed to increase knowledge, self-efficacy and subsequent disease management and glycemic control.

Five focus group interviews were conducted with 24 people who participated in TExT-MED. Through analysis of transcripts, researchers identified that the strengths of the program were messages that cued specific behaviors such as medication reminders and challenge messages. In addition, they found that increasing personalization of message delivery and content could augment these cues.

"This analysis shows that a fully automated mHealth intervention tailored for low-income Latinos with diabetes is acceptable and persuasive for the target audience," concludes the article's authors. "This low-cost, scalable mHealth intervention acts as a behavioral trigger rather than a patient education platform. Increased personalization is an opportunity to enhance the strength of these cues to action."

A similar pilot conducted by the University of Minnesota, whose findings were recently published in JMIR's mHealth and uHealth, supported the feasibility and value of a text messaging assessment delivery system for use with Latino adolescent females. Adolescent Latina youth were sought because they represent the largest and fastest growing ethnic minority group in the United States. 

As part of the study, the Youth Ecological Momentary Assessment System was developed to collect automated texted reports of daily activities, behaviors and attitudes among adolescents. The system was created to collect and transfer real-time data about individual- and social-level factors that influence physical, mental, emotional and social well-being.

To learn more:
- read the Health Affairs abstract
- read the JMIR article