New diabetes texting programs have ambitious goals

After more than a year of testing the concept of using text messaging to change health behavior, a federal/state/local partnership is taking things to the next level.

It's a program called txt4health, developed on the model of text4baby, which just launched in three Beacon communities in New Orleans, Cincinnati and--most recently--in Detroit, late last week. The program uses text messaging to reduce residents' risks for Type 2 diabetes.

I talked this week with Nebeyou Abebe, program manager in New Orleans, to find out what the program's goals and ambitions are, and how achievable they may be. What interested me the most: The programs are pretty low-tech, and don't involve any sophisticated glucose monitoring, software-directed interventions or any high-tech devices other than a cell phone.

The initiative simply relies on somewhat personalized text messages to get users to stick with a diet, keep exercising and lose weight. No physicians or clinicians are involved, nor is any real clinical care. The program asks users to take a simple diabetes risk assessment, and using that information, tailors a series of texts over a 14-week period to motivate patients. For example, if a patient has committed to exercising three times per week, but only exercises once in a given week, that patient will receive a text encouraging them to get back on track the following week in order to meet their goal of a 10-pound weight loss.

What sets this initiative apart, in my mind, is its very public face. Unlike small pilot texting projects conducted over the past two years, this project has a major marketing campaign behind it, designed to ramp up participation, Abebe says. It boasts more than 30 outdoor billboards, as well as a raft of 15- to 30-second radio and television ads that are showing now; they will continue to air for the program's 15-month duration.

The initiative even has "grassroots" efforts to gin up interest, Abebe says. Program staff will appear at New Orleans Hornets basketball games, Walmart health fairs and other events around the city. They're even pushing a "faith-based initiative" offering educational sessions at churches, and asking religious leaders to encourage participation.

The goal: 10,000-plus participants by the first quarter of 2013. That's 5 percent of the 200,000 target population the program is focusing on, he notes.

Interestingly, some of the individual text messages will have a community-engagement component, designed to get users involved in local health events, Abebe says. For example, if the National Association for the Advancement of Colored People (NAACP) is holding a wellness fair, the txt4health program will send out messages to African-Americans, Hispanics and other users to encourage them to attend.

One area that hasn't been as nailed down is how to determine clinical success. Abebe says the program hopes about half of enrollees will actually complete the 14-week series, but they aren't sure yet what to expect in terms of compliance or weight loss.

With that said, txt4health's sibling program, text4baby, has had relative success over the past year, so it'll be interesting to see how text-based interventions translate into care for a chronic condition like diabetes, rather than a shorter-term issue such as pregnancy. - Sara