Txt4health gets mixed results in type 2 diabetes study

A two-part study published in the Journal of Medical Internet Research found postive and negative aspects of a text message program used to raise type 2 diabetes risk awareness and to promote health behavior change‏.

Funded by the Office of the National Coordinator for Health Information Technology, part 1 of the study is an assessment of participant reach and adoption, while part 2 is an assessment of participants' perceptions on efficacy.

Under the Beacon Community Cooperative Agreement Program, txt4health, a free mobile service designed to help people understand their risk for type 2 diabetes and become more informed about the steps they can take to lead healthy lives, was launched in three Beacon Communities: the Southeast Michigan Beacon Community in Detroit, the Greater Cincinnati Beacon Community in Cincinnati and the Crescent City Beacon Community in New Orleans. 

During the 10-month txt4health pilots, 5,570 people enrolled in the program: 1,834 in Southeast Michigan and 3,736 in Greater Cincinnati.

"Although broadly focused public health text message interventions may have the potential to reach large populations and show high levels of engagement among some users, the level of individual engagement among participants varies widely, suggesting that this type of approach may not be appropriate for all," concludes the first part of the study, which conducted a retrospective records analysis of individual-level txt4health system usage data by focusing on enrollment and participant engagement in program pilots in Southeast Michigan and Greater Cincinnati.

In the second part of the study, researchers sought to document the txt4health program's efficacy in terms of participants' perceptions of program satisfaction, ease of use, and usefulness. A multimodal user survey with txt4health users, recruited via text message through the program, was conducted to understand participant perceptions of program use and satisfaction, as well as self-reported perceptions of behavior change as a result of using txt4health.

"Results 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," concluded the second part of the study, which revealed very high levels of program satisfaction among txt4health users.

In October, another study found early signs that mHealth could have a positive impact on behavior change for people with type 2 diabetes. Participants in the pilots received 4 - 7 messages per week, including general educational messages, diet and exercise tips, health reminders, and information about local healthcare providers and resources. They could also set and track progress toward weight loss and exercise goals by responding to text message prompts.

Despite their success, these community-based pilots encountered a number of challenges in the design, execution, evaluation and sustainability, according to JIMR article. "Beacon Communities encountered a number of barriers at each stage, including issues related to developing tailored, culturally competent messages; designing comprehensive outreach strategies; enrolling participants; engaging providers in mHealth programs; evaluating mHealth programs; and sustaining and scaling pilots." 

To learn more:
- read part1 and part 2 of the JMIR study