Research Activities, October 2013
Mobile phones can help patients with their diabetes self-care
Need help with diabetes self-care? Eventually you may get this help by checking your mobile phone for reminders, educational or encouraging text messages, and even feedback on your texted self-reports, according to a new study.
Self-management is the key to good outcomes for the more than 9 percent of U.S. adults affected by type 2 diabetes. Adapting a commercial automated text-messaging program allowed researchers to develop a 4-week program that delivers support in the form of cell phone text messages, as a substitute for human-moderated support groups that require substantial staff resources. However, the system was designed such that certain responses to messages would trigger an alert to the care manager, who would follow up by calling the patient, according to a pair of papers on the intervention from the same research group.
The studies, supported by AHRQ (T32 HS00084), are briefly summarized here.
Nundy, S., Dick, J.J., Solomon M.C., and others (2013, January). "Developing a behavioral model for mobile phone-based diabetes interventions." Patient Education and Counseling 90(1), pp. 125-132.
In this paper, the researchers pilot-tested the mobile phone-based intervention on 18 black adults with type 2 diabetes for 4 weeks, followed by in-depth, individual interviews with each participant. The interviews were audiotaped, transcribed verbatim, coded, and analyzed to identify emerging themes. The patients (mean age of 55 years) had been diagnosed with diabetes for an average of 8 years. Two-thirds of the patients had at least 6 years of experience with cell phone calling and text messaging. Based on the interviews, the constant, daily communications reduced denial of diabetes and reinforced the importance of self-management. Also, responding positively to questions about self-management increased confidence in self-care. Most surprisingly, participants viewed the automated program as a "friend" and "support group," the researchers found.
Nundy, S., Dick, J.J., Goddu, A.P., and others (2012). "Using mobile health to support the Chronic Care Model: Developing an institutional initiative." International Journal of Telemedicine and Applications, 8 pp.
In this paper, the researchers focused on the processes involved in developing the mobile phone system, pilot-testing the intervention, modifying the system based on the pilot study's findings, and putting it into wider, long-term use at six clinics associated with the large, urban medical center where the diabetes intervention was developed. The researchers note that patients receive 2-week educational modules in each topic area (medications—if appropriate, glucose monitoring, nutrition, foot care, exercise, and living with a chronic disease), which are dynamically tailored based on the patient's expressed interests and self-reported adherence information. The care model is estimated to require one full-time-equivalent (FTE) care manager per 300 enrolled patients, and software licensing and other technology-related expenses cost $25/enrollee/month. This is a substantially lower cost than other care management programs described in the scientific literature, which typically serve 30–100 patients per FTE care manager.