Open AccessUser Engagement Among Diverse Adults in a 12-Month Text Message–Delivered Diabetes Support Intervention: Results from a Randomized Controlled Trial
Author(s) -
Lyndsay A. Nelson,
Andrew J. Spieker,
Robert A. Greevy,
Lauren M. LeStourgeon,
Kenneth A. Wallston,
Lindsay S. Mayberry
Publication year - 2020
Publication title -
jmir mhealth and uhealth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.356
H-Index - 50
ISSN - 2291-5222
DOI - 10.2196/17534
Subject(s) - psychological intervention , randomized controlled trial , thematic analysis , coaching , psychology , intervention (counseling) , health coaching , medicine , health promotion , health care , mhealth , qualitative research , nursing , public health , social science , surgery , sociology , economic growth , economics , psychotherapist
Background Text message–delivered interventions are a feasible and scalable approach for improving chronic disease self-care and reducing health disparities; however, information on long-term user engagement with these interventions is limited. Objective The aim of this study is to examine user engagement in a 12-month text message–delivered intervention supporting diabetes self-care, called REACH (Rapid Education/Encouragement And Communications for Health), among racially and socioeconomically diverse patients with type 2 diabetes (T2D). We explored time trends in engagement, associations between patient characteristics and engagement, and whether the addition of a human component or allowing patients to change their text frequency affected engagement. Qualitative data informed patients’ subjective experience of their engagement. Methods We recruited patients with T2D for a randomized trial evaluating mobile phone support relative to enhanced treatment as usual. This analysis was limited to participants assigned to the intervention. Participants completed a survey and hemoglobin A1c (HbA1c) test and received REACH text messages, including self-care promotion texts, interactive texts asking about medication adherence, and adherence feedback texts. For the first 6 months, texts were sent daily, and half of the participants also received monthly phone coaching. After 6 months, coaching stopped, and participants had the option to receive fewer texts for the subsequent 6 months. We defined engagement via responses to the interactive texts and responses to a follow-up interview. We used regression models to analyze associations with response rate and thematic and structural analysis to understand participants’ reasons for responding to the texts and their preferred text frequency. Results The participants were, on average, aged 55.8 (SD 9.8) years, 55.2% (137/248) female, and 52.0% (129/248) non-White; 40.7% (101/248) had ≤ a high school education, and 40.7% (101/248) had an annual household income