Lyndsay A. Nelson|Andrew J. Spieker|Robert A. Greevy|Lauren M. LeStourgeon|Kenneth A. Wallston|Lindsay S. Mayberry
User Engagement Among Diverse Adults in a 12-Month Text Message–Delivered Diabetes Support Intervention: Results from a Randomized Controlled Trial
Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center
background text messagedelivered interventions feasible scalable approach improving chronic disease selfcare reducing health disparities however information longterm user engagement interventions limited objective aim study examine user engagement 12month text messagedelivered intervention supporting diabetes selfcare called reach rapid educationencouragement communications health among racially socioeconomically diverse patients type 2 diabetes t2d explored time trends engagement associations patient characteristics engagement whether addition human component allowing patients change text frequency affected engagement qualitative data informed patients subjective experience engagement methods recruited patients t2d randomized trial evaluating mobile phone support relative enhanced treatment usual analysis limited participants assigned intervention participants completed survey hemoglobin a1c hba1c test received reach text messages including selfcare promotion texts interactive texts asking medication adherence adherence feedback texts first 6 months texts sent daily half participants also received monthly phone coaching 6 months coaching stopped participants option receive fewer texts subsequent 6 months defined engagement via responses interactive texts responses followup interview used regression models analyze associations response rate thematic structural analysis understand participants reasons responding texts preferred text frequency results participants average aged 558 sd 98 years 552 137248 female 520 129248 nonwhite 407 101248 high school education 407 101248 annual household income ltus 25000 median response rate interactive texts 91 iqr 7597 12 months engagement gradually declined throughout intervention remained high engagement differ age gender education income diabetes duration insulin status health literacy numeracy black race worse baseline medication adherence hba1c associated lower engagement although effects small nearly half participants chose continue receiving daily texts last 6 months intervention participants continued daily text messages said wanted continue experiencing benefits health whereas chose fewer texts said daily texts helped create routines longer needed often engagement impacted receiving coaching participants chosen text frequency conclusions welldesigned interactive text messages engage diverse patients selfcare intervention least 1 year variation reasons frequency preference suggest offering frequency choice may important users engagement