Studies have shown that mobile technology can help patients with heart disease improve self-care and disease management. Few studies, however, have explored why these programs are effective and their broader applicability to other disease settings, including diabetes. Understanding the underlying factors that interfere with good self-care practices among patients with diabetes may help with the development of mobile technologies that targeted this population.

Testing an Intervention

In a pilot study, Monica E. Peek, MD, MPH, and colleagues tested an interactive, mobile phone-based intervention in which patients with diabetes received a wide range of automated text messages. These messages provided tips on things like foot care, checking blood sugar, healthy eating, and physical activity. Other messages were reminders of upcoming physician visits or alerts to take medications. “We tailored the intervention to patients’ lifestyles, treatment regimens, and personal preferences,” says Dr. Peek. A study coordinator called patients several times throughout the study to ensure that messages were received and determine if patients wanted to change the timing of any messages.

With a bank of about 1,000 text messages that could be automatically delivered from a computer, Dr. Peek and colleagues expanded the intervention and published data on their findings in Diabetes Educator. For certain scenarios—such as a patient failing to respond to messages or responding three consecutive times that they had not taken their medication—an algorithm of alert messages was created so that a nurse care manager was notified directly.

“Patients would then be called back by the nurse care manager and offered potential solutions to their problems,” explains Dr. Peek. “The patient’s primary healthcare provider was then emailed so that they were aware of the situation. The tiered system of involvement in the health system was directed by patients and their interactions with the system. It wasn’t burdensome for providers, and patients were able to interact daily and get the responses they needed when they needed it.” She adds that, overall, patients participating in the pilot program felt a sense of social support from the messages and interaction with the study coordinator.

An Important Step Forward

Dr. Peek and colleagues found that their intervention led to improvements in medication taking, glucose monitoring, foot care, exercise, and healthy eating. Improvements were also seen in one or more measures of self-efficacy, social support, and perceived control. Participants reported that their knowledge and attitudes were affected positively by the program. “Identifying effective ways to help patients achieve behavioral changes in clinical practice is an important step toward improving outcomes,” Dr. Peek says. “Tools like our mobile phone intervention have the potential to improve self-care behaviors and empower patients to reach their diabetes-related goals.”



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