Use of Booster Calls in a Behavioral Intervention for Adolescents with Type 1 Diabetes

Rachel Sweenie,¹ Linda Herbert,¹Eleanor Macky,¹Clarissa Holmes,² Randi Streisand,^1
1Children’s National Medical Centre²Virginia Commonwealth University

Journal MTM 1:4S:16, 2012
DOI:10.7309/jmtm.39

Abstract

Behavioral interventions are commonly utilized to prevent declines in adherence and glycemic control among adolescents with type 1 diabetes (T1D). Mobile health strategies may maintain participant engagement and improve retention rates and outcomes in such interventions. The present study explored the use of booster calls (BCs; quick telephone check-ins), in maintaining participant engagement throughout an ongoing RCT for adolescents with T1D.

Data are available from 143 adolescent-parent dyads (Mchild age= 12.96 years) who were randomized to the treatment condition. Most adolescents were female (54%) and Caucasian (68%), and ninety-two percent of parents were mothers. Most were prescribed a basal bolus or pump regimen (75%), and average glycosolatedhemoglobin (HbA1c) at baseline was 8.69%. Dyads participated in four treatment sessions designed to improve coping skills and promote medical regimen adherence. BCs were conducted one month after each session, and participants completed follow-up assessment 3 months after their final session.

Ninety-six percent of participants completed at least one BC; 29% completed all four. On average, 2.88 contact attempts were made per BC and completed calls lasted eight minutes. Adolescents on a basal bolus/pump regimen were more likely to complete BCs (p < .05); however, child age, gender, and A1c were unrelated to BC completion. Families who completed at least one BC were more likely to participate in follow-up assessment (p < .05). Overall, families reported that BCs were “somewhat helpful” (34%), or “pretty helpful”/ “very helpful” (46%).

Many families participated in BCs and found them helpful, and completion of BCs was related to participant retention at 3 month follow-up, suggesting that this mHealth strategy may be a promising tool for improving participant retention and treatment outcomes in behavioral interventions. Further exploration of the use of mhealth strategies among adolescents with T1D participating in behavioral RCTs and their families is warranted.

Use of parent consultants in a telehealth intervention for parents of children newly diagnosed with Type 1 diabetes

Randi Streisand,¹Linda Herbert,¹Victoria Owen,¹Maureen Monaghan^1
1Children’s National Medical Centre

Journal MTM 1:4S:15, 2012
DOI:10.7309/jmtm.38

Abstract

Management of type 1 diabetes (T1D) in young children requires significant parent effort and parents often report feeling overwhelmed following diagnosis. The current study examined the use of a novel mHealthcomponent, parent consultant (PC) contact via telephone, to augment an ongoing randomized controlled trial for parents of young children recently diagnosed with diabetes. Pilot data are available on the PC development and training process and from 13 parents randomized to the treatment condition.

Four out of 5 parents who were invited to serve as PCs completed a 4-hour PC training with our team. All PCs (100% female; 75% Caucasian) had children diagnosed with T1D at a young age (M age at diagnosis=3.72 years; M disease duration=4.87 years). Usage and satisfaction data were examined from 13 primary caregivers (100% female; 76.9% Caucasian) of children age 2-6 with T1D (M age=4.85 years).

The 13 participants randomized to the treatment condition were offered optional PC telephone contact (up to 4 contacts) to augment the intervention (5 telephone sessions with a research counselor).. All but one participant (92.3%) agreed to PC phone contact, and thus far, 7 participants (58.3%) have successfully connected with their assigned PC, ranging from 1-3 phone contacts. PC phone calls ranged from 16-60 minutes and covered a variety of topics including diabetes management, school concerns, nutrition, and sleep.

Satisfaction data suggest that use of a PC via an augmented mHealth strategy (telephone contact) is feasible, and can be a positive addition to behavioral interventions. Participants noted that PCs were ‘extremely helpful,’ with one parent commenting “I loved this”… component. Connecting with trained PCs with a shared history of parenting a young child with T1D may offer additional benefits to regularly used mHealth strategies by promoting parental adjustment to diabetes, quality of life, and child physical and emotional well-being.

Utilizing mHealth Recruitment & Retention Strategies in an RCT with Young Children with Type 1 Diabetes

Victoria Owen,¹LaurenPascarellal,¹LindaHerbert,¹FranCogen,¹RandiStreisand,^1
1Children’s National Medical Centre

Journal MTM 1:4S:14, 2012
DOI:10.7309/jmtm.37

Abstract

Due to an increase in cell phone and email use in recent years, mHealth strategies are commonly used in research data collection and intervention delivery and provide increased flexibility for scheduling and completing assessments and treatment sessions. Dissemination of effective mHealth strategies is vital to their successful use in future studies. The goal of the current study was to examine the use of mHealth strategies in an ongoing RCT to promote parental management of type 1 diabetes (T1D) in young children and specifically explore recruitment/data collection completion/retention rates.

Primary caregivers of children with T1D who were fluent in English and had telephone access completed an eligibility phone screener, a pretreatment phone assessment, an in-person orientation session, 5 telephone-based program sessions, and 3 post-treatment phone assessments. mHealth recruitment/retention strategies included flexible scheduling of assessments/interventions, email communication, and frequent contact according to participants’ phone/email preference.

Of 285 recruits, 16 did not meet inclusion criteria. No recruits were ineligible due to lack of telephone access. The majority of eligible recruits (82.3%) agreed to participate and completed all phone sessions (85% of intervention and 98% of control participants). Most treatment/control phone sessions were completed as scheduled (73%); only 7% needed to be rescheduled more than once. Interruptions occurred for 24% of sessions, with the most frequent interruption being child-related. Of the 127 participants in the study’s follow up portion, over 90% have been completed.

For the current RCT, mHealth strategies encouraged high recruitment/retention in program sessions and follow up and resulted in few rescheduled/interrupted sessions. This may suggest that phone contact for assessment as well as intervention is a strong medium for consistent participant contact. Continuation of flexible contact and the extension of text message reminders, Skype intervention sessions, and online questionnaires may be desirable options for encouraging higher retention rates in future projects.

Using Mobile Technology to Promote Healthy Behaviors in Teens

Misbah Mohammed,¹Meghan Searl,¹Khinlei Myint-U,¹Joseph Kvedar,¹Kamal Jethwani,^1
1Center for Connected Health, Partners Healthcare, Boston MA, USA

Journal MTM 1:4S:13, 2012
DOI:10.7309/jmtm.36

Abstract

The prevalence of childhood obesity has more than tripled in the past 30 years. To combat this growing problem it is essential that public health interventions promote healthy eating and regular physical activity (PA). In March 2011 the Center for Connected Health (CCH) launched the Partners Step it UP program to 200 elementary students at two Boston schools. The health promotion program incorporates PA tracking using a pedometer, educational feedback relating to physical activity and a fun team-oriented foot race. This year the program expanded to 6 schools and 400 students. The program has met with huge success and CCH is currently exploring ways to modify the Step it UP program for use among high school students. As a first step in understanding the needs and preferences of this group, we conducted a focus group session with twenty-four 9th graders to understand what features they would want included in a health promotion program. Participants revealed that on average they text 300times/day and would like this to be a way to engage in this program. Participants also provided useful feedback on the frequency of messages to send, how to frame messages and discussed the importance of competition and incentives to drive health behavior changes. These findings have provided CCH with a clear understanding of how to develop a health promotion program for this population. Thirty high school students will be recruited to participate in a11-week pilot study. The participants will be divided into 2 groups based on their PA levels during Week 1 and will compete to earn points based on their PA level during the study. The purpose of this pilot study is to engage high school students in the program, increase and sustain students’ level of PA, and understand the role of team competition in promoting healthy behavior change.

NightWatch 2.0: The Role of Mobile Phones in Malaria BCC

Hannah Bowen^1
1Malaria No More

Journal MTM 1:4S:11-12, 2012
DOI:10.7309/jmtm.35

Abstract

Two years ago, as governments across Africa began ramping up delivery of mosquito nets, diagnostic tests, and malaria treatments, we asked ourselves: how can we ensure these investments in malaria control tools translate into malaria control behavior (and therefore, into malaria control success)? Our answer: NightWatch. The idea is simple: send out messages with a signature style – delivered by recognized local celebrities – through multiple media channels every night, reminding people to protect themselves from malaria.

Developed by Malaria No More and Lalela Project, the NightWatch program aims to increase the utilization of malaria control tools, such as mosquito nets, through a targeted communications campaign. NightWatch campaigns in Senegal, Tanzania, Cameroon, and Chad all began with radio and TV spots, but immediately expanded to reach individuals through their mobile phones with SMS reminders to sleep under a mosquito net. NightWatch SMS messages are free to subscribers – and to Malaria No More – thanks to generous in-kind donations by leading African telecoms. Mobile partners MTN (Cameroon), Airtel (Chad), and Tigo (Senegal) have generously sent SMS messages to over 10 million subscribers. The messages are distinguished from “spam” by coming from trusted sources – the companies themselves, the Ministries of Health, and celebrity spokespeople.

Our research shows that SMS is expanding the reach of NightWatch and impacting behavior. In Cameroon, the “K.O. Palu” (“Knock Out Malaria”) NightWatch program reached over 6.8 million adults. In a nationally representative survey (n=2,176 adults 15+) conducted in March/April 2012, 22% of all respondents recalled receiving an SMS and one or more other elements of the campaign (anthem, radio or TV ads), and 8% – representing over 875,000 adults – only recalled the SMS without other elements; 30% recalled some element(s) of the campaign but not SMS and 40% did not recall the campaign. Thus, SMS not only increased the reach of the campaign by 15% over what it otherwise would have been, but also reinforced the messages for a large portion of the total campaign audience.

Analysis of the link between NightWatch campaign exposure and malaria control behavior in the Cameroon 2012 survey data shows a strong impact of the campaign on net use. Cameroonians exposed to the campaign were 13% more likely to sleep under a net, and 24% more likely to have their children sleep under a net, than those not exposed. Even after controlling for other factors through propensity score matching analysis, K.O. Palu NightWatch exposure was associated with 7 percentage point higher net usage by adults (12 percentage point higher net usage by respondents’ children) in households with at least one net.

However, our research suggests that the added value of SMS is still limited. Analyzed on its own, exposure to SMS still had a positive impact on net use, but not as large or significant as the impact of the K.O. Palu anthem or the joint impact of NightWatch elements together. Therefore, we are focusing on next steps: how do we build on the early success of SMS to use mobile phones better, to make NightWatch more interactive and engaging?

We’ve already begun experimenting with more interactive and engaging ways of incorporating mobile phones into NightWatch. In Tanzania, audience members were encouraged to vote via SMS for winners in the televised 2011 Tanzanian Gospel Music Awards; of more than 3 million subscribers who received voting reminders with malaria messaging, 192,000 responded by voting – and received another malaria-themed message. But we want to go further – using pre-recorded voice messages from celebrities to reach illiterate phone users, linking our successful malaria anthems to ring tones and call tones, having a presence on social media (accessed on mobile phones), and incorporating call-ins and SMS input into local radio programs.

With generous support from the IWG mHealth catalytic grant mechanism, funded by the Norwegian Agency for Development Cooperation (Norad) and implemented in partnership with the World Health Organization (WHO) and mHealth Alliance, Malaria No More will expand NightWatch mobile phone tools in Tanzania in 2013-2014. The lessons learned in Tanzania will then be used to enhance the mobile phone elements of NightWatch in other countries as well. Elements of the program that are successful in Tanzania can be rolled out with mobile phone partners in Cameroon, Chad, and Senegal. The results of the NightWatch mobile expansion will also be shared within the malaria control community to encourage adoption of interactive and engaging communication strategies by national malaria control programs.