A Qualitative Analysis of Emergency Department Patients’ Experiences with TExT-MED, a Text-message Based mHealth Program to Improve Diabetes Management

Elizabeth Burner,¹Sanjay Arora,¹  Elena Taylor,²  Michael Menchine^1
1Keck Medical School of USC Department of Emergency Medicine ²USC Memory and Aging Center

Journal MTM 1:4S:42, 2012
DOI:10.7309/jmtm.63

Abstract

Background: In the United States, diabetes plagues Latinos, and their diabetes can be difficult to manage due to cultural, language and access barriers. The extent of benefits from mHealth technologies to improve the management of diabetes among low-income Latinos is currently unknown. Understanding the complex changes to self-efficacy and health beliefs can be difficult to measure quantitatively, especially in minority populations were traditional health belief models may not translate well culturally.

Methods: A text-messaged based educational and motivational program designed to improve disease knowledge, self-efficacy and glycemic control among low-income, inner-city Latinos was piloted for feasibility. Self-efficacy, diabetes knowledge and frequency of healthy behaviors were measured at the start and end of the trial. Focus groups were then convened to explore patient experiences with the program, and the program’s impact on patients’ self-efficacy and health beliefs. The findings of these sessions were used to reanalyze the quantitative data measured previously in the study.

Results: 23 patients were recruited for the feasibility study. Through qualitative analysis, we found thatmen and women had different information sources and differing self-efficacy towards diet management. Using this knowledge, the quantitative data gather was stratified by gender, and differential changes were noted between genders in diabetes knowledge, self-efficacy and healthy food choices.

Conclusions: Men and women have differences in self-efficacy towards diet management and information sources. These differences may affect the effectiveness of mHealth interventions to improve diabetes. Gender and culture should be considered when designing interventions to achieve maximal impact.

Are We Sure That Mobile Health Is Really Mobile?

Brie Turner-Mc Grievy,¹Deborah Tate^1
[1]Department of Health Promotion, Education and Behaviour, Arnold School of Medicine, University of Southern California

Journal MTM 1:4S:41, 2012
DOI:10.7309/jmtm.62

Abstract

The “m” in mHealth is often thought of as the ability to receive health information and monitor behaviors on the go. The term “wireless” stands in for smartphones, tablets, etc. that can travel through time and space; while “wired” is the traditional desktop access method. Little is known about how people actually use mobile vs. traditional access methods. This study examines the results of 2 mobile weight loss interventions (Pounds Off Digitally (POD 1 and 2)) where participants were required to own a mobile device (POD1: Mp3 player; POD2: smartphone) for study entry and received weight loss information delivered via podcast. In POD1, participants were randomized to theory-based podcast (TPB) (n=41) or general weight loss podcast (n=37) conditions. In POD2, participants were randomized to either TPB (n=49) or TPB+mobile (a diet/PA app and Twitter app) (n=47). Examining data from both studies in aggregate, despite a mobile delivery method, 75% of participants accessed the podcasts at their home or work, 65% were sitting when listening, and 55% used a non-mobile device to access the podcasts (desktop computers). Examining objective download data for POD2, 49% of downloads (2889/5944) originated from non-mobile delivery methods (e.g., QuickTime) vs. mobile platforms (3055/5944). At 3 months, 46% of posts to Twitter originated from the web site (n=665 posts) vs. an app (n=540; 38%) or dashboard tool (e.g. TweetDeck) (n=233; 16%). Combining POD1 and 2, use of a mobile device for podcasts access was not related to % weight loss or podcasts downloaded at 3 months, but number of podcasts downloaded was related to % weight loss (β=-0.13; P<0.01). In conclusion, providing people with multiple platforms may be more important than providing only mobile options. Future studies should examine why people choose wired over wireless methods and how we can tailor delivery method to optimize use.

Using social networking technologies for mixed methods HIV prevention research

Sean D Young,¹Devan Jaganath^2
[1]Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA ²David Geffen School of Medicine, University of California, Los Angeles, CA, USA

Journal MTM 1:4S:40, 2012
DOI:10.7309/jmtm.61

Abstract

Background: Rapid growth in social networking usage, especially among at-risk populations, enables these technologies to be used as tools for mixed (qualitative and quantitative) methods HIV prevention research. We seek to analyze quantitative and qualitative data from a study-recruited social networking group to determine 1) participants willingness to use social networking technologies for HIV prevention research, 2) the topics and content discussed on social networking groups, and 3) the relationship between online discussions about HIV-related behaviors and actual HIV behavior change, among men who have sex with men (MSM).

Methods: Participants, primarily African American and Latino, were invited to join a “secret” Facebook group where participation was voluntary. Peer leaders, trained in HIV prevention, posted HIV-related content. Participant public group conversations were qualitatively and thematically analyzed. Multivariate quantitative methods tested associations between qualitative data, participants’ demographic information, and likelihood of requesting a home-based HIV testing kit.

Results: Latino and African-American participants (N=57) voluntarily used Facebook to discuss the following HIV-related topics (N=485 conversations): Prevention and Testing; Stigma; Knowledge; and Advocacy. Older participants more frequently discussed Prevention and Testing, Stigma, and Advocacy, and younger participants more frequently engaged in HIV Knowledge-related discussions. The proportion of messages related to Prevention and Testing and HIV Stigma increased during the course of the study. Results showed that participants posting about HIV Prevention and Testing (compared to those who did not) were significantly more likely to request an HIV testing kit (OR 11.14, p = 0.001).

Conclusions: Social networking technologies are engaging platforms that can be used for increasing HIV prevention-related conversations behaviors. Data from these technologies can be analyzed used both qualitative and quantitative methods.

I’ll text you if there’s a problem: How the Canadian Cancer Society used live text chat to help you g adults quit smoking

Trevorvan Mierlo,^1,2
1Evolution Health Systems Inc. ²Henley Business School, University of Reading

Journal MTM 1:4S:39, 2012
DOI:10.7309/jmtm.60

Abstract

Background: Smoking rates are higher among young adults, especially in Quebec where 30% of 18-24 year-olds smoke. In 2010-2011, the Canadian Cancer Society (CCS) Quebec Division launched Phase I of SMAT (Service de Messageiretexte pour Arrêter le Tabac), which utilized proactive and reactive text messaging to promote cessation. Based on the success of Phase I, CCS Quebec launched Phase II in December 2011 adding live expert text chat.

Purpose: To test feasibility and outcomes of a proactive and reactive text messaging smoking cessation service including live text chat support by trained Quit Specialists.
MethodsText and Chat Integrated (TaChI) enabled telephone Quit Specialists to simultaneously coach multiple participants.

Results: Out of 994 participants 51% were male (n=508). 40.5% (n=403) were between 18-24 and 22.1% were full time students. On average, participants smoked 17 cigarettes per day for 12.3 years.

A total of 42,613 algorithm-based proactive messages were sent to participants.

65% (n=651) of participants used the reactive keyword text service, with equal usage by men and women. Keyword users tended to be younger (28 years) than non-keyword users (34 years), with the most popular keywords “distraction”, “envie” (translation: craving), and “stress” sent 825, 791 and 690 times, respectively.
A total of 1,099 text-chats occurred, with 38% (n=374) using the text-chat service at least once. Slightly more women 52% (n=196) than men 48% (n=178) chatted with a Quit Specialist.
Complete self-report cessation data is being collected. To date, 28% of respondents (8% of total participants) indicated via text survey that they had quit smoking.

Conclusions: Interactive features of the SMAT program (reactive messaging and text chat) were especially engaging, particularly among younger demographics. In order to remain relevant and efficient, cessation services must quickly react to the rapid adoption of new technological modalities. Limitations and future directions will be discussed.

Tailored Rapid Interactive Mobile Messaging (TRIMM) for Weight Management Among Underserved Adults

Michael K. Lin,¹Lawrence J.Cheskin^1
1John Hopkins Weight Management Centre

Journal MTM 1:4S:37-38, 2012
DOI:10.7309/jmtm.59

Abstract

Background: While obesity continues to escalate as an important clinical and public health problem, it remains a challenge for physicians to help obese patients lose weight. Most existing therapeutic options are limited in impact due to cost and accessibility.

Purpose: Our purpose was to develop a cost-effective, proven, and scalable obesity intervention that can be deployed as a sustainable treatment option for obesity.

Methods: We designed TRIMM as an automated, 6-month text message program that tailored itself in two main ways to offer individualized interaction and content for weight control. First, we targeted relevant behaviors at the opportune times by personalizing the program to each individual’s weight control challenges and daily routine. Second, we engaged participants with daily interactive messages that asked participants a question regarding their weight, motivation level, or health behavior. Upon receiving a participant’s response, we delivered finely-tailored feedback automatically, promoting accountability and self-monitoring.
The study is a two-arm randomized controlled trial of 118 overweight or obese adults recruited from inner city Baltimore churches. With the control group, we aimed to capture the standard care for an obese patient. Participants in this group received an initial clinic assessment and follow-up at months 3, 6, and 12 at the Johns Hopkins Weight Management Center. The intervention group received daily TRIMM text messages in addition to standard care.

Results: We have captured our primary outcome data, 6-month weight loss, and we’ll share our preliminary analyses here. Complete case analysis (42% of participants) indicates that the TRIMM group achieved more weight loss than the standard care group (8.0 lb vs 1.3 lb, p

Conclusions: Our small pilot study has limitations. The duration of the TRIMM program was only 6 months, and our study population was recruited exclusively from Baltimore churches. While 80% of participants returned for the intended 6-month follow-up, this trial had low rates of follow-up occurring within our protocol defined 6-month window due to challenges in scheduling of the follow-up visits during clinic hours and participants’ transportation to the clinic; this resulted in an underpowered study. For those participants who returned for their 6-month follow-up visit on time, our entirely automated program (that requires no personnel efforts beyond enrollment) resulted in significantly more weight loss when added to standard care. And, we observed encouragingly high levels of participant engagement and satisfaction with TRIMM. These results suggest that TRIMM can help some fraction of overweight and obese individuals lose weight. TRIMM’s low cost (< $1/week for an individual), scalability, and reach (no smartphone required) further supports its potential as a tool in the battle against obesity.

The study was funded by a McKesson Foundation Mobilizing for Health grant.
The authors conduct research at the Johns Hopkins Weight Management Center.
– Michael K. Lin is a Johns Hopkins medical student on hiatus and is supported by the Doris Duke Clinical Research Fellowship. Disclosures: team member, Reify Health, LLC.
– Lawrence J. Cheskin, MD is Associate Professor of Health, Behavior & Society at the Johns Hopkins Bloomberg School of Public Health and Director of the Johns Hopkins Weight Management Center. Disclosures: Stockholder, Scientific Advisory Board member, Medifast, Inc; stockholder, National Advisory Board member, Vivus, Inc.