BACKGROUND
Gestational diabetes mellitus (GDM) affects 5-10% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM.
OBJECTIVE
This study aimed to perform user experience testing and assess usability and acceptability of a text messaging program (Text 4 Success) for women with GDM.
METHODS
An automated two-way texting program was developed. It included: 1) reminders to check blood glucoses, 2) positive feedback to user-reported glucoses, 3) weekly educational messages and 4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semi-structured interviews. For women in the usability study, glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percent of recommended SMBG checks performed (a secondary outcome).
RESULTS
Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (>90%). In comparing the week prior to the trial to the two weeks during the trial, there was a small but statistically insignificant difference in the percentage of recommended SMBG performed (median 93% [5 to 95 percentile 82-100%] vs median 97% [83-100%]).
CONCLUSIONS
Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have a low adherence to self-monitoring of blood glucose at baseline. Adaptations to the program will be made based on user suggestions. Further study of text messaging to improve SMBG in GDM is needed.
Barriers and facilitators of self-monitoring of blood glucose engagement among women with gestational diabetes mellitus in China: A mixed-methods study
