Supplemental Text Message Support With the National Diabetes Prevention Program: Pragmatic Comparative Effectiveness Trial

Background The evidence-based National Diabetes Prevention Program (NDPP) is now widely disseminated, yet strategies to increase its effectiveness are needed, especially for underserved populations. The yearlong program promotes lifestyle changes for weight loss and can be offered in-person, online, via distance learning, or a combination of modalities. Less is known about which delivery features are optimal and may help address disparities in outcomes for subgroups. We previously demonstrated the efficacy of a stand-alone text messaging intervention based on the NDPP (SMS4PreDM) in a randomized controlled trial in a safety net health care system. Upon broader dissemination, we then showed that SMS4PreDM demonstrated high retention and modest weight loss at a relatively low cost, suggesting the potential to improve in-person NDPP delivery. Objective In this study, we aim to compare the effectiveness of in-person NDPP classes with and without supplementary SMS4PreDM on attendance and weight loss outcomes to determine whether text messaging can enhance in-person NDPP delivery for a safety net patient population. Methods From 2015 to 2017, patients with diabetes risks were identified primarily from provider referrals and enrolled in NDPP classes, SMS4PreDM, or both per their preference and availability. Participants naturally formed three groups: in-person NDPP with SMS4PreDM (n=236), in-person NDPP alone (n=252), and SMS4PreDM alone (n=285). This analysis compares the first two groups to evaluate whether supplemental text messaging may improve in-person NDPP outcomes. Outcomes for SMS4PreDM-only participants were previously reported. NDPP classes followed standard delivery guidelines, including weekly-to-monthly classes over a year. SMS4PreDM delivery included messages promoting lifestyle change and modest weight loss, sent 6 days per week for 12 months. Differences in characteristics between intervention groups were assessed using chi-square and t tests. Differences in NDPP attendance and weight loss outcomes were analyzed with multivariable linear and logistic regressions. Results The mean age was 50.4 years (SD 13.9). Out of a total of 488 participants, 76.2% (n=372) were female and 59.0% (n=288) were Hispanic. An additional 17.2% (n=84) were non-Hispanic white and 12.9% (n=63) were non-Hispanic black. A total of 48.4% (n=236) of participants elected to receive supplemental text message support in addition to NDPP classes. Participants who chose supplemental text message support were on average 5.7 (SD 1.2) years younger (P<.001) than the 252 participants who preferred in-person classes alone. Relatively more women and Hispanic individuals enrolled in the NDPP with supplemental text messages than in NDPP classes alone, 83.9% (n=198) vs 69.0% (n=174, P<.001) and 68.6% (n=162) vs 50.0% (n=126, P=.001), respectively. Attendance and weight loss outcomes were comparable between groups. Conclusions Despite its appeal among priority populations, supplemental text messaging did not significantly increase attendance and weight loss for the in-person NDPP. Further research is needed to identify optimal strategies to improve the effectiveness of the NDPP.

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Supplemental Text Message Support With the National Diabetes Prevention Program: Pragmatic Comparative Effectiveness Trial (Preprint)

10.2196/preprints.15478 ◽

2019 ◽

Author(s):

Natalie D Ritchie ◽

Silvia Gutiérrez-Raghunath ◽

Michael Josh Durfee ◽

Henry Fischer

Keyword(s):

Weight Loss ◽

Prevention Program ◽

Text Messaging ◽

Diabetes Prevention ◽

Text Message ◽

Diabetes Prevention Program ◽

Safety Net ◽

Text Messages ◽

Modest Weight Loss ◽

Weight Loss Outcomes

BACKGROUND The evidence-based National Diabetes Prevention Program (NDPP) is now widely disseminated, yet strategies to increase its effectiveness are needed, especially for underserved populations. The yearlong program promotes lifestyle changes for weight loss and can be offered in-person, online, via distance learning, or a combination of modalities. Less is known about which delivery features are optimal and may help address disparities in outcomes for subgroups. We previously demonstrated the efficacy of a stand-alone text messaging intervention based on the NDPP (SMS4PreDM) in a randomized controlled trial in a safety net health care system. Upon broader dissemination, we then showed that SMS4PreDM demonstrated high retention and modest weight loss at a relatively low cost, suggesting the potential to improve in-person NDPP delivery. OBJECTIVE In this study, we aim to compare the effectiveness of in-person NDPP classes with and without supplementary SMS4PreDM on attendance and weight loss outcomes to determine whether text messaging can enhance in-person NDPP delivery for a safety net patient population. METHODS From 2015 to 2017, patients with diabetes risks were identified primarily from provider referrals and enrolled in NDPP classes, SMS4PreDM, or both per their preference and availability. Participants naturally formed three groups: in-person NDPP with SMS4PreDM (n=236), in-person NDPP alone (n=252), and SMS4PreDM alone (n=285). This analysis compares the first two groups to evaluate whether supplemental text messaging may improve in-person NDPP outcomes. Outcomes for SMS4PreDM-only participants were previously reported. NDPP classes followed standard delivery guidelines, including weekly-to-monthly classes over a year. SMS4PreDM delivery included messages promoting lifestyle change and modest weight loss, sent 6 days per week for 12 months. Differences in characteristics between intervention groups were assessed using chi-square and t tests. Differences in NDPP attendance and weight loss outcomes were analyzed with multivariable linear and logistic regressions. RESULTS The mean age was 50.4 years (SD 13.9). Out of a total of 488 participants, 76.2% (n=372) were female and 59.0% (n=288) were Hispanic. An additional 17.2% (n=84) were non-Hispanic white and 12.9% (n=63) were non-Hispanic black. A total of 48.4% (n=236) of participants elected to receive supplemental text message support in addition to NDPP classes. Participants who chose supplemental text message support were on average 5.7 (SD 1.2) years younger (P<.001) than the 252 participants who preferred in-person classes alone. Relatively more women and Hispanic individuals enrolled in the NDPP with supplemental text messages than in NDPP classes alone, 83.9% (n=198) vs 69.0% (n=174, P<.001) and 68.6% (n=162) vs 50.0% (n=126, P=.001), respectively. Attendance and weight loss outcomes were comparable between groups. CONCLUSIONS Despite its appeal among priority populations, supplemental text messaging did not significantly increase attendance and weight loss for the in-person NDPP. Further research is needed to identify optimal strategies to improve the effectiveness of the NDPP.

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Presessions to the National Diabetes Prevention Program May be a Promising Strategy to Improve Attendance and Weight Loss Outcomes

American Journal of Health Promotion ◽

10.1177/0890117118786195 ◽

2018 ◽

Vol 33 (2) ◽

pp. 289-292 ◽

Cited By ~ 6

Author(s):

Natalie D. Ritchie ◽

Peter G. Kaufmann ◽

R. Mark Gritz ◽

Katherine A. Sauder ◽

Jodi Summers Holtrop

Keyword(s):

Health Care ◽

Weight Loss ◽

Health Care System ◽

Prevention Program ◽

Diabetes Prevention ◽

Diabetes Prevention Program ◽

Safety Net ◽

Analysis Of Covariance ◽

Weight Loss Outcomes ◽

Care System

Purpose: The National Diabetes Prevention Program (NDPP) is a widely disseminated lifestyle intervention. Attendance is problematic, leading to suboptimal weight loss, especially among racial/ethnic minority participants. We conducted a novel “presession” protocol to improve engagement of diverse NDPP candidates, comparing NDPP participants who attended a presession to those who did not on attendance and weight loss outcomes. Design: Longitudinal cohort study. Setting: A safety net health-care system. Participants: A total of 1140 patients with diabetes risks (58.9% Hispanic, 19.8% non-Hispanic black, 61.8% low income). Intervention: The NDPP has been delivered in a Denver, Colorado health-care system since 2013. The program included 22 to 25 sessions over 1 year. Beginning September 2016, individuals were required to attend a presession before enrollment that focused on (1) increasing risk awareness, (2) motivational interviewing to participate in the NDPP, and (3) problem-solving around engagement barriers. Measures: Duration and intensity of NDPP attendance and weight loss. Analysis: Outcomes of 75 presession participants who enrolled in the NDPP were compared to 1065 prior participants using analysis of covariance and multivariable logistic regression. Results: Presession participants stayed in the NDPP 99.8 days longer ( P < .001) and attended 14.3% more sessions ( P < .001) on average than those without a presession. Presession participants lost 2.0% more weight ( P < .001) and were 3.5 times more likely to achieve the 5% weight loss target ( P < .001). Conclusion: Presessions may improve NDPP outcomes for individuals from diverse backgrounds. A full-scale trial is needed to determine whether presessions reliably improve NDPP effectiveness.

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Secondary Impact of Social Media via Text Message Screening for Type 2 Diabetes Risk in Kuwait: Survey Study

JMIR Diabetes ◽

10.2196/20532 ◽

2020 ◽

Vol 5 (4) ◽

pp. e20532

Author(s):

Naeema Alqabandi ◽

Ebaa Al-Ozairi ◽

Adel Ahmed ◽

Edgar L Ross ◽

Robert N Jamison

Keyword(s):

Type 2 Diabetes ◽

Health Care ◽

At Risk ◽

Social Media ◽

Prevention Program ◽

Text Messaging ◽

Diabetes Prevention ◽

Text Message ◽

Diabetes Prevention Program

Background Type 2 diabetes mellitus (T2DM) is an international problem of alarming epidemic proportions. T2DM can develop due to multiple factors, and it usually begins with prediabetes. Fortunately, this disease can be prevented by following a healthy lifestyle. However, many health care systems fail to properly educate the public on disease prevention and to offer support in embracing behavioral interventions to prevent diabetes. SMS messaging has been combined with cost-effective ways to reach out to the population at risk for medical comorbidities. To our knowledge, the use of nationwide SMS messaging in the Middle East as a screening tool to identify individuals who might be at risk of developing T2DM has not been reported in the literature. Objective The primary aim of this study was to assess the feasibility of conducting a series of SMS messaging campaigns directed at random smartphone users in Kuwait for the detection and prevention of T2DM. It was predicted that 1% of those receiving the text message would find it relevant and participate in the study. The secondary aim of this study was to assess the incidence of participation of those who were forwarded the initial text message by family members and friends. Methods In this study, 5 separate text message screening campaigns were launched inviting recipients to answer 6 questions to determine the risk of developing T2DM. If subjects agreed to participate, a link to the prediabetes screening test devised by the Centers for Disease Control and Prevention was automatically transmitted to their mobile devices. Those identified as high risk were invited to participate in a diabetes prevention program. Results A total of 180,000 SMSs were sent to approximately 6% of the adult population in Kuwait. Of these, 0.14% (260/180,000) of the individuals who received the SMS agreed to participate, of whom 58.8% (153/260) completed the screening. Surprisingly, additional surveys were completed by 367 individuals who were invited via circulated SMS messages forwarded by family members and friends. Altogether, 23.3% (121/520) qualified and agreed to participate in a diabetes prevention program. The majority of those who chose to participate in the prevention program were overweight, aged 45-65 years, and reported being less physically active than those who chose not to participate (χ22=42.1, P<.001). Conclusions Although health care screening via text messaging was found to have limited effectiveness by itself, it exhibited increased reach through shared second-party social media messaging. Despite the fact a subpopulation at possible risk of developing T2DM could be reached via text messaging, most responders were informed about the screening campaign by family and friends. Future research should be designed to tap into the benefits of social media use in health risk campaigns.

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Presessions to the National Diabetes Prevention Program Are a Promising Strategy to Improve Attendance and Weight Loss Outcomes

Diabetes ◽

10.2337/db18-246-or ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 246-OR

Author(s):

NATALIE RITCHIE ◽

PETER G. KAUFMANN ◽

MARK GRITZ ◽

JODI S. HOLTROP

Keyword(s):

Weight Loss ◽

Prevention Program ◽

Diabetes Prevention ◽

Diabetes Prevention Program ◽

Promising Strategy ◽

Weight Loss Outcomes

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Evaluation and Refinement of a Bank of Text Messages to Promote Behaviour Change Adherence Following a Diabetes Prevention Program (Preprint)

10.2196/preprints.28163 ◽

2021 ◽

Author(s):

Megan MacPherson ◽

Kaela Cranston ◽

Cara Johnston ◽

Sean Locke ◽

Mary Jung

Keyword(s):

Behaviour Change ◽

Prevention Program ◽

Text Messaging ◽

Diabetes Prevention ◽

Diabetes Prevention Program ◽

Evidence Base ◽

Text Messages ◽

Message Content ◽

Behaviour Change Wheel ◽

Diet And Exercise

BACKGROUND Text messaging presents a low-cost and far-reaching modality which can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behaviour change adherence. To date, little research has been published regarding the process of text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base, and to guide implementation of effective and scalable mHealth interventions in public health initiatives and in future research. OBJECTIVE This paper describes the development and refinement of a bank of text messages targeting diet and exercise behaviour change to be implemented following a diabetes prevention program. METHODS A bank of 124 theory-based text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behaviour change techniques OR BCTs). The Behaviour Change Wheel is a theory-based framework which provides structure to intervention development, and can guide the use of evidence-based practices in behaviour change interventions. Once messages were written, 18 individuals who either took part in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance using a 5-point Likert scale. Messages were refined according to participant feedback and re-coded to have an accurate representation of BCTs in the final bank. RESULTS Seventy-six messages (61%) were edited, four were added, and 8 were removed based on participant scores and feedback. Of the 76 messages edited, 43 received minor word choice and grammar alterations while retaining their original BCT code; the remaining 33 (plus the four newly written messages) were re-coded by a reviewer trained in BCT identification. CONCLUSIONS This study outlines the process used to develop and refine a bank of text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed text messages which were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users.

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Secondary Impact of Social Media via Text Message Screening for Type 2 Diabetes Risk in Kuwait: Survey Study (Preprint)

10.2196/preprints.20532 ◽

2020 ◽

Author(s):

Naeema Alqabandi ◽

Ebaa Al-Ozairi ◽

Adel Ahmed ◽

Edgar L Ross ◽

Robert N Jamison

Keyword(s):

Type 2 Diabetes ◽

Health Care ◽

At Risk ◽

Social Media ◽

Prevention Program ◽

Text Messaging ◽

Diabetes Prevention ◽

Text Message ◽

Diabetes Prevention Program

BACKGROUND Type 2 diabetes mellitus (T2DM) is an international problem of alarming epidemic proportions. T2DM can develop due to multiple factors, and it usually begins with prediabetes. Fortunately, this disease can be prevented by following a healthy lifestyle. However, many health care systems fail to properly educate the public on disease prevention and to offer support in embracing behavioral interventions to prevent diabetes. SMS messaging has been combined with cost-effective ways to reach out to the population at risk for medical comorbidities. To our knowledge, the use of nationwide SMS messaging in the Middle East as a screening tool to identify individuals who might be at risk of developing T2DM has not been reported in the literature. OBJECTIVE The primary aim of this study was to assess the feasibility of conducting a series of SMS messaging campaigns directed at random smartphone users in Kuwait for the detection and prevention of T2DM. It was predicted that 1% of those receiving the text message would find it relevant and participate in the study. The secondary aim of this study was to assess the incidence of participation of those who were forwarded the initial text message by family members and friends. METHODS In this study, 5 separate text message screening campaigns were launched inviting recipients to answer 6 questions to determine the risk of developing T2DM. If subjects agreed to participate, a link to the prediabetes screening test devised by the Centers for Disease Control and Prevention was automatically transmitted to their mobile devices. Those identified as high risk were invited to participate in a diabetes prevention program. RESULTS A total of 180,000 SMSs were sent to approximately 6% of the adult population in Kuwait. Of these, 0.14% (260/180,000) of the individuals who received the SMS agreed to participate, of whom 58.8% (153/260) completed the screening. Surprisingly, additional surveys were completed by 367 individuals who were invited via circulated SMS messages forwarded by family members and friends. Altogether, 23.3% (121/520) qualified and agreed to participate in a diabetes prevention program. The majority of those who chose to participate in the prevention program were overweight, aged 45-65 years, and reported being less physically active than those who chose not to participate (χ22=42.1, P<.001). CONCLUSIONS Although health care screening via text messaging was found to have limited effectiveness by itself, it exhibited increased reach through shared second-party social media messaging. Despite the fact a subpopulation at possible risk of developing T2DM could be reached via text messaging, most responders were informed about the screening campaign by family and friends. Future research should be designed to tap into the benefits of social media use in health risk campaigns.

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Using the behavior change wheel to develop text messages to promote diet and physical activity adherence following a diabetes prevention program

Translational Behavioral Medicine ◽

10.1093/tbm/ibab058 ◽

2021 ◽

Author(s):

Megan M MacPherson ◽

Kaela D Cranston ◽

Sean R Locke ◽

Jessica E Bourne ◽

Mary E Jung

Keyword(s):

Physical Activity ◽

Behavior Change ◽

Prevention Program ◽

Text Messaging ◽

Diabetes Prevention ◽

Diabetes Prevention Program ◽

Text Messages ◽

Behavior Change Wheel ◽

Diet And Physical Activity ◽

Physical Activity Adherence

Lay Summary Making changes to one’s physical activity and diet can reduce future risk of developing type 2 diabetes. That being said, making life-long changes to complex behaviors such as diet or physical activity is easier said than done. Text messages can be used to improve long-term diet and physical activity changes; however, it can be difficult to identify what should be said in a text message to nudge those behaviors. To improve utility and reduce cost of sending unnecessary messages, theory should be used in developing text messaging content. The current study used the Behavior Change Wheel to develop a library of text messages that can be used to improve diet and physical activity in individuals who have taken part in an effective community-based diabetes prevention program. The Behavior Change Wheel guides researchers to develop real-world interventions based on evidence and theory. Overall, we created a library of 124 theory-based messages which can be further tested following a diabetes prevention program.

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