Improved Diabetes Care Management Through a Text-Message Intervention for Low-Income Patients: Mixed-Methods Pilot Study

Abstract Objective to determine the effect of a mHealth (text-message) intervention compared with a structured health educational session on the oral care and hygiene practices of pregnant women. Methods We conducted a pilot Randomized Control Trial parallel design superiority trial with a 1:1 allocation ratio. A total of 76 pregnant women up-to 20 weeks of gestational age and capable of reading mobile phone text-messages were recruited during August-October’ 2020 from the antenatal clinic of a primary health centre in a low-income urban agglomeration in Delhi, India. The mHealth intervention arm participants were sent a daily text-message for 30 days while all participants were provided a face-face, brief didactic structured educational sessions towards oral health promotion. Results The baseline characteristics of both groups were comparable in terms of age-structure, education, parity, and oral hygiene but differed in terms of oral health problems. Post-intervention, although, the twice-brushing frequency increased in both arms, only the mHealth arm revealed a statistically significant reduction in the incidence of missed twice daily brushing episodes (p = 0.016). The absolute effect size for the primary outcome signifying the difference in the proportion of participants reporting twice daily brushing frequency habit between the mHealth and comparison arms’ was 0.090, the Cohen’s H was 0.182, and the odds of twice brushing habit in the mHealth arm was 1.44 times higher than in the comparison arm. Conclusions a mHealth based daily text-message intervention for one month was not superior to a one-time brief didactic structured educational intervention for oral health promotion in antenatal women. Keywords mHealth; Dental health promotion; Dental health education; Antenatal care

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Implementation of a text message intervention to promote behavioural change and weight loss among overweight and obese Brazilian primary care patients

Journal of Telemedicine and Telecare ◽

10.1177/1357633x18782092 ◽

2018 ◽

Vol 25 (8) ◽

pp. 476-483 ◽

Cited By ~ 2

Author(s):

Lorenn L Gusmão ◽

Antonio L Ribeiro ◽

Maíra Viana Rego Souza-Silva ◽

Paulo R Gomes ◽

Alline M Beleigoli ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

Pilot Study ◽

Behavioural Change ◽

Text Message ◽

Text Messages ◽

Wilcoxon Test ◽

Message Delivery ◽

Belo Horizonte ◽

Text Message Intervention

Introduction Mobile-technology-based interventions are promising strategies for promoting behavioural change in obese patients. The aims of this study were to evaluate the feasibility of implementing a text message intervention, and to assess the effects of the intervention on body mass index (BMI) and self-reported behavioural change. Methods TELEFIT was a three-phase feasibility study comprising the following stages: (a) the development of text messages; (b) testing; and (c) a quasi-experimental pilot study in which patients who were engaged in obesity/overweight educational groups in public primary care centres in Belo Horizonte, Brazil, were recruited. A bank of text messages was drafted and reviewed by an expert panel, text message delivery software was developed and tested, and a pilot study assessed patients before and after receiving the intervention using validated questionnaires and body measures. The data were analysed using the Wilcoxon test. Results A total of 46 patients completed the follow-up; 93.5% were women and the median age was 42 years (interquartile range (IQR) 34–52 years). At four months, participants had a significant reduction in BMI (median 31.3 (IQR 28.2–34.6) vs. 29.9 (IQR 27.2–34.6) kg/m2, p < 0.001), systolic (median 125 (IQR 120–132) vs. 120 (IQR 110–130) mmHg, p = 0.013) and diastolic blood pressure (median 80 (IQR 70–100) vs. 80 (IQR 70–80) mmHg, p = 0.006), when compared to baseline. All patients reported to be satisfied and willing to continue receiving the intervention, and 93.3% felt that the intervention helped them change their behaviours. Discussion This study has shown that a text message intervention to promote behavioural change and weight loss was feasible and effective in a short-term period. Participants were satisfied and willing to continue receiving the SMS messages.

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Improved Diabetes Care Management Through a Text-Message Intervention for Low-Income Patients: Mixed-Methods Pilot Study (Preprint)

10.2196/preprints.8645 ◽

2017 ◽

Author(s):

Jessica L Watterson ◽

Hector P Rodriguez ◽

Stephen M Shortell ◽

Adrian Aguilera

Keyword(s):

Mixed Methods ◽

Pilot Study ◽

Clinical Outcomes ◽

Low Income ◽

Patient Engagement ◽

Text Messaging ◽

Fixed Effects ◽

Comparison Group ◽

Clinical Care ◽

Improvement Program

BACKGROUND Diabetes is a major contributor to global death and disability. Text-messaging interventions hold promise for improving diabetes outcomes through better knowledge and self-management. OBJECTIVE The aim of this study was to examine the implementation and impact of a diabetes text-messaging program targeted primarily for low-income Latino patients receiving care at 2 federally qualified health centers (FQHCs). METHODS A mixed-methods, quasi-experimental research design was employed for this pilot study. A total of 50 Spanish or English-speaking adult patients with diabetes attending 2 FQHC sites in Los Angeles from September 2015 to February 2016 were enrolled in a 12-week, bidirectional text-messaging program. A comparison group (n=160) was constructed from unexposed, eligible patients. Demographic data and pre/post clinical indicators were compared for both the groups. Propensity score weighting was used to reduce selection bias, and over-time differences in clinical outcomes between groups were estimated using individual fixed-effects regression models. Population-averaged linear models were estimated to assess differential effects of patient engagement on each clinical indicator among the intervention participants. A sample of intervention patients (n=11) and all implementing staff (n=8) were interviewed about their experiences with the program. Qualitative data were transcribed, translated, and analyzed to identify common themes. RESULTS The intervention group had a mean glycated hemoglobin (HbA1c) reduction of 0.4 points at follow-up, relative to the comparison group (P=.06). Patients who were more highly engaged with the program (response rate ≥median of 64.5%) experienced a 2.2 point reduction in HbA1c, relative to patients who were less engaged, controlling for demographic characteristics (P<.001). Qualitative analyses revealed that many participants felt supported, as though “someone was worrying about [their] health.” Participants also cited learning new information, setting new goals, and receiving helpful reminders. Staff and patients highlighted strategies to improve the program, including incorporating patient responses into in-person clinical care and tailoring the messages to patient knowledge. CONCLUSIONS A diabetes text-messaging program provided instrumental and emotional support for participants and may have contributed to clinically meaningful improvements in HbA1c. Patients who were more engaged demonstrated greater improvement. Program improvements, such as linkages to clinical care, hold potential for improving patient engagement and ultimately, improving clinical outcomes.

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Grocery Delivery of Healthy Foods to Pregnant Young Women With Low Incomes: Feasibility and Acceptability Mixed Methods Study

JMIR Formative Research ◽

10.2196/21602 ◽

2020 ◽

Vol 4 (12) ◽

pp. e21602

Author(s):

Ione Locher ◽

Marika Waselewski ◽

Kendrin Sonneville ◽

Ken Resnicow ◽

Tammy Chang

Keyword(s):

Weight Gain ◽

Pilot Study ◽

Young Women ◽

Low Income ◽

Vegetable Consumption ◽

Text Message ◽

Nutrition Intervention ◽

Healthy Weight ◽

Healthy Foods ◽

Low Incomes

Background Poor maternal diets increase the risk of excess gestational weight gain which can contribute to serious intergenerational morbidity for both the mother and infant. Pregnant young women with low incomes have disproportionately high rates of inadequate fruit and vegetable consumption as well as excess weight gains during pregnancy. Objective Our aim was to describe the feasibility and acceptability of Special Delivery, a longitudinal nutrition intervention that delivers healthy foods to pregnant youth (aged 14-24 years) with low incomes. Methods The Special Delivery pilot study, conducted in Michigan, enrolled pregnant young women with low incomes. Study participants were sent twice-monthly grocery deliveries consisting of US $35 worth of healthy foods, primarily fruits and vegetables. Between grocery deliveries, participants received daily SMS text message prompts to confirm receipt of delivery and document diet and weight. Program feasibility was assessed by the number of grocery orders placed, delivered, and confirmed by participants. Qualitative interviews and SMS text message data were used to determine acceptability by assessing participants’ perspectives on grocery delivery, participants’ perspectives on dietary impact of the program, and foods consumed by participants. Results A total of 27 participants were enrolled in the pilot study. The mean age was 20.3 years (SD 2.0), and 59.3% (16/27) were African American or Black. During the pilot, 263 deliveries were sent with 98.5% (259/263) successful deliveries and 89.4% (235/263) deliveries confirmed by participants. Participants reported that grocery delivery was convenient; that delivered foods were high quality; and that the program improved their diet, increased access to healthy foods, and promoted healthy habits during pregnancy. Conclusions A grocery delivery–based weight gain and nutrition intervention is both feasible and acceptable among low-income pregnant youth. Grocery deliveries were successfully completed and participants were willing and able to receive grocery deliveries, eat the healthy foods that were delivered, and communicate via SMS text message with study coordinators. The Special Delivery program warrants further evaluation for efficacy in promoting healthy weight gain for low-income youth during pregnancy.

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Grocery Delivery of Healthy Foods to Pregnant Young Women With Low Incomes: Feasibility and Acceptability Mixed Methods Study (Preprint)

10.2196/preprints.21602 ◽

2020 ◽

Author(s):

Ione Locher ◽

Marika Waselewski ◽

Kendrin Sonneville ◽

Ken Resnicow ◽

Tammy Chang

Keyword(s):

Weight Gain ◽

Pilot Study ◽

Young Women ◽

Low Income ◽

Vegetable Consumption ◽

Text Message ◽

Nutrition Intervention ◽

Healthy Weight ◽

Healthy Foods ◽

Low Incomes

BACKGROUND Poor maternal diets increase the risk of excess gestational weight gain which can contribute to serious intergenerational morbidity for both the mother and infant. Pregnant young women with low incomes have disproportionately high rates of inadequate fruit and vegetable consumption as well as excess weight gains during pregnancy. OBJECTIVE Our aim was to describe the feasibility and acceptability of Special Delivery, a longitudinal nutrition intervention that delivers healthy foods to pregnant youth (aged 14-24 years) with low incomes. METHODS The Special Delivery pilot study, conducted in Michigan, enrolled pregnant young women with low incomes. Study participants were sent twice-monthly grocery deliveries consisting of US $35 worth of healthy foods, primarily fruits and vegetables. Between grocery deliveries, participants received daily SMS text message prompts to confirm receipt of delivery and document diet and weight. Program feasibility was assessed by the number of grocery orders placed, delivered, and confirmed by participants. Qualitative interviews and SMS text message data were used to determine acceptability by assessing participants’ perspectives on grocery delivery, participants’ perspectives on dietary impact of the program, and foods consumed by participants. RESULTS A total of 27 participants were enrolled in the pilot study. The mean age was 20.3 years (SD 2.0), and 59.3% (16/27) were African American or Black. During the pilot, 263 deliveries were sent with 98.5% (259/263) successful deliveries and 89.4% (235/263) deliveries confirmed by participants. Participants reported that grocery delivery was convenient; that delivered foods were high quality; and that the program improved their diet, increased access to healthy foods, and promoted healthy habits during pregnancy. CONCLUSIONS A grocery delivery–based weight gain and nutrition intervention is both feasible and acceptable among low-income pregnant youth. Grocery deliveries were successfully completed and participants were willing and able to receive grocery deliveries, eat the healthy foods that were delivered, and communicate via SMS text message with study coordinators. The Special Delivery program warrants further evaluation for efficacy in promoting healthy weight gain for low-income youth during pregnancy.

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Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study

JMIR Formative Research ◽

10.2196/formative.5322 ◽

2018 ◽

Vol 2 (1) ◽

pp. e6 ◽

Cited By ~ 4

Author(s):

Juhee Kim ◽

Holly Mathews ◽

Lindsay M Cortright ◽

Xiaoming Zeng ◽

Edward Newton

Keyword(s):

Mixed Methods ◽

Pilot Study ◽

Pregnant Women ◽

Low Income ◽

Patient Portal ◽

Factors Affecting

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Co-designing a lifestyle-focused text message intervention for women after breast cancer treatment: a mixed methods study (Preprint)

Journal of Medical Internet Research ◽

10.2196/27076 ◽

2021 ◽

Author(s):

Anna Singleton ◽

Rebecca Raeside ◽

Stephanie R Partridge ◽

Molly Hayes ◽

Katherine Maka ◽

...

Keyword(s):

Breast Cancer ◽

Mixed Methods ◽

Cancer Treatment ◽

Text Message ◽

Breast Cancer Treatment ◽

Mixed Methods Study ◽

Text Message Intervention

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Adaptation to family-based treatment for Medicaid-insured youth with anorexia nervosa in publicly-funded settings: Protocol for a mixed methods implementation scale-out pilot study

Journal of Eating Disorders ◽

10.1186/s40337-021-00454-0 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Erin C. Accurso ◽

Karen J. Mu ◽

John Landsverk ◽

Joseph Guydish

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Mixed Methods ◽

Pilot Study ◽

San Francisco ◽

Low Income ◽

Local Treatment ◽

Publicly Funded ◽

Family Based Treatment ◽

Family Based

Abstract Background Family-based treatment (FBT) for anorexia nervosa is an evidence-based treatment, but its effectiveness is untested among socioeconomically disadvantaged and racially diverse youth. Adapting FBT may facilitate “scale-out” for Medicaid-insured youth served in publicly-funded settings and potentially improve outcomes for more diverse populations. Methods This mixed methods effectiveness-implementation Hybrid Type 3 pilot study protocol included a planning period in collaboration with the San Francisco Department of Public Health, culminating in a two-day in-person FBT training for 25 therapists in the county, followed by the opportunity to engage in one year of weekly supervision. The training incorporated FBT adaptations intended to improve fit for low-income families within community-based settings. Treatment appropriateness and acceptability will be measured immediately post-training. Following the training, cases referred for FBT will only be assigned to the trained clinicians who voluntarily opted into long-term group supervision. Clinicians treating at least one FBT case during the supervision period will report on implementation, adaptations, and patient weight gain. Finally, semi-structured interviews with clinician participants will be conducted, focused on implementation challenges and facilitators, local treatment adaptations, and overall satisfaction with FBT. Discussion Learning about clinician adaptations will advance knowledge about treatment of eating disorders in publicly-funded community clinics, which serve a racially/ethnically and socioeconomically diverse group of youth. This project is designed to accelerate FBT implementation in publicly-funded mental health systems, and inform service improvements for underserved youth with eating disorders.

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