Text Messaging and Type 1 Diabetes Management: Qualitative Study Exploring Interactions Among Patients and Health Care Professionals (Preprint)

BACKGROUND The diffusion of information and communication technologies (ICTs) in type 1 diabetes (T1D) management has generated a debate on the ways in which ICTs can support the patient-provider relationship. Several studies have focused on text messages. Most of the literature proposes quantitative analysis of the impact of text messaging on the clinical conditions of patients and/or their satisfaction with the technology, while the qualitative studies have focused mainly on patients’ perceptions about strengths and weaknesses of this technology. OBJECTIVE In contrast to past studies, we adopted a qualitative approach for the in-depth examination of patient-health care professionals’ interactions in text messaging. METHODS The study focused on the use of the Trento Cartella Clinica del Cittadino Diabetes System (TreC-DS), a digital platform with a built-in messaging system, in two diabetes centers, integrating message analysis with interviews with patients and health care professionals. Each center focused on a specific patient profile: the first one focused on pregnant women with T1D and the second one focused on adult patients with poorly controlled diabetes. RESULTS The main results of the study were as follows: (1) Health care professionals and patients perceived the messaging system as useful for sharing information (ie, pregnant women for prescriptions and adults with poorly controlled diabetes for advice); (2) The content and communication styles of the two centers differed: in the case of pregnant women, interactions via text messaging were markedly prescriptive, while in the case of adult patients with poorly controlled diabetes, they were conceived as open dialogues; and (3) Conversations were initiated mainly by professionals; in the cases considered, it was mainly the diabetes center that decided whether a messaging conversation was needed. CONCLUSIONS The results show how the features of interactions of text messaging changed based on the patient profiles in two different centers. In addition, in both diabetes centers that were involved, the system seems to have laid a foundation for a closer relationship between patients and health care professionals.

Download Full-text

Facilitation of motivation to self-management in pediatric diabetes health care consultations with adolescents with type 1 diabetes. A qualitative triangulation study

10.21203/rs.2.15261/v2 ◽

2020 ◽

Author(s):

Rose Marie Teyken ◽

Johanne Jeppesen Lomholt ◽

Anders Jørgen Schou

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Health Care Professionals ◽

Developmental Process ◽

Self Management ◽

Care Clinic ◽

Qualitative Research Design ◽

Pediatric Diabetes ◽

The Impact

Abstract Background. The impact of health care professionals on the motivation for self-management in adolescents with type 1 diabetes has been highlighted as important. It is, however, not well understood how pediatric diabetes health care practitioners can help adolescents become more motivated to self-management. The aim of the study was to investigate how practitioners can motivate their patients to self-management in consultation and how adolescents with type 1 diabetes experienced that consultation could facilitate motivation to self-management. Methods. Based on a qualitative research design, the study triangulated participant observations of 11 consultations at a pediatric health care clinic and 10 interviews of the adolescents (15-17 years of age) about their experiences of consultations. Using Giorgi’s phenomenological method, the analysis showed five categories important to consultation-facilitated motivation to self-management: 1. Consultation setting, 2. Consultation conversation, 3. Roles in treatment, 4. Assuming consultation-facilitated responsibility for self-management, and 5. Relationship in treatment. Results from the analysis were compared to fulfilment of the motivational needs for autonomy, competence and relatedness described in Self-Determination Theory. Results. Overall findings showed that the adolescent’s developmental process of becoming autonomous in relation to self-management was influenced by consultations, and that the need for relatedness was experienced as valued by the adolescents. Conclusions. The conclusion of the study was that relatedness and development of autonomy were experienced as important for how consultations could facilitate motivation to self-management in 15-17-year-olds and may be fundamental to adolescents’ experience of competence in relation to self-management.

Download Full-text

Text Messaging and Type 1 Diabetes Management: Qualitative Study Exploring Interactions Among Patients and Health Care Professionals

JMIR Diabetes ◽

10.2196/11343 ◽

2019 ◽

Vol 4 (2) ◽

pp. e11343

Author(s):

Francesco Miele ◽

Silvia Clementi ◽

Renzo Gennaro ◽

Ilaria Nicolao ◽

Tiziana Romanelli ◽

...

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Qualitative Study ◽

Health Care Professionals ◽

Text Messaging ◽

Diabetes Management

Download Full-text

Consultation-dependent motivation to self-management in adolescents with type 1 diabetes: a qualitative triangulation study

10.21203/rs.2.15261/v1 ◽

2019 ◽

Author(s):

Rose Marie Teyken ◽

Johanne Jeppesen Lomholt ◽

Anders Jørgen Schou

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Health Care Professionals ◽

Developmental Process ◽

Self Management ◽

Care Clinic ◽

Pediatric Health Care ◽

Qualitative Research Design ◽

The Impact

Abstract Background. The impact of health care professionals on the motivation for self-management in adolescents with type 1 diabetes has been highlighted as important. It is, however, not well understood how pediatric diabetes health care practitioners can help adolescents become more motivated to self-management. The aim of the study was to investigate how practitioners can motivate their patients to self-management in consultation and how adolescents with type 1 diabetes experienced consultation-dependent motivation to self-management. Methods. Based on a qualitative research design, the study triangulated participant observations of 11 consultations at a pediatric health care clinic and 10 interviews of the adolescents (15-17 years of age) about their experiences of consultations. Using Giorgi’s phenomenological method, the analysis showed five categories important to consultation-dependent motivation to self-management: 1. Consultation setting, 2. Consultation conversation, 3. Roles in treatment, 4. Assuming consultation-dependent responsibility for self-management, and 5. Relationship in treatment. Results from the analysis were compared to fulfilment of the motivational needs for autonomy, competence and relatedness described in Self-Determination Theory. Results. Overall findings showed that the adolescent’s developmental process of becoming autonomous in relation to self-management was influenced by consultations, and that the need for relatedness was experienced as valued by the adolescents. Conclusions. The conclusion of the study was that relatedness and development of autonomy were experienced as important for consultation-dependent motivation to self-management in 15-17-year-olds and may be fundamental to adolescents’ experience of competence in relation to self-management.

Download Full-text

A Text Messaging Intervention with Financial Incentive for Adolescents with Type 1 Diabetes

Journal of Diabetes Science and Technology ◽

10.1177/1932296820952786 ◽

2020 ◽

pp. 193229682095278

Author(s):

Tara Kaushal ◽

Lorraine E. Levitt Katz ◽

Janet Joseph ◽

Michelle Marowitz ◽

Knashawn H. Morales ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Financial Incentives ◽

Text Messaging ◽

Intervention Group ◽

Self Care ◽

Suboptimal Control ◽

Significant Difference ◽

The Impact

Background: Adolescents with type 1 diabetes (T1D) have higher hemoglobin A1C (HbA1c) levels than others. In general, adolescents engage with text messaging (TM) and financial incentives, both associated with improved diabetes outcomes. This study aimed to assess the impact of a TM intervention with financial incentives on self-care behaviors and HbA1c. Methods: A six-month randomized controlled trial compared MyDiaText™, a TM education and support application, with standard care. The sample included 166 teens with T1D, 12-18 years old, attending a diabetes clinic. The intervention group received one daily TM and were instructed to respond. Participants who responded to TMs for the most consecutive days were eligible for a financial reward biweekly via lottery. All participants received prompts to complete the self-care inventory (SCI) at baseline, 90, and 180 days. HbA1c was collected at clinic visits. Changes in SCI and HbA1c were analyzed using a multilevel mixed-effects linear regression model. Intention-to-treat and per-protocol analyses were performed. Results: The median TM response rate was 59% (interquartile range 40.1%-85.2%) and decreased over time. After adjustment for baseline characteristics, in per-protocol analysis, there was a statistically significant difference in SCI score increase in those receiving one TM per day vs control ( P = .035). HbA1c decreased overall, without significant difference between groups ( P = .786). Conclusions: A TM intervention with financial incentives for adolescents with T1D in suboptimal control was associated with increasing self-care report; however, glycemic control did not differ from controls. Further research is needed to develop digital health interventions that will impact glycemic control.

Download Full-text

Patients’ and Doctors’ Perceptions of a Mobile Phone–Based Consultation Service for Maternal, Neonatal, and Infant Health Care in Bangladesh: A Mixed-Methods Study (Preprint)

10.2196/preprints.11842 ◽

2018 ◽

Author(s):

Mafruha Alam ◽

Cathy Banwell ◽

Anna Olsen ◽

Kamalini Lokuge

Keyword(s):

Health Care ◽

Mobile Phone ◽

Pregnant Women ◽

Infant Health ◽

Text Messages ◽

New Mothers ◽

Consultation Service ◽

The Right ◽

The Impact ◽

Remote Consultations

BACKGROUND A mobile-based consultation service, or telehealth, can be used for remote consultations with health care professionals for screening, self-care management, and referral. In rural Bangladesh, where there is high demand for scarce male and even scarcer female doctors, remote consultations may help women seeking maternal and child health care. Aponjon is a mHealth service in Bangladesh that provides weekly voice or text messages to pregnant women, new mothers, and family members on various aspects of maternal, neonatal, and infant health. Subscribers can also access a dedicated 24*7 call center to discuss maternal, neonatal, and infant health or emergencies with medically trained doctors. The service provides advice, primary diagnoses, prescriptions, and referrals to subscriber callers. OBJECTIVE We investigated the Aponjon service to understand access, acceptability, usability, benefits, and challenges of a mobile phone-based consultation service. METHODS We conducted call log data analysis for September to November 2015 to understand how many unique subscribers accessed the service, who accessed the service, the geographical distribution of callers, and the purpose of the calls. We also conducted a qualitative exploratory substudy of eight married women and eight married men who were subscribers to and accessed the service during this time to understand their experiences. We interviewed 11 doctors from the same service who provided phone consultations to subscribers. RESULTS Approximately 3894 unique subscribers accessed the service for single or multiple consultations during the study period; 68.36% (2662/3894) of subscribers were from rural households, and 53.00% (2064/3894) of calls were made by pregnant women or new mothers. Approximately 96.08% (5081/5288) calls were nonurgent, 2.69% (142/5288) semiurgent, and 1.23% (65/5288) urgent. Almost 64.7% (134/207) semiurgent or urgent calls came between 8 PM and 8 AM. Callers found the consultation service trustworthy, cost-effective, and convenient. The doctors dispelled misconceptions and promoted good health care practices, regular health check-ups, and responsible use of medicine. They helped families understand the severity of sicknesses and advised them to seek care at health facilities for semiurgent or urgent conditions. The service lacked a pro-poor policy to support talk times of subscribers from poor households and a proper referral system to help patients find the right care at the right facilities. CONCLUSIONS Although a regular messaging service is constrained by a one-way communication system, this service using the same platform, gave subscribers access to an abbreviated “consultation” with medical doctors. The consultations provided subscribers with valued medical advice and support, although they were limited in their population reach and their integration into the wider medical system. Further research is required to understand the impact of advice and referral, cost-effectiveness, and willingness to pay for mHealth consultation services, but this research suggests that these services should be supported or even expanded.

Download Full-text

The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps

Nutrients ◽

10.3390/nu13103558 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3558

Author(s):

Dieter Furthner ◽

Andreas Lukas ◽

Anna Maria Schneider ◽

Katharina Mörwald ◽

Katharina Maruszczak ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Therapy ◽

Dietary Fat ◽

Health Care Professionals ◽

Scientific Evidence ◽

Observation Time ◽

Bolus Insulin ◽

The Impact

Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary.

Download Full-text

931-P: Supporting Physical Activity in Children with Type 1 Diabetes: A Survey of Health Care Professionals

Diabetes ◽

10.2337/db21-931-p ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 931-P

Author(s):

EMMA COCKCROFT ◽

PARTH NARENDRAN ◽

EVA WOODING ◽

ROBERT C. ANDREWS

Keyword(s):

Physical Activity ◽

Health Care ◽

Type 1 Diabetes ◽

Health Care Professionals

Download Full-text

Impacts of glycemic variability on the relationship between glucose management indicator from iPro™2 and laboratory hemoglobin A1c in adult patients with type 1 diabetes mellitus

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018820931664 ◽

2020 ◽

Vol 11 ◽

pp. 204201882093166

Author(s):

Hongxia Liu ◽

Daizhi Yang ◽

Hongrong Deng ◽

Wen Xu ◽

Jing Lv ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Hemoglobin A1c ◽

Glycemic Variability ◽

Adult Patients ◽

Glucose Management ◽

The Impact ◽

The Relationship

Aims: Our aim was to investigate the impact of glycemic variability (GV) on the relationship between glucose management indicator (GMI) and laboratory glycated hemoglobin A1c (HbA1c). Methods: Adult patients with type 1 diabetes mellitus (T1D) were enrolled from five hospitals in China. All subjects wore the iPro™2 system for 14 days before HbA1c was measured at baseline, 3 months and 6 months. Data derived from iPro™2 sensor was used to calculate GMI and GV parameters [standard deviation (SD), glucose coefficient of variation (CV), and mean amplitude of glycemic excursions (MAGE)]. Differences between GMI and laboratory HbA1c were assessed by the absolute value of the hemoglobin glycation index (HGI). Results: A total of 91 sensor data and corresponding laboratory HbA1c, as well as demographic and clinical characteristics were analyzed. GMI and HbA1c were 7.20 ± 0.67% and 7.52 ± 0.73%, respectively. The percentage of subjects with absolute HGI 0 to lower than 0.1% was 21%. GMI was significantly associated with laboratory HbA1c after basic adjustment (standardized β = 0.83, p < 0.001). Further adjustment for SD or MAGE reduced the standardized β for laboratory HbA1c from 0.83 to 0.71 and 0.73, respectively (both p < 0.001). In contrast, the β remained relatively constant when further adjusting for CV. Spearman correlation analysis showed that GMI and laboratory HbA1c were correlated for each quartile of SD and MAGE (all p < 0.05), with the corresponding correlation coefficients decreased across ascending quartiles. Conclusions: This study validated the GMI formula using the iPro™2 sensor in adult patients with T1D. GV influenced the relationship between GMI and laboratory HbA1c.

Download Full-text

Health care professionals talking: Are services for young adults with type 1 diabetes fit for purpose?

Journal of Evaluation in Clinical Practice ◽

10.1111/jep.13210 ◽

2019 ◽

Vol 26 (1) ◽

pp. 335-342 ◽

Cited By ~ 1

Author(s):

Margaret Harris ◽

Steven James ◽

Lin Perry ◽

Julia Lowe ◽

Janet Dunbabin ◽

...

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Young Adults ◽

Health Care Professionals ◽

Fit For Purpose

Download Full-text

MyDiaText™: Feasibililty and Functionality of a Text Messaging System for Youth With Type 1 Diabetes

The Diabetes Educator ◽

10.1177/0145721719837895 ◽

2019 ◽

Vol 45 (3) ◽

pp. 253-259 ◽

Cited By ~ 3

Author(s):

Tara Kaushal ◽

Kathleen A. Montgomery ◽

Reid Simon ◽

Kelly Lord ◽

Jennifer Dougherty ◽

...

Keyword(s):

Type 1 Diabetes ◽

User Satisfaction ◽

Text Messaging ◽

Pilot Trial ◽

Text Message ◽

Text Messages ◽

Support Tool ◽

Reading Text

Purpose The purpose of this study was to determine the feasibility and functionality of MyDiaText™, a website and text messaging platform created to support behavior change in adolescents with type 1 diabetes (T1DM) and to evaluate user satisfaction of the application. Methods This study was a nonrandomized, prospective, pilot trial to test the feasibility and user interface with MyDiaText, a text message system for 10- to 17-year-old youths with newly diagnosed T1DM. Feasibility was evaluated by assessing for the user’s ability to create a profile on the website. Functionality was defined by assessing whether a subject responded to at least 2 text messages per week and by their accumulating points on the website. User satisfaction of the text messaging system was assessed using an electronic survey. The 4 phases of this study were community engagement—advisory sessions, screening and enrollment, intervention, and follow-up. Results Twenty subjects (14 male, 6 female) were enrolled. All subjects were able to create a profile, and of these, 86% responded to at least 2 text messages per week. A survey administered during follow-up showed that users enjoyed reading text messages, found them useful, and thought the frequency of messages was appropriate. Conclusion MyDiaText is a feasible, functional behavioral support tool for youth with T1DM. Users of the application reported high satisfaction with text messages and the reward system.

Download Full-text