mHealth Intervention Elements and User Characteristics Determine Utility: A Mixed-Methods Analysis

Abstract

Background: Mobile health (mHealth) interventions are improving the medication adherence of adults with type 2 diabetes mellitus (T2DM), but few studies examine how users experience these interventions. Therefore, we used a mixed-methods approach to understand how T2DM users experience a text messaging and interactive voice response (IVR)-delivered medication adherence intervention called MEssaging for Diabetes (MED). Methods: Adults with T2DM used MED as part of a 3-month pilot study. MED sends daily tailored text messages addressing adherence barriers, daily assessment text messages asking about adherence, and weekly tailored IVR calls providing adherence feedback, encouragement, and questions to facilitate problem solving. Sixty participants completed feedback interviews. We used a mixed-methods approach to understand their experience, examining associations between participants' characteristics and their feedback. Results: Participants who completed feedback interviews were on average 50.0 -10.1 years old; 65% female, 62% non-white; 15% had less than a high school education, 70% had annual incomes less than $20K; and average hemoglobin A1c was 8.0% -1.9%. Participants rated each intervention element favorably; common reasons for MED's helpfulness included receiving novel information about diabetes medications, emotional support, and reminders to take medication. People who were younger and more recently diagnosed with T2DM had more favorable experiences using MED. In general, users valued text messages more than IVR calls. Conclusions: Consideration of the user experience is critical for developing engaging mHealth interventions.User feedback reveals what mHealth elements have the most value and why, which users to target, and how to optimize an intervention's utility and appeal.

Mobile Diabetes Intervention Study of Patient Engagement and Impact on Blood Glucose: Mixed Methods Analysis

“…We identified coding themes reflecting patient messages sent to CDEs and analyzed these themes against changes in patient HbA 1c values. Results of this study reinforce findings from previous mobile health investigations that use a mixed-methods approach to examine data, collecting self-care behavior and self-efficacy data to measure outcomes [ 47 , 56 , 57 ]. These studies add valuable knowledge about the usability of digital health applications for the management of diabetes and reveal areas lacking in development that, if revised, could enhance patient user experience and improve diabetes outcomes.…”

“…Racial minorities, older patients, and patients with low health literacy showed the least engagement in telemedicine and digital health interventions [ 46 , 48 ]. In a 3-month mobile health intervention involving adults with type 2 diabetes, Nelson and colleagues [ 47 ] found that those who were younger or were diagnosed with type 2 diabetes closer to the start of the intervention displayed higher engagement activities and had more favorable experiences than older individuals or those with a longer diabetes duration. Our results are consistent with others, showing that nonwhite patients were less likely to send messages to assigned CDEs.…”

The Impact of a Mobile Diabetes Health Intervention on Diabetes Distress and Depression Among Adults: Secondary Analysis of a Cluster Randomized Controlled Trial

“…If patients did not enter their glucose levels, medication use, or other diabetes-specific information into their mobile devices regularly, they would receive fewer automated self-management messages and thus potentially have missed the opportunity to reduce feelings of distress or depression. Specific participant demographics, such as race, age, health literacy, or proximity of diagnosis to study treatment, may influence the utilization of a mobile health intervention [ 53 , 54 ]. Although participants in our study had low levels of diabetes distress and depression at baseline, it may be that the technology design, including messaging content, should address potential disease burden which impacts emotional health.…”

User Experiences With a Type 2 Diabetes Coaching App: Qualitative Study

“…As diabetes is a self-managed condition, successful models of care, especially for those who are not intrinsically motivated, must focus on strategies that promote and maintain autonomy [ 43 ]. Strategies to improve engagement in this group could include gamification elements such as quizzes and features that promote accountability, such as goal setting and mechanisms that re-engage users, such as regular feedback [ 24 , 32 , 44 , 45 ]. It may also be useful to consider giving these users more customization choices, for example, the device they prefer, because many users were more comfortable with a desktop computer or tablet than with a smartphone.…”