Objectives
This study aimed to identify, assess and summarize available scientific
evidence on tailored text messaging interventions focused on type 2 diabetes
self-management. The systematic review concentrated on message design and
delivery features, and tailoring strategies. The meta-analysis assessed the
moderators of the effectiveness of tailored text messaging
interventions.
Methods
A comprehensive search strategy included major electronic databases, key
journal searches and reference list searching for related studies. PRISMA
and Cochrane Collaboration's guidelines and recommended tools for data
extraction, quality appraisal and data analysis were followed. Data were
extracted on participant characteristics (age, gender, ethnicity), and
interventional and methodological characteristics (study design, study
setting, study length, choice of modality, comparison group, message type,
format, content, use of interactivity, message frequency, message timing,
message delivery, tailoring strategies and theory use). Outcome measures
included diet, physical activity, medication adherence and glycated
hemoglobin data (HbA1C). Where possible, a random effects meta-analysis was
performed to pool data on the effectiveness of the tailored text messaging
interventions and moderator variables.
Results
The search returned 13 eligible trials for the systematic review and 11
eligible trials for the meta-analysis. The majority of the studies were
randomized controlled trials, conducted in high-income settings, used
multi-modalities, and mostly delivered informative, educational messages
through an automated message delivery system. Tailored text messaging
interventions produced a substantial effect (
g
= 0.54, 95%
CI = 0.08–0.99,
p
< 0.001) on HbA1C values for a total
of 949 patients. Subgroup analyses revealed the importance of some
moderators such as message delivery (
Q
B
= 18.72,
df = 1,
p
= 0.001), message direction
(
Q
B
= 5.26, df = 1,
p
= 0.022), message frequency
(
Q
B
= 18.72, df = 1,
p
= 0.000) and using multi-modalities
(
Q
B
= 6.18, df = 1,
p
= 0.013).
Conclusions
Tailored mobile text messaging interventions can improve glycemic control in
type 2 diabetes patients. However, more rigorous interventions with larger
samples and longer follow-ups are required to confirm these findings and
explore the effects of tailored text messaging on other self-management
outcomes.