• Application
• Biomarkers
• Health management
• Health-related behaviours
• Productivity

• Pain management
• Psychosocial Intervention
• Self-Management
• Trauma management

• Adult
• Female
• Humans
• Male
• Analgesics, Opioid/therapeutic use
• Analgesics, Opioid/administration & dosage
• Australia
• Double-Blind Method
• Pain Management/methods
• Pain Measurement
• Randomized Controlled Trials as Topic
• Rib Fractures/therapy
• Rib Fractures/complications
• Self-Management/methods
• Telemedicine
• Text Messaging

• Paul Ramsay Foundation

• and diabetes mellitus patients
• app user
• interest
• mobile health
• mobile/smartphone

• Humans
• Diabetes Mellitus/therapy
• Mobile Applications/statistics & numerical data
• Self Care/methods
• Self Care/statistics & numerical data
• Telemedicine/statistics & numerical data

• behaviour change
• chronic illness
• mobile health
• treatment compliance

• Behavior Therapy/methods
• Communication
• Humans
• Medication Adherence
• Telephone
• Text Messaging

• National Institute for Health Research

International guidelines advocate providing prompt structured education to individuals with diabetes at diagnosis. However, among the few eligible structured education programs, heterogeneous intervention regimens and inconsistent findings were reported. Eligible programs for Chinese individuals with diabetes are lacking. This study aimed to investigate the effects of a nurse-led integrative medicine-based structured education program on self-management behaviors, glycemic control and self-efficacy among individuals with newly diagnosed type 2 diabetes.

Employing a randomized controlled trial, 128 individuals with type 2 diabetes diagnosed in the preceding three to nine months were recruited from four university-affiliated tertiary hospitals in Xi’an City, Northwest China, and randomly allocated to the intervention or control groups after baseline assessments. Participants in the intervention group received a 4-week nurse-led integrative medicine-based structured education program, which is theoretically based on the Health Belief Model and Self-Efficacy Theory, in line with updated diabetes management guidelines, and informed by relevant systematic reviews. Participants in the control group received routine care. Self-management behaviors and self-efficacy were measured with the Summary of Diabetes Self-Care Activities and the Diabetes Management Self-Efficacy Scale at baseline, immediate post-intervention and 12 weeks following the intervention while Glycated Hemoglobin A was measured at baseline and the 12th-week follow-up. The intervention effects were estimated using the generalized estimating equation models.

Participants in the intervention group exhibited significantly better self-management performance in specific diet regarding intake of fruits and vegetables at both follow-ups (β = 1.02, p = 0.011 and β = 0.98, p = 0.016, respectively), specific diet regarding intake of high-fat foods at the immediate post-intervention follow-up (β = 0.83, p = 0.023), blood glucose monitoring at the 12th-week follow-up (β = 0.64, p = 0.004), foot care at both follow-ups (β = 1.80, p <  0.001 and β = 2.02, p <  0.001, respectively), and medication management at both follow-ups (β = 0.83, p = 0.005 and β = 0.95, p = 0.003, respectively). The intervention also introduced significant improvements in Glycated Hemoglobin A (β = − 0.32%, p <  0.001), and self-efficacy at both follow-ups (β = 8.73, p <  0.001 and β = 9.71, p <  0.001, respectively).

The nurse-led integrative medicine-based structured education program could produce beneficial effects on multiple diabetes self-management behaviors, glycemic control and self-efficacy.

This study was retrospectively registered in the ClinicalTrials.gov. on 25/08/2017; registration number: NCT03261895.

The online version contains supplementary material available at 10.1186/s12912-022-00970-7.

• Culture-tailored interventions
• Glycemic control
• Self-efficacy
• Self-management
• Structured education
• Type 2 diabetes

Little is known about the feasibility of mobile health (mHealth) support among people with type 1 diabetes (T1D) using advanced diabetes technologies including continuous glucose monitoring (CGM) systems and hybrid closed-loop insulin pumps (HCLs).

This study aims to evaluate patient access and openness to receiving mHealth diabetes support in people with T1D using CGM systems or HCLs.

We conducted a cross-sectional survey among patients with T1D using CGM systems or HCLs managed in an academic medical center. Participants reported information regarding their mobile device use; cellular call, SMS text message, or internet connectivity; and openness to various channels of mHealth communication (smartphone apps, SMS text messages, and interactive voice response [IVR] calls). Participants’ demographic characteristics and CGM data were collected from medical records. The analyses focused on differences in openness to mHealth and mHealth communication channels across groups defined by demographic variables and measures of glycemic control.

Among all participants (N=310; female: n=198, 63.9%; mean age 45, SD 16 years), 98.1% (n=304) reported active cellphone use and 80% (n=248) were receptive to receiving mHealth support to improve glucose control. Among participants receptive to mHealth support, 98% (243/248) were willing to share CGM glucose data for mHealth diabetes self-care assistance. Most (176/248, 71%) were open to receiving messages via apps, 56% (139/248) were open to SMS text messages, and 12.1% (30/248) were open to IVR calls. Older participants were more likely to prefer SMS text messages (P=.009) and IVR calls (P=.03) than younger participants.

Most people with T1D who use advanced diabetes technologies have access to cell phones and are receptive to receiving mHealth support to improve diabetes control.

• K23 DK129724 NIDDK NIH HHS
• P30 DK092926 NIDDK NIH HHS

• data visualization
• mobile health data
• symptom visualizations

• digital health
• mHealth
• self-monitoring
• type 2 diabetes mellitus

• Blood Glucose
• Cell Phone
• Diabetes Mellitus, Type 2/therapy
• Electronic Health Records
• Humans
• Mobile Applications

• cardiovascular
• medication management
• patient teaching
• quality of life
• warfarin

• guidelines
• health technology
• mobile applications
• mobile health
• self-management
• type 2 diabetes

• action research
• diabetes self-management
• health information technology intervention
• social support
• telehealth

Poor diabetes self-management in emerging adulthood (age 18-25 years) is associated with poorer diabetes health and diabetes complications. Emerging adults’ focus on individuation and independence underlies their poor diabetes outcomes, offering a lever for behavior change. Self-determination theory (SDT) suggests that interventions leveraging emerging adults’ innate developmental need for autonomy may offer a route to improving diabetes outcomes by increasing feelings of responsibility for and control over diabetes self-management activities.

This research project will use the multiphase optimization strategy to test the efficacy of three autonomy-supportive intervention components to elicit a clinically significant improvement in metabolic control, assessed by a 0.5% improvement in hemoglobin A_1c (HbA_1c), among older adolescents and emerging adults (16-25 years) with poorly controlled type 1 diabetes (T1D; HbA_1c≥9.0%).

A question prompt list (QPL) is a tool to empower patients to assume a more active role during medical visits by asking questions and stating concerns. The motivation enhancement system (MES) is a brief counseling intervention that uses motivational interviewing communication strategies to build intrinsic motivation and self-efficacy for self-management. Text message reminders to complete diabetes care tasks may increase self-efficacy for diabetes self-management. After refining these intervention components for emerging adults, we will conduct a component selection experiment using an eight-arm full factorial design: 2 (QPL yes or no)×2 (MES yes or no)×2 (Text yes or no). Participants will complete 3 study visits: baseline, treatment end at 2 months, and a follow-up at 6 months. The primary outcome is metabolic control, which will be measured via HbA_1c. Secondary outcomes include diabetes management and diabetes clinic attendance. SDT constructs of intrinsic motivation, self-efficacy, and the quality of the patient-provider relationship (ie, relatedness) are hypothesized mediators. Depression symptoms and emerging adults’ gender are hypothesized moderators. We will use the mixed-effects linear model for the analysis of variance of a factorial design to analyze continuous longitudinal experimental data; the generalized linear model will be used with categorical outcomes (eg, treatment attendance). The experiment was powered to detect the main effects of the intervention on the primary outcome.

A total of 20 participants have enrolled and completed a qualitative interview after reviewing one or more intervention components. Analysis of interview data are underway, with a report of these results anticipated in the fall of 2020. The clinical trial will be launched in the fall 2020, with participants enrolled through May 2023 and data collection continuing through November 2023.

At the end of this experiment, we will have empirical evidence to support a large-scale, multisite effectiveness trial of an intervention package that has been optimized for older adolescents and emerging adults with poorly controlled T1D.

ClinicalTrials.gov NCT04066959; https://clinicaltrials.gov/ct2/show/NCT04066959

DERR1-10.2196/20191

• emerging adults
• motivational interviewing
• self-determination theory
• type 1 diabetes

Given the growing burden of diabetes in underserved communities and the complexity of diabetes self-management during pregnancy, the development of interventions to support low-income pregnant women with diabetes is urgently needed.

This study aims to develop and pilot test a theory-driven curriculum of SMS text messaging for diabetes support and education during pregnancy.

This was a prospective pilot investigation of a novel SMS text messaging intervention offered to pregnant women with pregestational or gestational diabetes mellitus and publicly funded prenatal care. Prior work yielded a conceptual model of diabetes self-management barriers and support factors in this population, which was used to guide curriculum development along with health behavior theories. Participants received three supportive or educational one-way text messages per week during pregnancy. In-depth semistructured interviews were performed at study exit to solicit feedback on the program. Narrative data were analyzed using the constant comparative technique to identify themes and subthemes.

Participants (N=31 enrolled and n=26 completed both interviews) consistently reported that SMS text messaging provided enhanced motivation for diabetes self-care, reduced diabetes-related social isolation, increased perceived diabetes-associated knowledge, enhanced comfort with the health care team, and reduced logistical burdens of diabetes during pregnancy. Participants requested enhanced interactive and customizable features in future intervention iterations.

Pregnant women with diabetes who were enrolled in this pilot study of an SMS text messaging curriculum for diabetes support described enhanced motivation, knowledge, and comfort with diabetes self-care activities as a result of the health education intervention. The next steps include enriching the interactive features of the intervention and investigating the effect of the intervention on perinatal outcomes.

• gestational diabetes mellitus
• mobile health
• mobile phone
• pregnancy
• text messaging
• type 2 diabetes mellitus

Text message–delivered interventions are a feasible and scalable approach for improving chronic disease self-care and reducing health disparities; however, information on long-term user engagement with these interventions is limited.

The aim of this study is to examine user engagement in a 12-month text message–delivered intervention supporting diabetes self-care, called REACH (Rapid Education/Encouragement And Communications for Health), among racially and socioeconomically diverse patients with type 2 diabetes (T2D). We explored time trends in engagement, associations between patient characteristics and engagement, and whether the addition of a human component or allowing patients to change their text frequency affected engagement. Qualitative data informed patients’ subjective experience of their engagement.

We recruited patients with T2D for a randomized trial evaluating mobile phone support relative to enhanced treatment as usual. This analysis was limited to participants assigned to the intervention. Participants completed a survey and hemoglobin A1c (HbA1c) test and received REACH text messages, including self-care promotion texts, interactive texts asking about medication adherence, and adherence feedback texts. For the first 6 months, texts were sent daily, and half of the participants also received monthly phone coaching. After 6 months, coaching stopped, and participants had the option to receive fewer texts for the subsequent 6 months. We defined engagement via responses to the interactive texts and responses to a follow-up interview. We used regression models to analyze associations with response rate and thematic and structural analysis to understand participants’ reasons for responding to the texts and their preferred text frequency.

The participants were, on average, aged 55.8 (SD 9.8) years, 55.2% (137/248) female, and 52.0% (129/248) non-White; 40.7% (101/248) had ≤ a high school education, and 40.7% (101/248) had an annual household income <US $25,000. The median response rate to interactive texts was 91% (IQR 75%-97%) over 12 months. Engagement gradually declined throughout the intervention but remained high. Engagement did not differ by age, gender, education, income, diabetes duration, insulin status, health literacy, or numeracy. Black race and worse baseline medication adherence and HbA1c were each associated with lower engagement, although the effects were small. Nearly half of the participants chose to continue receiving daily texts for the last 6 months of the intervention. Participants who continued daily text messages said they wanted to continue experiencing benefits to their health, whereas those who chose fewer texts said that the daily texts had helped them create routines and they no longer needed them as often. Engagement was not impacted by receiving coaching or by participants’ chosen text frequency.

Well-designed interactive text messages can engage diverse patients in a self-care intervention for at least 1 year. Variation in and reasons for frequency preference suggest that offering a frequency choice may be important to users’ engagement.

• diabetes mellitus, type 2
• engagement
• mHealth
• medication adherence
• mobile health
• mobile phone
• self-care
• self-management
• technology
• text messaging

• NIDDK
• NIH
• diabetes
• disparities
• obesity
• social determinants

• Disadvantaged
• Disparities
• HbA1c
• Lifestyle intervention
• Mobile
• Technology interventions
• Type 2 diabetes

• Adult
• Cell Phone
• Developing Countries
• Diabetes Mellitus, Type 2/economics
• Diabetes Mellitus, Type 2/epidemiology
• Diabetes Mellitus, Type 2/therapy
• Ethnicity
• Humans
• Internet
• Minority Groups
• Patient Acceptance of Health Care/statistics & numerical data
• Poverty
• Rural Population
• Self-Management
• Telemedicine/economics
• Telemedicine/instrumentation
• Telemedicine/statistics & numerical data
• Vulnerable Populations/statistics & numerical data

• K01 DK106306 NIDDK NIH HHS
• R00 HS022408 AHRQ HHS
• R01 DK100694 NIDDK NIH HHS
• F32 DK009294 NIDDK NIH HHS
• P30 DK092949 NIDDK NIH HHS
• R01 HS025429 AHRQ HHS

• glucose level prediction
• long short-term memory (LSTM)-based recurrent neural networks (RNNs)
• mobile health lifestyle data
• type 2 diabetes

• Blood Glucose/analysis
• Deep Learning/trends
• Diabetes Mellitus, Type 2/blood
• Diabetes Mellitus, Type 2/physiopathology
• Female
• Forecasting/methods
• Humans
• Male
• Middle Aged
• Pilot Projects
• Predictive Value of Tests
• Self-Management

• SC2 GM118266 NIGMS NIH HHS
• TL1 TR002647 NCATS NIH HHS

• community engagement
• diabetes
• participatory research
• partnership working
• patient involvement
• realist review

• Biomedical Research/methods
• Community Participation
• Diabetes Mellitus/therapy
• Humans
• Patient Participation
• Treatment Outcome

• 221065 Norwegian Research Council

• information technology
• primary care
• public health
• telemedicine

• Caregivers/education
• Caregivers/organization & administration
• Diabetes Mellitus, Type 2/therapy
• Female
• Home Care Services/organization & administration
• Humans
• Male
• Primary Health Care/organization & administration
• Program Evaluation
• Qualitative Research
• Quality of Life
• Randomized Controlled Trials as Topic
• Rwanda
• Telemedicine/methods

• Karen Elise Jensens Fond
• Université du Luxembourg
• Aarhus Universitet

Despite the growing use of mobile applications (apps) for chronic disease management, the evidence on the effectiveness of this technology on clinical and behavioural outcomes of the patients is scant. Many studies highlight the importance of the theoretical foundations of mobile-based interventions. One of the most widely accepted models for the management of chronic diseases, such as diabetes, is the Chronic Care Model (CCM). In this study, we investigated the conformity of the selected diabetes mobile apps with CCM.

We searched online journal databases related to diabetes mobile apps to find common features. Then considering the components of the CCM as a reference model, features of some popular and top-ranking apps were compared with CCM.

Among 23 studied apps, 34 per cent of them had medium conformity and 66 per cent of these apps were in weak conformity. The self-management support component is covered by 100 per cent of them. Ninety-five per cent of apps have covered the proactive follow-up component.

App conformance with CCM is generally weak. App developers are recommended to give greater consideration to established theoretical models in their design and implementation.

• chronic care model
• diabetes type 2
• mhealth
• mobile applications
• mobile apps
• mobile health

• Diabetes
• Glycaemic control
• HbA1c
• Mobile phone
• SMS
• Self-management
• Text message

• adherence
• intervention
• medical adherence
• systematic review
• type 2 diabetes mellitus

• e-health
• interactive visualization
• m-health
• monitoring
• telemedicine
• type 1 diabetes mellitus

• behavioral health
• e-health
• military medicine
• telecommunications

• Hypertension
• health information technology
• prevention
• risk factors
• self-management
• stroke

• Health care
• Reminders
• SMS
• Text message
• mHealth

• Cancer prevention
• health promotion
• heart disease
• intervention

• Black or African American
• Aged
• Blood Pressure
• Body Weights and Measures
• Breast Neoplasms/diagnosis
• Breast Neoplasms/ethnology
• Cardiovascular Diseases/diagnosis
• Cardiovascular Diseases/ethnology
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/ethnology
• Cultural Competency
• Early Detection of Cancer/methods
• Female
• Glycated Hemoglobin
• Health Behavior/ethnology
• Health Promotion/methods
• Health Status
• Humans
• Lipids/blood
• Male
• Middle Aged
• Prostatic Neoplasms/diagnosis
• Prostatic Neoplasms/ethnology
• Risk Factors
• Socioeconomic Factors
• Text Messaging

Technology-delivered interventions have the potential to improve diabetes self-care and glycemic control among adults with type 2 diabetes (T2D). However, patients who do not engage with interventions may not reap benefits, and there is little evidence on how engagement with mobile health interventions varies by health literacy status.

This study explored how patients with limited health literacy engaged with and experienced Rapid Education/Encouragement and Communications for Health (REACH), a text messaging intervention designed to support the self-care adherence of disadvantaged patients with T2D. We recruited adults with T2D from federally qualified health centers and used mixed methods to examine (1) associations between users' health literacy status and their prior mobile phone use and their engagement with REACH and (2) similarities and differences in users' self-reported benefits by health literacy status.

Participants (N = 55) completed a survey, including measures of health literacy and prior mobile phone use. For 2 weeks, participants experienced REACH, which included daily text messages promoting self-care and asking about medication adherence, and weekly text messages providing medication adherence feedback. After 2 weeks, participants completed a semi-structured telephone interview about their experiences.

Participants with limited health literacy were less likely to have used cell phones to access the Internet (48% vs. 90%, p = .001) or email (36% vs. 87%, p < .001), but equally as likely to have used text messaging and to respond to REACH text messages (p = .12 and p = .40, respectively) compared to participants with adequate health literacy. Participants responded to 93% of text messages on average and reported benefits of the intervention, including reminders and accountability, convenience and accessibility, and information and motivation. Participants with limited health literacy described a unique benefit of receiving social support from the intervention.

Text messaging interventions may engage and benefit patients with T2D, regardless of health literacy status. Text messaging may have the potential to reduce T2D health disparities related to limited health literacy. [Health Literacy Research and Practice. 2017;1(4):e192–e202.]

Limited health literacy is associated with less engagement with health information technology, but there is little evidence on how engagement with text messaging interventions varies by health literacy status. This intervention engaged and benefited adults with type 2 diabetes in safety-net clinics, regardless of health literacy status. Participants with limited health literacy described a unique intervention benefit of social support.

• African Americans
• eHealth
• mHealth
• obesity
• weight management

• Intervention
• Medication adherence
• Mobile health
• Qualitative research
• Type 2 diabetes mellitus

• Adult
• Aged
• Diabetes Mellitus, Type 2/drug therapy
• Female
• Humans
• Male
• Medication Adherence
• Middle Aged
• Pilot Projects
• Reminder Systems
• Self Care
• Telemedicine
• Text Messaging

• K01 DK087894 NIDDK NIH HHS
• P30 DK092986 NIDDK NIH HHS
• R01 DK100694 NIDDK NIH HHS

• education, nursing
• preceptorship
• education, higher
• learning
• clinical clerkship
• concept formation

• Adult
• Aged
• Aged, 80 and over
• Diabetes Mellitus/therapy
• Diet, Diabetic
• Exercise
• Female
• Humans
• Male
• Middle Aged
• Self Care
• Single-Blind Method
• Telemedicine
• Telephone

• Emergency department
• Healthcare utilization
• Medical mistrust
• Primary care
• Social context
• Usual source of care

• Adolescent
• Adolescent Behavior
• Diet, Healthy/methods
• Female
• Formative Feedback
• Fruit
• Health Behavior
• Health Education/methods
• Health Promotion
• Humans
• Male
• Self Efficacy
• Sex Factors
• Text Messaging/statistics & numerical data
• Vegetables

• Connected health
• diabetes mellitus
• health information technology (HIT)
• social support

• African American men
• SMS text messaging
• church-based health promotion
• health information technology
• prostate cancer disparities

• behavioral change
• diabetes
• disparities
• intervention
• minority health

Stress among diabetic patients is much more as compared to normal individuals. A delayed recognition of stress undoubtedly worsens the prognosis for survival for many diabetic patients. Hence, this study was planned to develop an intervention model for the reduction of stress among diabetic patients and to evaluate the developed intervention model in the proposed group.

This study was conducted in endocrinology outpatient department of a tertiary care hospital. Starting at random, the patients were allocated to control group and test group. Controls were given printed educational materials. Test group were counseled with intense lifestyle education using both printed materials and computers; they were contacted by telephones by the investigator every 3 weeks for 3 months and SMS were sent every week containing some educational tips.

Mean age was 54 ± 11.5 years overall ranging from 30 years to 80 years. About two-third of participants were males with similar distribution in both the groups (intervention = 66%, control = 64%). Half (50%) of the participants lived in joint families, followed by nuclear families (40%). Most (83%) were married and with either graduate or above graduate education (n = 39%). No significant difference was observed in socio-demographic characteristics among both control and intervention groups (P > 0.05). The average stress scores were similar (18.9) at baseline for control and intervention arms. At 3-month follow-up, however, these scores reduced to 17.05 in the intervention arm while they increased to 20.7 in the control arm. At 3 months follow-up, higher proportion of stress reduction was seen in the intervention group.

Intervention in the form of intensive lifestyle education and phone calls and SMS significantly decrease their stress score. Mobile-based education has great potential to improve their mental status and increase patient-provider communication, and to decrease stress.

• Mobile phone-based education
• SMS
• stress

• A1C value
• diabetes type 2
• self-management education
• short message service (SMS)
• web-enabled technology

• Biomarkers/blood
• Communication
• Diabetes Mellitus, Type 2/blood
• Diabetes Mellitus, Type 2/diagnosis
• Diabetes Mellitus, Type 2/drug therapy
• Glycated Hemoglobin/metabolism
• Health Knowledge, Attitudes, Practice
• Humans
• Hypoglycemic Agents/therapeutic use
• Medication Adherence
• Patient Care Team
• Patient Education as Topic
• Patient Satisfaction
• Professional-Patient Relations
• Reminder Systems
• Self Care/methods
• Telemedicine/methods
• Text Messaging
• Time Factors
• Treatment Outcome

• Chronic Care
• Information Technology
• Organization and Delivery of Care
• Primary Care
• Research And Technology