title: Patients' engagement with "Sweet Talk" - a text messaging support system for young people with diabetes.
abstract: BACKGROUND
  Guidelines for optimizing type 1 diabetes in young people advocate intensive insulin therapy coupled with personal support from the health care team. "Sweet Talk" is a novel intervention designed to support patients between clinic visits using text messages sent to a mobile phone. Scheduled messages are tailored to patient profiles and diabetes self-management goals, and generic messages include topical "newsletters" and anonymized tips from other participants. The system also allows patients to submit data and questions to the diabetes care team.
  
  
  OBJECTIVE
  The aim was to explore how patients with type 1 diabetes interact with the Sweet Talk system in order to understand its utility to this user group.
  
  
  METHODS
  Subjects were 64 young people with diabetes who were participating in the intervention arms of a randomized controlled trial. All text messages submitted to Sweet Talk during a 12-month period were recorded. Messaging patterns and content were analyzed using mixed quantitative and qualitative methods.
  
  
  RESULTS
  Patients submitted 1180 messages during the observation period (mean 18.4, median 6). Messaging frequency ranged widely between participants (0-240) with a subset of 5 high users contributing 52% of the total. Patients' clinical and sociodemographic characteristics were not associated with total messaging frequency, although girls sent significantly more messages unrelated to diabetes than did boys (P = .002). The content of patients' messages fell into 8 main categories: blood glucose readings, diabetes questions, diabetes information, personal health administration, social messages, technical messages, message errors, and message responses. Unprompted submission of blood glucose values was the most frequent incoming message type (35% of total). Responses to requests for personal experiences and tips generated 40% of all the incoming messages, while topical news items also generated good responses. Patients also used the service to ask questions, submit information about their self-management, and order supplies. No patients nominated supporters to receive text messages about their self-management goals. Another option that was not used was the birthday reminder service.
  
  
  CONCLUSIONS
  Automated, scheduled text messaging successfully engaged young people with diabetes. While the system was primarily designed to provide "push" support to patients, submission of clinical data and queries illustrates that it was seen as a trusted medium for communicating with care providers. Responses to the newsletters and submission of personal experiences and tips for circulation to other participants also illustrate the potential value of such interventions for establishing a sense of community. Although participants submitted relatively few messages, positive responses to the system suggest that most derived passive support from reading the messages. The Sweet Talk system could be readily adapted to suit other chronic disease models and age groups, and the results of this study may help to inform the design of future text message support interventions.
authors.affiliation: Maternal and Child Health Sciences, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: Victoria Louise
authors.initials: VL
authors.lastname: Franklin
authors.forename: Alexandra
authors.initials: A
authors.lastname: Greene
authors.forename: Annalu
authors.initials: A
authors.lastname: Waller
authors.forename: Stephen Alan
authors.initials: SA
authors.lastname: Greene
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
mesh_terms: D000293:Adolescent; D001786:Blood Glucose; D015190:Blood Glucose Self-Monitoring; D040421:Cell Phone; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D012606:Scotland; D012944:Social Support
chemical_list: D001786:Blood Glucose