title: A mobile health intervention for inner city patients with poorly controlled diabetes: proof-of-concept of the TExT-MED program.
abstract: OBJECTIVE
  Numerous mobile health (mHealth) interventions are being developed to aid in management of complex chronic medical conditions. However, the acceptance of mHealth programs by low-income, bilingual populations has not yet been evaluated. The Trial to Examine Text-based mHealth for Emergency department patients with Diabetes (TExT-MED) program is a text message-based mHealth program designed specifically for resource-poor patients with diabetes. We conducted a prospective proof-of-concept trial to assess satisfaction and preliminary effectiveness of the TExT-MED program.
  
  
  METHODS
  A consecutive sample of adult patients in the emergency department with diabetes and a text message-capable mobile phone was enrolled in the TExT-MED program. Participants received three text messages daily for 3 weeks in English or Spanish in the following domains: educational/motivational, medication reminders, healthy living challenges, diabetes trivia, and links to free diabetes management tools.
  
  
  RESULTS
  Twenty-three patients with diabetes (median hemoglobin A1c, 8.9%) were enrolled in TExT-MED. In the week before TExT-MED, 56.5% of subjects reported eating fruits/vegetables daily versus 83% after, 43.5% reported exercising before versus 74% after, and 74% reported performing foot checks before versus 85% after. Self-efficacy, measured by the Diabetes Empowerment Scale-Short Form, improved from 3.9 to 4.2. Scores on the Morisky Medication Adherence Scale improved more dramatically from 3.5 to 4.75. Ninety percent of participants indicated they would like to continue the program, and 100% would recommend the program to family or friends.
  
  
  CONCLUSIONS
  This pilot trial of the TExT-MED program demonstrated increased healthy behaviors, improved diabetes self-efficacy and medication adherence, and received excellent satisfaction scores in resource-poor, inner city patients with diabetes.
authors.affiliation: Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. sanjay.arora@usc.edu
authors.forename: Sanjay
authors.initials: S
authors.lastname: Arora
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.forename: Chad
authors.initials: C
authors.lastname: Agy
authors.forename: Michael
authors.initials: M
authors.lastname: Menchine
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005260:Female; D015438:Health Behavior; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011446:Prospective Studies; D017010:Reminder Systems; D012648:Self Care; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000458:organization & administration* / Q000706:statistics & numerical data; D060145:Text Messaging; D014505:Urban Population; D016903:Drug Monitoring