Developing a behavioral model for mobile phone-based diabetes interventions.
OBJECTIVE
Behavioral models for mobile phone-based diabetes interventions are lacking. This study explores the potential mechanisms by which a text message-based diabetes program affected self-management among African-Americans.


METHODS
We conducted in-depth, individual interviews among 18 African-American patients with type 2 diabetes who completed a 4-week text message-based diabetes program. Each interview was audio-taped, transcribed verbatim, and imported into Atlas.ti software. Coding was done iteratively. Emergent themes were mapped onto existing behavioral constructs and then used to develop a novel behavioral model for mobile phone-based diabetes self-management programs.


RESULTS
The effects of the text message-based program went beyond automated reminders. The constant, daily communications reduced denial of diabetes and reinforced the importance of self-management (Rosenstock Health Belief Model). Responding positively to questions about self-management increased mastery experience (Bandura Self-Efficacy). Most surprisingly, participants perceived the automated program as a "friend" and "support group" that monitored and supported their self-management behaviors (Barrera Social Support).


CONCLUSIONS
A mobile phone-based diabetes program affected self-management through multiple behavioral constructs including health beliefs, self-efficacy, and social support.


CONCLUSIONS
Disease management programs that utilize mobile technologies should be designed to leverage existing models of behavior change and can address barriers to self-management associated with health disparities.
Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA. Shantanu.Nundy@uchospitals.edu
Shantanu
S
Nundy
Jonathan J
JJ
Dick
Marla C
MC
Solomon
Monica E
ME
Peek
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D040421:Cell Phone; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D010817:Physician-Patient Relations; D010865:Pilot Projects; D015397:Program Evaluation; D012648:Self Care / Q000379:methods*; D012944:Social Support; D060145:Text Messaging; D055815:Young Adult