title: Gender differences in diabetes self-management: a mixed-methods analysis of a mobile health intervention for inner-city Latino patients.
abstract: BACKGROUND
  The benefit of mobile health (mHealth) on diabetes management among low-income, inner-city patients is largely unknown, particularly for Latino patients. TExT-MED (Trial to Examine Text Message for Emergency Department Patients with Diabetes) is a text message-based program designed to improve disease knowledge, self-efficacy, and glycemic control among low-income, inner-city Latinos. In phase I, 23 patients participated in        an acceptability and feasibility study. Contrary to our model, there was no increase in knowledge despite increases in self-efficacy and healthy behaviors. In phase II, we performed a mixed-methods analysis to understand how TExT-MED achieved these seemingly contradictory findings.
  
  
  METHODS
  We performed a qualitative analysis of focus groups with patients from phase I. We explored patients' receipt of health information from TExT-MED and other information sources. We used these qualitative findings to perform a mixed-methods analysis of the outcomes from phase I, reanalyzing the quantitative measures of self-efficacy, diabetes knowledge, and healthy behaviors.
  
  
  RESULTS
  We conducted two focus groups, one in English and one in Spanish. Through qualitative analysis, we found gender differences in information sources, dietary self-efficacy, and desired educational content. Applying this knowledge, we re-stratified phase I outcomes by gender and found differential changes in diabetes knowledge, self-efficacy, and behaviors. Men had increased self-efficacy while women showed increased knowledge.
  
  
  CONCLUSIONS
  The efficacy of mHealth on diabetes management was affected by gender. Specifically, men and women differ in their dietary self-efficacy, information sources, and desired topics in future mHealth interventions. To achieve maximal impact, future mHealth interventions should be mindful of this gender difference.
authors: Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. eburner@usc.edu
authors: Elizabeth
authors: E
authors: Burner
authors: Michael
authors: M
authors: Menchine
authors: Elena
authors: E
authors: Taylor
authors: Sanjay
authors: S
authors: Arora
mesh_terms: D003920:Diabetes Mellitus; D005260:Female; D015438:Health Behavior; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D012648:Self Care / Q000379:methods; D012737:Sex Factors; D060145:Text Messaging; D014505:Urban Population