title: The effectiveness of text messages support for diabetes self-management: protocol of the TEXT4DSM study in the democratic Republic of Congo, Cambodia and the Philippines.
abstract: BACKGROUND
  People with diabetes find it difficult to sustain adequate self-management behaviour. Self-Management Support strategies, including the use of mobile technology, have shown potential benefit. This study evaluates the effectiveness of a mobile phone support intervention on top of an existing strategy in three countries, DR Congo, Cambodia and the Philippines to improve health outcomes, access to care and enablement of people with diabetes, with 480 people with diabetes in each country who are randomised to either standard support or to the intervention.
  
  
  METHODS
  The study consists of three sub-studies with a similar design in three countries to be independently implemented and analysed. The design is a two-arm Randomised Controlled Trial, in which a total of 480 adults with diabetes participating in an existing DSME programme will be randomly allocated to either usual care in the existing programme or to usual care plus a mobile phone self-management support intervention. Participants in both arms complete assessments at baseline, one year and two years after inclusion.Glycosylated haemoglobin blood pressure, height, weight, waist circumference will be measured. Individual interviews will be conducted to determine the patients' assessment of chronic illness care, degree of self-enablement, and access to care before implementation of the intervention, at intermediate moments and at the end of the study.Analyses of quantitative data including assessment of differences in changes in outcomes between the intervention and usual care group will be done. A probability of <0.05 is considered statistically significant. Outcome indicators will be plotted over time. All data are analysed for confounding and interaction in multivariate regression analyses taking potential clustering effects into account.Differences in outcome measures will be analysed per country and realistic evaluation to assess processes and context factors that influence implementation in order to understand why it works, for whom, under which circumstances. A costing study will be performed.
  
  
  CONCLUSIONS
  The intervention addresses the problem that the greater part of diabetes management takes place without external support and that many challenges, unforeseen problems and questions occur at moments in between scheduled contacts with the support system, by exploiting communication technology.
  
  
  BACKGROUND
  ISRCTN86247213.
authors: Department of Public Health, Institute of Tropical Medicine, Brussels, Antwerp, Belgium. jvanolmen@itg.be
authors: Josefien
authors: J
authors: van Olmen
authors: Grace Marie
authors: GM
authors: Ku
authors: Maurits
authors: M
authors: van Pelt
authors: Jean Clovis
authors: JC
authors: Kalobu
authors: Heang
authors: H
authors: Hen
authors: Christian
authors: C
authors: Darras
authors: Kristien
authors: K
authors: Van Acker
authors: Balthazar
authors: B
authors: Villaraza
authors: Francois
authors: F
authors: Schellevis
authors: Guy
authors: G
authors: Kegels
mesh_terms: D000328:Adult; D002160:Cambodia; D002985:Clinical Protocols; D003920:Diabetes Mellitus / Q000517:prevention & control*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010679:Philippines; D015397:Program Evaluation; D012107:Research Design; D012648:Self Care / Q000379:methods*; D012944:Social Support; D011795:Surveys and Questionnaires; D060145:Text Messaging
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