title: Use of a text message program to raise type 2 diabetes risk awareness and promote health behavior change (part II): assessment of participants' perceptions on efficacy.
abstract: BACKGROUND
  Although there is great enthusiasm in both the public and private sector for the further development and use of large-scale consumer-facing public health applications for mobile platforms, little is known about user experience and satisfaction with this type of approach. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing, mobile phone-based health information service targeting type 2 diabetes, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. This program was marketed via large public health campaigns and drew many users within the respective communities.
  
  
  OBJECTIVE
  The purpose of this investigation was to use the RE-AIM framework to document txt4health efficacy by focusing on perceptions of satisfaction, usage, and behavior change among individuals who used txt4health in pilot studies in Southeast Michigan and Greater Cincinnati.
  
  
  METHODS
  We conducted a multimodal user survey with txt4health users recruited via text message through the program to understand participant perceptions of program use and satisfaction, as well as self-reported perceptions of behavior change as a result of using txt4health.
  
  
  RESULTS
  Txt4health users reported very high levels of program satisfaction, with 67.1% (108/161) reporting satisfaction scores of ≥8 on a 10-point scale, with 10 equivalent to most satisfied (mean 8.2, SD 1.6). All survey participants agreed/strongly agreed that the messages included in txt4health were clear and easy to understand (100.0%, 160/160), and most found txt4health made them knowledgeable about their risk for type 2 diabetes (88.1%, 140/159) and made them conscious of their diet and physical activity (88.8%, 142/160). Most participants reported that txt4health helped them to make behavior changes related to diet; after having completed txt4health, most agreed/strongly agreed that they are more likely to replace sugary drinks, such as juice or soda, with water (78.0%, 124/159), have a piece of fresh fruit instead of dessert (74.2%, 118/159), substitute a small salad for chips or fries when dining out (76.1%, 121/159), buy healthier foods when grocery shopping (79.7%, 126/158), and eat more grilled, baked, or broiled foods instead of fried (75.5%, 120/159).
  
  
  CONCLUSIONS
  Results from this study suggest that participants in txt4health, a large-scale, public health-focused text message program targeting type 2 diabetes, have positive perceptions of the program and that participation has led to positive behavior change.
authors.affiliation: University of Michigan, Department of Family Medicine, Ann Arbor, MI, United States. buisl@umich.edu.
authors.forename: Lorraine R
authors.initials: LR
authors.lastname: Buis
authors.forename: Lindsey
authors.initials: L
authors.lastname: Hirzel
authors.forename: Scott A
authors.initials: SA
authors.lastname: Turske
authors.forename: Terrisca R
authors.initials: TR
authors.lastname: Des Jardins
authors.forename: Hossein
authors.initials: H
authors.lastname: Yarandi
authors.forename: Patricia
authors.initials: P
authors.lastname: Bondurant
mesh_terms: D000328:Adult; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005518:Food Preferences; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057566:Self Report; D017216:Telemedicine / Q000379:methods*; D060145:Text Messaging; D016896:Treatment Outcome; D014481:United States
keywords: cellular phone; diabetes mellitus, type 2; mobile health; program evaluation; risk reduction behavior; text messaging