title: Diabetes Text-Message Self-Management Support Program (SMS4BG): A Pilot Study.
abstract: BACKGROUND
  The increasing prevalence of diabetes and costly long-term complications associated with poor glycemic control are issues facing health services worldwide. Diabetes self-management, with the support of health care providers, is critical for successful outcomes, however, frequent clinical contact is costly. Text messages via short message service (SMS) have the advantage of instant transmission at low cost and, given the ubiquity of mobile phones, may be the ideal platform for the delivery of diabetes self-management support. A tailored text message-based diabetes support intervention called Self-Management Support for Blood Glucose (SMS4BG) was developed. The intervention incorporates prompts around diabetes education, management, and lifestyle factors (healthy eating, exercise, and stress management), as well as blood glucose monitoring reminders, and is tailored to patient preferences and clinical characteristics.
  
  
  OBJECTIVE
  To determine the usability and acceptability of SMS4BG among adults with poorly controlled diabetes.
  
  
  METHODS
  Adults (aged 17 to 69 years) with type 1 (n=12) or type 2 diabetes (n=30), a hemoglobin A1c (HbA1c) over 70 mmol/mol (8.6%), and who owned a mobile phone (n=42) were recruited to take part in a 3-month pilot study of SMS4BG. At registration, participants selected the modules they would like to receive and, where appropriate, the frequency and timing of blood glucose monitoring reminders. Patient satisfaction and perceptions of the usability of the program were obtained via semistructured phone interviews conducted at completion of the pilot study. HbA1c was obtained from patient records at baseline and completion of the pilot study.
  
  
  RESULTS
  Participants received on average 109 messages during the 3-month program with 2 participants withdrawing early from the study. Follow-up interviews were completed with 93% of participants with all reporting SMS4BG to be useful and appropriate to their age and culture. Participants reported a range of perceived positive impacts of SMS4BG on their diabetes and health behaviors. HbA1c results indicated a positive impact of the program on glycemic control with a significant decrease in HbA1c from baseline to follow-up.
  
  
  CONCLUSIONS
  A tailored text message-based intervention is both acceptable and useful in supporting self-management in people with poorly controlled diabetes. A randomized controlled trial of longer duration is needed to assess the efficacy and sustainability of SMS4BG.
authors.affiliation: National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. r.dobson@auckland.ac.nz.
authors.forename: Rosie
authors.identifier: http://orcid.org/0000-0003-0122-1000
authors.initials: R
authors.lastname: Dobson
authors.forename: Karen
authors.identifier: http://orcid.org/0000-0001-6430-6912
authors.initials: K
authors.lastname: Carter
authors.forename: Richard
authors.identifier: http://orcid.org/0000-0002-4171-059X
authors.initials: R
authors.lastname: Cutfield
authors.forename: Ashley
authors.identifier: http://orcid.org/0000-0002-9627-8087
authors.initials: A
authors.lastname: Hulme
authors.forename: Richard
authors.identifier: http://orcid.org/0000-0002-5298-027X
authors.initials: R
authors.lastname: Hulme
authors.forename: Catherine
authors.identifier: http://orcid.org/0000-0002-5342-3694
authors.initials: C
authors.lastname: McNamara
authors.forename: Ralph
authors.identifier: http://orcid.org/0000-0001-8564-5518
authors.initials: R
authors.lastname: Maddison
authors.forename: Rinki
authors.identifier: http://orcid.org/0000-0002-0043-2423
authors.initials: R
authors.lastname: Murphy
authors.forename: Matthew
authors.identifier: http://orcid.org/0000-0003-4238-7541
authors.initials: M
authors.lastname: Shepherd
authors.forename: Johan
authors.identifier: http://orcid.org/0000-0002-3788-0369
authors.initials: J
authors.lastname: Strydom
authors.forename: Robyn
authors.identifier: http://orcid.org/0000-0003-0901-9149
authors.initials: R
authors.lastname: Whittaker
keywords: SMS; diabetes mellitus; mHealth; mobile phone; self-management; text message
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