title: The impact of tailored text messages on health beliefs and medication adherence in adults with diabetes: A randomized pilot study.
abstract: BACKGROUND
  Inadequate medication adherence reduces optimal health outcomes and can lead to increased costs, particularly in patients with diabetes. Efforts to improve adherence have resulted in limited effects; approaches leveraging mobile technology have emerged, but their focus has mainly been limited to simple reminder messages.
  
  
  OBJECTIVE
  The purpose of this pilot study was to test the effectiveness of tailored text messages focusing on improving medication adherence and health beliefs in adults with diabetes.
  
  
  METHODS
  Adults aged 21-64, with uncontrolled diabetes, and taking at least one anti-diabetic medication were recruited and randomized into 2 study arms: daily tailored text messaging for 90 days or standard care. Comparing baseline and endpoint survey responses, changes in theory-driven health beliefs and attitudes were assessed. The impact on medication adherence was evaluated using pharmacy claims by calculating the percent of days covered (PDC).
  
  
  RESULTS
  A total of 75 subjects were consented, and 48 were randomized. Mean PDC at baseline were comparable between cohorts (84.4% and 87.1%, respectively). Declines in adherence were observed in both groups over time but no significant differences were observed between groups or from baseline to the end of the active study period. Unadjusted tests suggested that perceived benefits and competence might have improved in the intervention arm.
  
  
  CONCLUSIONS
  Tailoring mobile phone text messages is a novel way to address medication nonadherence and health beliefs; further investigation to this combined technique is needed to better understand its impact on behavior change in adults with diabetes.
authors.affiliation: University of Tennessee, College of Pharmacy, Memphis, TN, USA. Electronic address: jgatwood@uthsc.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Gatwood
authors.affiliation: University of Michigan, College of Pharmacy, Ann Arbor, MI, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.affiliation: University of Michigan, College of Pharmacy, Ann Arbor, MI, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Erickson
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Center for Health Communication Research, Ann Arbor, MI, USA.
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: An
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA; Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; University of Michigan School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.affiliation: University of Michigan, College of Pharmacy, Ann Arbor, MI, USA.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Farris
mesh_terms: D000328:Adult; D001294:Attitude to Health; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017010:Reminder Systems; D012648:Self Care; D012959:Socioeconomic Factors; D060145:Text Messaging / Q000706:statistics & numerical data*; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D007004:Hypoglycemic Agents
keywords: Adherence; Behavioral theory; Mobile health; Self-management; Tailoring