title: Disparities in the use of a mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes.
abstract: OBJECTIVE
  Mobile health (mHealth) interventions may improve diabetes outcomes, but require engagement. Little is known about what factors impede engagement, so the authors examined the relationship between patient factors and engagement in an mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes (T2DM).
  
  
  METHODS
  Eighty patients with T2DM participated in a 3-month mHealth intervention called MEssaging for Diabetes that leveraged a mobile communications platform. Participants received daily text messages addressing and assessing medication adherence, and weekly interactive automated calls with adherence feedback and questions for problem solving. Longitudinal repeated measures analyses assessed the relationship between participants' baseline characteristics and the probability of engaging with texts and calls.
  
  
  RESULTS
  On average, participants responded to 84.0% of texts and participated in 57.1% of calls. Compared to Whites, non-Whites had a 63% decreased relative odds (adjusted odds ratio [AOR] = 0.37, 95% confidence interval [CI], 0.19-0.73) of participating in calls. In addition, lower health literacy was associated with a decreased odds of participating in calls (AOR = 0.67, 95% CI, 0.46-0.99, P = .04), whereas older age (Pnonlinear = .01) and more depressive symptoms (AOR = 0.62, 95% CI, 0.38-1.02, P = .059) trended toward a decreased odds of responding to texts.
  
  
  CONCLUSIONS
  Racial/ethnic minorities, older adults, and persons with lower health literacy or more depressive symptoms appeared to be the least engaged in a mHealth intervention. To facilitate equitable intervention impact, future research should identify and address factors interfering with mHealth engagement.
authors.affiliation: Department of Medicine, Vanderbilt University, Nashville, TN, USA Center for Health Behavior and Health Education, Vanderbilt University, Nashville, TN, USA.
authors.forename: Lyndsay A
authors.initials: LA
authors.lastname: Nelson
authors.affiliation: School of Nursing, Vanderbilt University, Nashville, TN, USA Center for Diabetes Translational Research, Vanderbilt University, Nashville, TN, USA Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA Department of Pediatrics, Vanderbilt University, Nashville, TN, USA.
authors.forename: Shelagh A
authors.initials: SA
authors.lastname: Mulvaney
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, TN, USA.
authors.forename: Tebeb
authors.initials: T
authors.lastname: Gebretsadik
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA.
authors.forename: Yun-Xian
authors.initials: YX
authors.lastname: Ho
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA Department of Pediatrics, Vanderbilt University, Nashville, TN, USA.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Johnson
authors.affiliation: Department of Medicine, Vanderbilt University, Nashville, TN, USA Center for Health Behavior and Health Education, Vanderbilt University, Nashville, TN, USA Center for Diabetes Translational Research, Vanderbilt University, Nashville, TN, USA Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA chandra.osborn@vanderbilt.edu.
authors.forename: Chandra Y
authors.initials: CY
authors.lastname: Osborn
mesh_terms: D000328:Adult; D000367:Age Factors; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017216:Telemedicine / Q000706:statistics & numerical data*; D060145:Text Messaging
keywords: disparities; mHealth; medication adherence; patient engagement; type 2 diabetes mellitus