The MEssaging for Diabetes Intervention Reduced Barriers to Medication Adherence Among Low-Income, Diverse Adults With Type 2.
Nonadherence to diabetes medication is prevalent and costly. MEssaging for Diabetes (MED), a mobile health (mHealth) intervention, identified and addressed user-specific barriers to medication adherence. We assessed whether MED reduced users' targeted barriers and if barrier reductions were associated with within-participant improvements in adherence or glycemic control (HbA1c).



Adults (N = 80) with type 2 diabetes completed self-report measures identifying barriers to adherence at baseline and monthly for 3 months. At each assessment, 17 barriers were assessed and ranked for each user. Each subsequent month, users received daily text messages addressing their 3 highest ranked barriers. Targeted barriers were different for each participant and could change monthly. Paired t-tests assessed within-participant improvement in targeted barriers each month, and nested regression models assessed if changes in a participant's barrier scores were associated with improvements in adherence and HbA1c.



Participants were 69% non-white and 82% had incomes <$25K. Average HbA1c was 8.2 ± 2.0%. Assessment completion rates were 100% at baseline, 59% at 1 month, 30% at 2 months, and 65% at 3 months. The most commonly reported barriers were the cost of medications (76%), believing medications are harmful (58%), and lacking information about medications (53%). Participants' barrier scores improved each month and barrier improvement predicted adherence assessed via nightly adherence assessment text messages ( P < .001). Among participants who completed assessments each month, barrier improvement in months 2 and 3 ( P < .05) predicted HbA1c improvement.



Iterative, individual tailoring may overcome users' barriers to adherence. Attrition is a challenge for mHealth interventions among low-income patients.
1 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.|2 Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA.|3 Center for Diabetes Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
Lindsay S
LS
Mayberry
3 Center for Diabetes Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.|4 School of Nursing, Vanderbilt University, Nashville, TN, USA.
Shelagh A
SA
Mulvaney
5 Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.|6 Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Kevin B
KB
Johnson
1 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.|2 Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA.|3 Center for Diabetes Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.|5 Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
Chandra Y
CY
Osborn
D000328:Adult; D040421:Cell Phone; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011203:Poverty; D017010:Reminder Systems; D060145:Text Messaging
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
intervention; mHealth; medication adherence; mobile phone; text message; type 2 diabetes