title: mHealth Intervention Elements and User Characteristics Determine Utility: A Mixed-Methods Analysis.
abstract: Mobile health (mHealth) interventions are improving the medication adherence of adults with type 2 diabetes mellitus (T2DM), but few studies examine how users experience these interventions. Therefore, we used a mixed-methods approach to understand how T2DM users experience a text messaging and interactive voice response (IVR)-delivered medication adherence intervention called MEssaging for Diabetes (MED).
  
  
  
  Adults with T2DM used MED as part of a 3-month pilot study. MED sends daily tailored text messages addressing adherence barriers, daily assessment text messages asking about adherence, and weekly tailored IVR calls providing adherence feedback, encouragement, and questions to facilitate problem solving. Sixty participants completed feedback interviews. We used a mixed-methods approach to understand their experience, examining associations between participants' characteristics and their feedback.
  
  
  
  Participants who completed feedback interviews were on average 50.0 ± 10.1 years old; 65% female, 62% non-white; 15% had less than a high school education, 70% had annual incomes less than $20K; and average hemoglobin A1c was 8.0% ± 1.9%. Participants rated each intervention element favorably; common reasons for MED's helpfulness included receiving novel information about diabetes medications, emotional support, and reminders to take medication. People who were younger and more recently diagnosed with T2DM had more favorable experiences using MED. In general, users valued text messages more than IVR calls.
  
  
  
  Consideration of the user experience is critical for developing engaging mHealth interventions. User feedback reveals what mHealth elements have the most value and why, which users to target, and how to optimize an intervention's utility and appeal.
authors.affiliation: 1 Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee.|2 Center for Health Behavior and Health Education, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Lyndsay A
authors.initials: LA
authors.lastname: Nelson
authors.affiliation: 3 School of Nursing, Vanderbilt University , Nashville, Tennessee.|4 Department of Biomedical Informatics, Vanderbilt University Medical Center , Nashville, Tennessee.|5 Department of Pediatrics, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Shelagh A
authors.initials: SA
authors.lastname: Mulvaney
authors.affiliation: 4 Department of Biomedical Informatics, Vanderbilt University Medical Center , Nashville, Tennessee.|5 Department of Pediatrics, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Johnson
authors.affiliation: 6 One Drop , New York, New York.
authors.forename: Chandra Y
authors.initials: CY
authors.lastname: Osborn
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010865:Pilot Projects; D017010:Reminder Systems; D012648:Self Care; D017216:Telemedicine; D060145:Text Messaging
keywords: Intervention; Medication adherence; Mobile health; Qualitative research; Type 2 diabetes mellitus