title: Enhancing mHealth Technology in the Patient-Centered Medical Home Environment to Activate Patients With Type 2 Diabetes: A Multisite Feasibility Study Protocol.
abstract: BACKGROUND
  The potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness. Some of the more promising results have been demonstrated using regular collection of biometric devices, SMS text messaging, secure email communication with clinical teams, and regular reporting of quality-of-life variables. In this study, we seek to incorporate several of the most promising mHealth capabilities in a patient-centered medical home (PCMH) workflow.
  
  
  OBJECTIVE
  We aim to address underlying technology needs and gaps related to the use of mHealth technology and the activation of patients living with type 2 diabetes. Stated differently, we enable supporting technologies while seeking to influence patient activation and self-care activities.
  
  
  METHODS
  This is a multisite phased study, conducted within the US Military Health System, that includes a user-centered design phase and a PCMH-based feasibility trial. In phase 1, we will assess both patient and provider preferences regarding the enhancement of the enabling technology capabilities for type 2 diabetes chronic care management. Phase 2 research will be a single-blinded 12-month feasibility study that incorporates randomization principles. Phase 2 research will seek to improve patient activation and self-care activities through the use of the Mobile Health Care Environment with tailored behavioral messaging. The primary outcome measure is the Patient Activation Measure scores. Secondary outcome measures are Summary of Diabetes Self-care Activities Measure scores, clinical measures, comorbid conditions, health services resource consumption, and technology system usage statistics.
  
  
  RESULTS
  We have completed phase 1 data collection. Formal analysis of phase 1 data has not been completed. We have obtained institutional review board approval and began phase 1 research in late fall 2016.
  
  
  CONCLUSIONS
  The study hypotheses suggest that patients can, and will, improve their activation in chronic care management. Improved activation should translate into improved diabetes self-care. Expected benefits of this research to the scientific community and health care services include improved understanding of how to leverage mHealth technology to activate patients living with type 2 diabetes in self-management behaviors. The research will shed light on implementation strategies in integrating mHealth into the clinical workflow of the PCMH setting.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02949037. https://clinicaltrials.gov/ct2/show/NCT02949037. (Archived by WebCite at http://www.webcitation.org/6oRyDzqei).
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Ronald
authors.identifier: http://orcid.org/0000-0001-8185-4013
authors.initials: R
authors.lastname: Gimbel
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Lu
authors.identifier: http://orcid.org/0000-0001-8352-2813
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Joel E
authors.identifier: http://orcid.org/0000-0001-6082-8799
authors.initials: JE
authors.lastname: Williams
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Cheryl J
authors.identifier: http://orcid.org/0000-0003-2462-8698
authors.initials: CJ
authors.lastname: Dye
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Liwei
authors.identifier: http://orcid.org/0000-0002-8458-5661
authors.initials: L
authors.lastname: Chen
authors.affiliation: Nellis Family Medicine Residency Program, Mike O'Callaghan Federal Hospital, Las Vegas, NV, United States.
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0001-7484-8328
authors.initials: P
authors.lastname: Crawford
authors.affiliation: Madigan Army Medical Center, Tacoma, WA, United States.
authors.forename: Eric A
authors.identifier: http://orcid.org/0000-0003-2643-0634
authors.initials: EA
authors.lastname: Shry
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Sarah F
authors.identifier: http://orcid.org/0000-0003-4820-3985
authors.initials: SF
authors.lastname: Griffin
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Karyn O
authors.identifier: http://orcid.org/0000-0002-4057-1938
authors.initials: KO
authors.lastname: Jones
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Windsor W
authors.identifier: http://orcid.org/0000-0002-2399-4744
authors.initials: WW
authors.lastname: Sherrill
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Khoa
authors.identifier: http://orcid.org/0000-0002-8996-4126
authors.initials: K
authors.lastname: Truong
authors.affiliation: MHIC Laboratory Lead, Telemedicine & Advanced Technology Research Center, U.S. Army Medical Research & Materials Command, Fort Gordon, GA, United States.
authors.forename: Jeanette R
authors.identifier: http://orcid.org/0000-0001-9144-7032
authors.initials: JR
authors.lastname: Little
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Karen W
authors.identifier: http://orcid.org/0000-0003-3584-0328
authors.initials: KW
authors.lastname: Edwards
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Marie
authors.identifier: http://orcid.org/0000-0003-3268-3187
authors.initials: M
authors.lastname: Hing
authors.affiliation: Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
authors.forename: Jennie B
authors.identifier: http://orcid.org/0000-0001-7992-5716
authors.initials: JB
authors.lastname: Moss
keywords: diabetes mellitus; eHealth; health information; mHealth; patient activation; patient centered care; patient-centered medical home