Lyndsay A Nelson1,2, Robert A Greevy3, Andrew Spieker3, Kenneth A Wallston4, Tom A Elasy1,5, Sunil Kripalani1, Chad Gentry6, Erin M Bergner1,2, Lauren M LeStourgeon1,2, Sarah E Williamson1,2, Lindsay S Mayberry7,2,5,8. 1. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN. 2. Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN. 3. Department of Biostatistics, Vanderbilt University, Nashville, TN. 4. Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN. 5. Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN. 6. Department of Pharmacy, College of Pharmacy and Health Sciences, Lipscomb University, Nashville, TN. 7. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN lindsay.mayberry@vumc.org. 8. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.
Abstract
OBJECTIVE: Text messaging interventions have high potential for scalability and for reductions in health disparities. However, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. RESEARCH DESIGN AND METHODS: Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized controlled trial and were assigned to receive Rapid Education/Encouragement and Communications for Health (REACH) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence and nontailored texts supporting other self-care behaviors. Outcomes included hemoglobin A1c (HbA1c), diabetes medication adherence, self-care, and self-efficacy. RESULTS: Participants (N = 506) were approximately half racial/ethnic minorities, and half were underinsured, had annual household incomes <$35,000, and had a high school education or less; 11% were homeless. Average baseline HbA1c was 8.6% ± 1.8%; 70.0 ± 19.7 mmol/mol) with n = 219 having HbA1c ≥8.5% (69 mmol/mol). Half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI -0.61%, -0.02%) was greater among those with baseline HbA1c ≥8.5% (-0.74%; 95% CI -1.26%, -0.23%), and there was no evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. CONCLUSIONS: REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain the effects.
OBJECTIVE: Text messaging interventions have high potential for scalability and for reductions in health disparities. However, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. RESEARCH DESIGN AND METHODS: Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized controlled trial and were assigned to receive Rapid Education/Encouragement and Communications for Health (REACH) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence and nontailored texts supporting other self-care behaviors. Outcomes included hemoglobin A1c (HbA1c), diabetes medication adherence, self-care, and self-efficacy. RESULTS: Participants (N = 506) were approximately half racial/ethnic minorities, and half were underinsured, had annual household incomes <$35,000, and had a high school education or less; 11% were homeless. Average baseline HbA1c was 8.6% ± 1.8%; 70.0 ± 19.7 mmol/mol) with n = 219 having HbA1c ≥8.5% (69 mmol/mol). Half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI -0.61%, -0.02%) was greater among those with baseline HbA1c ≥8.5% (-0.74%; 95% CI -1.26%, -0.23%), and there was no evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. CONCLUSIONS: REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain the effects.
Authors: Lyndsay A Nelson; Kenneth A Wallston; Sunil Kripalani; Lauren M LeStourgeon; Sarah E Williamson; Lindsay S Mayberry Journal: Diabetes Res Clin Pract Date: 2018-06-04 Impact factor: 5.602
Authors: Lyndsay A Nelson; Kenneth A Wallston; Sunil Kripalani; Robert A Greevy; Tom A Elasy; Erin M Bergner; Chad K Gentry; Lindsay S Mayberry Journal: JMIR Res Protoc Date: 2018-04-10
Authors: Lyndsay A Nelson; Andrew J Spieker; Lindsay S Mayberry; Candace McNaughton; Robert A Greevy Journal: J Am Med Inform Assoc Date: 2021-12-28 Impact factor: 4.497
Authors: Deborah A Greenwood; Michelle L Litchman; Diana Isaacs; Julia E Blanchette; Jane K Dickinson; Allyson Hughes; Vanessa D Colicchio; Jiancheng Ye; Kirsten Yehl; Andrew Todd; Malinda M Peeples Journal: J Diabetes Sci Technol Date: 2021-08-11
Authors: Lyndsay A Nelson; Sarah E Williamson; Lauren M LeStourgeon; Lindsay S Mayberry Journal: Contemp Clin Trials Date: 2021-04-02 Impact factor: 2.261