November 21, 2014
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Mobile telehealth program helped shift behavior in patients with diabetes

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Behaviorally driven telephone health interventions can be used to address several pathways associated with sustained lifestyle change in patients with diabetes, according to research published in The Diabetes Educator.

“A theory-driven mobile phone intervention led to improvements in diabetes self-care and multiple behavioral constructs including self-efficacy, social support and health beliefs,” the researchers wrote.

Shantanu Nundy, MD, of the University of Chicago Medical Center, and colleagues conducted a mixed-methods observational cohort study involving 74 members of the University of Chicago Health Plan with type 1 or type 2 diabetes. The median age of the patients was 54 years, and they were largely from a working-class, urban black community.

For 6 months, the researchers investigated the effects of the “CareSmarts” intervention that combined automated text messaging and remote nursing through an interactive system. The program has been shown to improve diabetes control and reduce health care costs among program participants, according to the researchers.

Surveys were given at baseline, 3 and 6 months. Additional in-depth individual interviews were conducted with 14 patients and analyzed using constant comparative method to identify new behavioral constructs affected by the intervention. 

The intervention was associated with improvements in five of six domains of self-care, including medication adherence, glucose monitoring, foot care, exercise and healthy eating. It also was linked to improvements in at least one measure of either self-efficacy, social support or health beliefs. Patients qualitatively reported that their knowledge, attitudes and accountability for their condition also were affected by the program.

“As a low-cost and widely available technology, mobile phones are already recognized as a readily scalable platform for addressing chronic diseases,” the researchers wrote. “This study suggests further that they can also be a successful and versatile tool for behavior change and may represent a powerful adjunct to traditional diabetes education.”

Disclosure: Nundy reported being co-founder/part owner of mHealth Solutions, with no financial relationship or affiliation since 2011. The work was supported by the Agency for Healthcare Research and Quality Health Services Research Training Program, NIDDK, Chicago Center for Diabetes Translation Research, Diabetes Research and Training Center and Alliance to Reduce Disparities in Diabetes of the Merck Foundation.