Effectiveness of short message service-based intervention (SMS) on self-care in type 2 diabetes: A feasibility study

doi:10.1016/j.pcd.2015.11.001

Primary Care Diabetes

Volume 10, Issue 4, August 2016, Pages 251-258

https://doi.org/10.1016/j.pcd.2015.11.001 Get rights and content

Highlights

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Patient education plays a significant role in diabetes management.
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Intervention reduced FBS, triglyceride and BMI significantly in both SMS groups.
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Intervention increased SCI-R scores significantly in both SMS groups.
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DSCB and DMSES scores decreased significantly in both SMS groups after intervention.

Abstract

Aim

The objective of the current study is to assess the effectiveness of Mobile Short Message Service (SMS) intervention on education of basic self-care skills in patients with type 2 diabetes. Moreover, we aimed to determine whether delivering individually-tailored educational messages can be more effective than general educational messages.

Methods

A total of 150 patients with diabetes type 2 were randomized into three groups: tailored SMS group, non-tailored SMS group, and the control group. Biochemical parameters including HbA1c, FBS, lipid profile were evaluated for the three groups at baseline and after 12 weeks. Moreover, self-care Inventory (SCI), Diabetes Management Self-Efficacy Scale (DMSES) and Diabetes Self-Care Barriers assessment scale for Older Adults (DSCB-OA) were completed. In the tailored SMS group, each person received 75% of their messages based on the top two barriers to adherence that they had experienced and reported in their scale. In the non-tailored SMS group, random messages were sent to every patient.

Results

After 12 weeks, although HgA1c levels did not significantly change, significant decline was observed in FBS and mean BMI in both intervention groups. Mean SCI-R scores significantly increased and mean DSCB and DMSES scores significantly decreased in both tailored and non-tailored SMS groups. In the control group, mean SCI-R scores decreased and mean DSCB and DMSES scores significantly increased (P < 0.001).

Conclusion

Sending short text messages as a method of education in conjunction with conventional diabetes treatment can improve glycemic control and positively influence other aspects of diabetes self-care. According to our findings, sending SMS regularly in particular times appears to be as effective as sending individually tailored messages.

Introduction

Diabetes mellitus is a globally widespread chronic and progressive metabolic disorder which is considered as a well-documented health problem, especially in the developing countries [1], [2]. World Health Organization estimates that there are more than 220 million diabetic patients in the world and this number will rise to 366 million by 2030 [3].

Past research has been found that recommended self-care activities in diabetes and adherence to these tasks are highly important for glycaemic control. Therefore, it can be concluded that patients’ active participation in their plan of care can play a key role in predicting favorable outcomes of the disease [3], [4]. The main objective of patient education is to change the patient's behavior or helping patients to modify old behaviors. This leads to the positive behavioral changes in patients and encourages them to get actively involved in their treatment plan. Therefore, it can be concluded that effective patient education that provides adequate information, support and monitoring can improve adherence, which in turn, can reduce the burden of diabetes chronic complications as well as providing a better quality of life for diabetes patients [5], [6], [7], [8].

Despite the benefits of diabetes self-management education being supported by literature [9], [10], [11]. It is imperative to develop novel diabetes patient education programs and to assess the effectiveness of them in order to ensure that limited health resources are being spent effectively. In this sense, it seems that mobile phone-based educational interventions as relatively new methods, offer potential to shift the focus away from the clinic towards patients’ daily lives, where behavior and attitude change is actualized [12], [13]. So this can be translated into more favorable clinical outcomes and better self-care skills, as well as reducing costs involved and patient referral to specialists.

Mobile telephones and SMS are becoming integrated into virtually all aspects of society. National statistics indicate that the number of mobile phone subscribers in Iran has sharply increased since its introduction two decades ago. Among different mobile services available in Iran, the text messaging is increasingly popular, reportedly reaching a peak of 50 million messages per day [14]. This service allows for instantaneous delivery of short messages directly to individuals at any time, place, or setting. Customized SMS messages can be tailored to individuals, which is important given that personally tailored messages are more effective for health behavior changes than untailored messages. Communication with SMS is also very affordable and cost effective. All these features have led to the increasing popularity of this service [15], and subsequently, it has been focus of attention of many researchers and a considerable number of studies have been carried out regarding utilization of this technology for improving the quality of care for diabetic patients [16]. For example, a study in United Kingdom has developed a novel support network, based on a unique text-messaging system designed to deliver individually targeted messages and general diabetes information [17]. Another study in Korea has assessed the impact of a nurse short message service intervention on HbA1c levels and adherence to treatment control recommendations in patients with diabetes [18]. Moreover, results of a study carried out in Bahrain demonstrated effectiveness of mobile phone short message service on diabetes mellitus management [19]. In addition, a study was done by Mulvaney et al. in the USA to determine whether a tailored messaging system according to individually-reported barriers to diabetes self-care would be effective on glycaemic control [4]. It is noteworthy, moreover, that another study done by Ramachandran et al. assessed effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India [20]. However, there are few studies regarding use of this service as a educational method in Iran [5], [13].

In the latest guideline developed by the Endocrinology and Metabolism Research Institute which is to be followed by Iranian general practitioners, a comprehensive approach to diabetes care is to be implemented with a particular emphasis on diabetes education. With the view of this potential and intention for implementation of future SMS-based diabetes care interventions in Iran, author conducted a feasibility study to assess the efficacy of an SMS-based education to support patients with diabetes type 2 and educate them about the four main areas of self-care skills which are useful in the management of their condition. Another goal of this study was to determine whether delivering individually-tailored educational messages can be more effective than general educational messages. So individually tailored SMS messages were sent to patients according to the barriers to diabetes self-care adherence they had reported. It is noteworthy, however, that the main objective of this study was to assess the efficacy of this educational method for implementation in the form of instructions across the entire country where possible by the Diabetes Research Network.

Section snippets

Study design and sample size

This study is a three-arm randomized controlled trial. 150 patients with diabetes type 2 were recruited through an outpatient diabetes clinic of the Endocrinology and Metabolism Research Institute affiliated to Tehran University of Medical Sciences. Patients referred to the clinic were screened for eligibility (Fig. 1). The inclusion criteria were as follows: owning a mobile phone, consenting to receive text messages, and ability to read text messages. Patients were excluded if they had a

Results

150 diabetic patients were recruited for the study (50 patients in each group) with a mean age of 52.5 ± 10.19 (range 18–79 years). 54% of the participants were male and 46% were female. There were no significantly differences between the three groups in terms of sex, age, family history of diabetes, duration of diabetes and occupation. However, there was a significant difference in level of education between three groups and more highly educated people were in the intervention groups (Table 1).

Discussion

Diabetes patient education is considered as a crucial part of comprehensive diabetes care. However, in many cases, once diabetic patients receive basic diabetes education, they are left on their own to manage their disease for the rest of their lives [28]. This study was designed to assess whether an educational intervention using the short message service (SMS) of cellular phone may fill this gap and result in improved diabetes care outcomes. In order to answer this question, the authors

Conclusion

Ultimately, it can be concluded that SMS system with the ability to deliver information on demand, to be easy to use and overcome the internet and computer systems troubles as a medium for information exchange in conjunction with conventional diabetes treatment can improve glycemic control and positively influence other aspects of diabetes care. Moreover, our results demonstrated that the differences between the therapeutic outcomes of the two intervention groups were not significant. In other

Conflict of interest

The authors have no conflict of interest regarding the present submission to declare.

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Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials
2023, The Lancet Digital Health
Digital health interventions have shown promising results for the management of type 2 diabetes, but a comparison of the effectiveness and implementation of the different modes is not currently available. Therefore, this study aimed to compare the effectiveness of SMS, smartphone application, and website-based interventions on improving glycaemia in adults with type 2 diabetes and report on their reach, uptake, and feasibility.
In this systematic review and meta-analysis, we searched CINAHL, Cochrane Central, Embase, MEDLINE, and PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) that examined the effectiveness of digital health interventions in reducing glycated haemoglobin A_1c (HbA_1c) in adults with type 2 diabetes, published in English from Jan 1, 2009. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint assessed was the change in the mean (and 95% CI) plasma concentration of HbA_1c at 3 months or more. Cochrane risk of bias 2 was used to assess risk of bias. Data on reach, uptake, and feasibility were summarised narratively and data on HbA_1c reduction were synthesised in a meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation criteria was used to evaluate the level of evidence. The study was registered with PROSPERO, CRD42021247845.
Of the 3236 records identified, 56 RCTs from 24 regions (n=11 486 participants), were included in the narrative synthesis, and 26 studies (n=4546 participants) in the meta-analysis. 20 studies used SMS as the primary mode of delivery of the digital health intervention, 25 used smartphone applications, and 11 implemented interventions via websites. Smartphone application interventions reported higher reach compared with SMS and website-based interventions, but website-based interventions reported higher uptake compared with SMS and smartphone application interventions. Effective interventions, in general, included people with greater severity of their condition at baseline (ie, higher HbA_1c) and administration of a higher dose intensity of the intervention, such as more frequent use of smartphone applications. Overall, digital health intervention group participants had a –0·30 (95% CI –0·42 to –0·19) percentage point greater reduction in HbA_1c, compared with control group participants. The difference in HbA_1c reduction between groups was statistically significant when interventions were delivered through smartphone applications (–0·42% [–0·63 to –0·20]) and via SMS (–0·37% [–0·57 to –0·17]), but not when delivered via websites (–0·09% [–0·64 to 0·46]). Due to the considerable heterogeneity between included studies, the level of evidence was moderate overall.
Smartphone application and SMS interventions, but not website-based interventions, were associated with better glycaemic control. However, the studies' heterogeneity should be recognised. Considering that both smartphone application and SMS interventions are effective for diabetes management, clinicians should consider factors such as reach, uptake, patient preference, and context of the intervention when deciding on the mode of delivery of the intervention. Nine in ten people worldwide own a feature phone and can receive SMS and four in five people have access to a smartphone, with numerous smartphone applications being available for diabetes management. Clinicians should familiarise themselves with this modality of programme delivery and encourage people with type 2 diabetes to use evidence-based applications for improving their self-management of diabetes. Future research needs to describe in detail the mediators and moderators of the effectiveness and implementation of SMS and smartphone application interventions, such as the optimal dose, frequency, timing, user interface, and communication mode to both further improve their effectiveness and to increase their reach, uptake, and feasibility.
EU's Horizon 2020 Research and Innovation Programme.
Digital interventions self-management education for type 1 and 2 diabetes: A systematic review and meta-analysis
2021, Computer Methods and Programs in Biomedicine
Objective: To describe and assess digital health-led diabetes self-management education and support (DSMES) effectiveness in improving glycosylated hemoglobin, diabetes knowledge, and health-related quality of life (HrQoL) of Type 1 and 2 Diabetes in the past 10 years.
Design: Systematic Review and Meta-Analysis. The protocol was registered on PROSPERO registration number CRD42019139884.
Data Sources: PubMed, EMBASE, Cochrane library, Web of Science, and Scopus between January 2010 and August 2019.
Study Selection and Appraisal: Randomized control trials of digital health-led DSMES for Type 1 (T1DM) or 2 (T2DM) diabetes compared to usual care were included. Outcomes were change in HbA1c, diabetes knowledge, and HrQoL. Cochrane Risk of Bias 2.0 tool was used to assess bias and GRADEpro for overall quality. The analysis involved narrative synthesis, subgroup and pooled meta-analyses.
Results: From 4286 articles, 39 studies (6861 participants) were included. Mean age was 51.62 years, range (13–70). Meta-analysis revealed intervention effects on HbA1c for T2DM with difference in means (MD) from baseline -0.480% (-0.661, -0.299), I²75% (6 months), -0.457% (-0.761, -0.151), I² 81% (12 months), and for T1DM -0.41% (-1.022, 0.208) I² 83% (6 months), -0.03% (-0.210, 0.142) I² 0% (12 months). Few reported HrQoL with Hedges’ g 0.183 (-0.039, 0.405), I² 0% (6 months), 0.153 (-0.060, 0.366), I² 0% (12 months) and diabetes knowledge with Hedges’ g 1.003 (0.068, 1.938), I² 87% (3 months).
Conclusion: Digital health-led DSMES are effective in improving HbA1c and diabetes knowledge, notably for T2DM. Research shows non-significant changes in HrQoL. Intervention effect on HbA1c was more impressive if delivered through mobile apps or patient portals. Further research is needed on the impact of DSMES on these outcomes, especially for newly diagnosed diabetes patients.
Effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management for people with type 2 diabetes. A randomized controlled trial
2021, Patient Education and Counseling
Citation Excerpt :
To date, DTEXT is the largest Australian randomized controlled trial to examine a health intervention delivered by mobile phone text messages for people with type 2 diabetes, and adds to the growing body of evidence in this field. The overall evidence for effectiveness however remains mixed with the most efficacious characteristics of interventions unknown, and research on text message frequency, duration, use of theory and tailoring of messages [14–16,29,30] being varied and inconclusive. A recent systematic review and meta-analysis of unidirectional text message interventions in 1710 people with type 2 diabetes by Haider et al. [14] showed that 5 of 11 studies had significant reductions in HbA1c [33,36,39–41], and the remaining studies, similar to DTEXT findings, had positive trends for reduction [29,30,42–46].
Determine the effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management behaviors for Australian adults with type 2 diabetes.
Using intention to treat analysis and generalized estimating equations, this randomized controlled trial of 395 adults determined change in HbA1c at 3 and 6 months between the intervention and control group. Secondary outcomes included change in nutrition, physical activity, blood lipid profile, body mass index, quality of life, self-efficacy, medication taking and program acceptability.
No significant difference was observed between the intervention or control group for HbA1c at 3 months (P = 0.23) or 6 months (P = 0.22). Significant improvements were seen in consumption of vegetables at 3 months (P < 0.001) and 6 months (P = 0.04); fruit at 3 months (P = 0.046) and discretionary sweet foods at 3 months (P = 0.02). No other significant effects seen. The intervention demonstrated high rates of acceptability (94.0%) and minimal withdrawal (1.5%).
DTEXT was an acceptable text message intervention that improved some nutritional behaviors in people with type 2 diabetes, but did not significantly improve HbA1c or other outcomes. Further research is required to optimize DTEXT.
DTEXT provides an acceptable, feasible form of self-management support that may complement existing diabetes care.
Effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life and clinical outcomes in patients with type 2 diabetes: A systematic review and meta-analysis
2021, International Journal of Nursing Studies
Citation Excerpt :
The studies included in our review could be categorized into four main types: ‘education’ (provision of diabetes-related and self-care education), ‘reminders’ (reminders to carry out specified self-care activities), ‘self-monitoring’ (monitoring and recording of self-care data obtained) and ‘feedback’ (provision of feedback or healthcare recommendations based on the self-care data input either by healthcare professionals or predesigned algorithm software). The majority of the included studies used a combination of type 2 diabetes mellitus self-management intervention components, except for three studies that only provided education (Fang and Deng, 2018; Goodarzi et al., 2012; Peimani et al., 2016). In addition, twelve studies delivered regular diabetes-related SMSes as the intervention at varying frequencies of twice a day (n = 2) (Agboola et al., 2016; Arora et al., 2014), daily (n = 5) (Capozza et al., 2015; Fortmann et al., 2017; Islam et al., 2015; Lim et al., 2016; Orsama et al., 2013), 4 per week (n = 1) (Goodarzi et al., 2012), 3 per week (n = 1) (Tamban et al., 2014), once in 3 days (n = 1) (Shetty et al., 2011), weekly (n = 1) (Kim, 2007) and monthly (n = 1) (Fang and Deng, 2018).
To review the evidence and determine the effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life, glycated hemoglobin, body mass index (BMI), and blood pressure (BP) levels of adults with type 2 diabetes mellitus .
A systematic search of five databases (PubMed, Embase, Cochrane, CINAHL and Scopus) was conducted. Studies published in English from January 2007 to January 2018 were considered. Only randomized controlled trials (RCTs) of smartphone-based self-management interventions for patients with type 2 diabetes mellitus that reported any of the study outcomes were included. Two reviewers independently screened the studies, extracted data and assessed the quality of the studies. Meta-analyses were conducted for the different study outcomes.
A total of 26 articles, consisting of 22 studies with 2645 participants, were included in the review. The results from meta-analysis on the studies revealed that as compared to control group, participants received smartphone-based self-management intervention had better self-efficacy with large effect size of 0.98 (P < 0.001), self-care activities with effect size of 0.90 (P < 0.001), health related quality of life with effect size of 0.26 (p=0.01), and lower glycated hemoglobin (pooled MD=-0.55; p<0.001). Subgroup analyses were also conducted for self-efficacy as significant heterogeneity was present among the studies. The effects on BMI and BP were not statistically significant.
Smartphone-based self-management interventions appear to have beneficial effects on self-efficacy, self-care activities and health-relevant outcomes for patients with type 2 diabetes mellitus. However, more research with good study design is needed to evaluate the effectiveness of smartphone-based self-care interventions for T2DM.
Identifying features of a mobile-based application for self-care of people living with T2DM
2021, Diabetes Research and Clinical Practice
Diabetes self-care requires support to empower patients to improve self-monitoring and maintain the necessary self-care behaviors. We aimed to identify features of a mobile-based application as a technology-based device for self-care of people living with T2DM.
This study was conducted in two main phases in 2020. In the first phase, a literature review study was performed to identify the data elements and technical features of the T2DM self-care application. In the second phase, using the information obtained from the review of similar articles, a questionnaire was designed to validate identified requirements. The statistical population of the present study consisted of 22 endocrinologists and metabolic specialists.
Identification of 55 data elements and technical features for mobile-based self-care application for people with T2DM, and according to the statistical population, 15data elements for demographic requirements, 16 data elements for clinical requirements, and 17 features for the technical capability of this app were selected.
Blood sugar monitoring, exercise, nutrition, weight monitoring, and educational capabilities were the most highlighted technical features of the T2DM self-care application. Software designers can use these requirements to design a self-care app for people with type-2 diabetes that can help manage and improve patients' health status.
The effect of nurse-led telephone-based interventions on glycosylated hemoglobin levels in people with type 2 diabetes: A meta-analysis
2024, Worldviews on Evidence-Based Nursing

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View full text

Original researchEffectiveness of short message service-based intervention (SMS) on self-care in type 2 diabetes: A feasibility study

Highlights

Abstract

Aim

Methods

Results

Conclusion

Introduction

Section snippets

Study design and sample size

Results

Discussion

Conclusion

Conflict of interest

J. Diabetes Metab. Disord.

Arch. Med. Res.

Patient Educ. Couns.

J. Biomed. Inform.

Am. J. Prev. Med.

Diabetes Res. Clin. Pract.

Lancet Diabetes Endocrinol.

Diabetes Res. Clin. Pract.

Diabetes Metab.

Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation

Diabetic Med.

Role of self-care in management of diabetes mellitus

J. Diabetes Metab. Disord.

Diabetes management via mobile phones: a systematic review

Telemed. J. E Health

A pilot test of a tailored mobile and web-based diabetes messaging system for adolescents

J. Telemed. Telecare

Review of the psychometric properties of the Diabetes Self-Efficacy Scale: Australian longitudinal study

Nurs. Health Sci.

Knowledge on diabetes mellitus in the self care process

Rev. Latino-Am. Enfermagem

Meta-analysis of diabetes patient education research: variations in intervention effects across studies

Res. Nurs. Health

Behavior changes in diabetes education

Diabetes Educ.

Mobile phone text messaging and Telephone follow-up in type 2 diabetic patients for 3 months: a comparative study

J. Diabetes Metab. Disord.

Adoption of the mobile messaging service: an empirical study of Iran context

The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review

PLoS Med.

Original research
Effectiveness of short message service-based intervention (SMS) on self-care in type 2 diabetes: A feasibility study