Feasibility of Implementing a Healthy Lifestyle Text Message Program for Older Adolescents and Young Adults with Type 1 Diabetes in an Adolescent Pediatric Setting
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Abstract
Background
Text messaging is a primary mode of communication among adolescents and young adults; teenagers rate cell phones as an item they can’t live without. Use of mHealth modalities in health care is expected to influence how health care systems and patients communicate with each other. Thus, understanding the feasibility of these mHealth modalities among teens managing chronic illness poses important empirical questions, especially as older adolescents transition to independent self-care.
Objective
This study tested the feasibility of implementing healthy lifestyle text messages among patients with type 1 and type 2 diabetes, ages 16-21, at a Boston-area diabetes center. In addition to checking blood glucose levels and administering insulin, teens with diabetes must also maintain basic healthy lifestyles for optimal health. The text messages were delivered as part of an adolescent health promotion platform, called BodiMojo.com. The adolescent user can set and track health goals related to healthy eating and physical activity, receive reminders about attending to those goals and receive developmentally relevant motivational tips with links to health quizzes and articles.
Methods
Ninety adolescent patients were recruited and consented/assented. Participants met with a research assistant (RA) once at baseline to complete questionnaires and set goals related to nutrition and physical activity. Participants were randomized to receive daily text message reminders about their goals for 1 month (text group) or to receive a pamphlet about healthy eating and activity (control group). In this study, text messages were sent three times a week to check in with adolescents about the health goals they set at the start of the study, e.g. “Did you meet your nutrition/exercise goal today?†In response to their text answers, adolescents then received immediate text feedback based on an inventory of replies, e.g. “Great job!†or “No big deal, just try again tomorrow.†They also received a daily health tip, e.g., “Remember: activity can be spread throughout the day, 10 minutes at a time!†After 1 month, participants completed online questionnaires and were compensated with a $25 gift card.
Results
Recruitment goals were accomplished within 2 months: 66% of participants approached enrolled in the study. The majority of participants were college students (67%), white (87%), and had type 1 diabetes (91%) for an average of 10±5 years. The majority (80%) identified as participating in sports or regular physical activity (30-60 minutes/day), with 50% being active 4 or more times per week. The majority (79%) used phones with internet access. Text group participants provided positive feedback: “The facts are helpful and are a reminder of ways to stay healthy.†“This has been an easy and nice way of reminding me to stay on track with my health goals!â€
Conclusions
Text messaging is a highly feasible method for health promotion initiatives with emerging adults with diabetes, as evidenced by the quick uptake in participant recruitment, as well as the positive responses, suggesting this text intervention appears to be acceptable to adolescents. Determining whether such an intervention produces positive behavior change will be addressed in future analyses.
Text messaging is a primary mode of communication among adolescents and young adults; teenagers rate cell phones as an item they can’t live without. Use of mHealth modalities in health care is expected to influence how health care systems and patients communicate with each other. Thus, understanding the feasibility of these mHealth modalities among teens managing chronic illness poses important empirical questions, especially as older adolescents transition to independent self-care.
Objective
This study tested the feasibility of implementing healthy lifestyle text messages among patients with type 1 and type 2 diabetes, ages 16-21, at a Boston-area diabetes center. In addition to checking blood glucose levels and administering insulin, teens with diabetes must also maintain basic healthy lifestyles for optimal health. The text messages were delivered as part of an adolescent health promotion platform, called BodiMojo.com. The adolescent user can set and track health goals related to healthy eating and physical activity, receive reminders about attending to those goals and receive developmentally relevant motivational tips with links to health quizzes and articles.
Methods
Ninety adolescent patients were recruited and consented/assented. Participants met with a research assistant (RA) once at baseline to complete questionnaires and set goals related to nutrition and physical activity. Participants were randomized to receive daily text message reminders about their goals for 1 month (text group) or to receive a pamphlet about healthy eating and activity (control group). In this study, text messages were sent three times a week to check in with adolescents about the health goals they set at the start of the study, e.g. “Did you meet your nutrition/exercise goal today?†In response to their text answers, adolescents then received immediate text feedback based on an inventory of replies, e.g. “Great job!†or “No big deal, just try again tomorrow.†They also received a daily health tip, e.g., “Remember: activity can be spread throughout the day, 10 minutes at a time!†After 1 month, participants completed online questionnaires and were compensated with a $25 gift card.
Results
Recruitment goals were accomplished within 2 months: 66% of participants approached enrolled in the study. The majority of participants were college students (67%), white (87%), and had type 1 diabetes (91%) for an average of 10±5 years. The majority (80%) identified as participating in sports or regular physical activity (30-60 minutes/day), with 50% being active 4 or more times per week. The majority (79%) used phones with internet access. Text group participants provided positive feedback: “The facts are helpful and are a reminder of ways to stay healthy.†“This has been an easy and nice way of reminding me to stay on track with my health goals!â€
Conclusions
Text messaging is a highly feasible method for health promotion initiatives with emerging adults with diabetes, as evidenced by the quick uptake in participant recruitment, as well as the positive responses, suggesting this text intervention appears to be acceptable to adolescents. Determining whether such an intervention produces positive behavior change will be addressed in future analyses.
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