Mobile Motivation for Health Promotion Among Adolescents
Condition: Diabetes
Study type: Interventional
Phase: Phase 1

Summary: 
      This 4-week pilot study is designed to test the feasibility, adherence, and effectiveness of
      a cell phone text message program for lifestyle goal setting among adolescents with type 1 or
      type 2 diabetes. The study entails a small-scale randomized controlled trial with pre-post
      test of a mobile text message program.
    

Detailed description: 
      Adolescents with diabetes are a complex target group for health prevention initiatives for a
      number of developmental reasons, such as drive for autonomy, lack of acknowledgement of long
      term effects of unhealthy behavior, and high frequency of sedentary behaviors and poor diets
      (Arnett, 2007). Developing interventions that adolescents find appealing and acceptable is a
      challenge. An emerging health area referred to as "mobile health" has begun to address these
      issues by developing innovative uses of basic mobile technologies (Vital Wave/United Nations
      Foundation, 2009). A recent review of 14 studies, most related to diabetes management (n=10)
      and preventive behaviors, suggests that mobile phone-delivered interventions have positive
      short-term behavioral outcomes (Fjedshoe et al., 2009). A number of obesity prevention
      studies with adults have informed the use of mobile features (e.g., tailored messages or
      visual display of goal progress) and include mobile applications for adult weight loss
      (Patrick et al., 2009) and physical activity monitoring for women (Consolvo et al., 2008).
      Studies targeting children are few. However, one randomized controlled trial of Sweet Talk, a
      text-messaging system to support young people with diabetes, reported some success (Franklin
      et al., 2006). In a randomized controlled trial, 126 children with type 1 diabetes were
      allocated to either conventional insulin therapy, conventional therapy and Sweet Talk (the
      text message program), or intensive insulin therapy and Sweet Talk. Text messages were
      tailored to patient's age, sex, and insulin regimen. Compared to conventional treatments,
      automatic daily text messages (info, tips, support) with weekly reminders about personal
      goals increased self-efficacy and adherence to diabetes management; overall acceptance rates
      of Sweet Talk were high (82% felt the program improved self-care; 90% wanted to continue
      receiving messages). Studies such as these prompted the development of BodiMojo, a mobile
      phone health application to address healthy nutrition, physical activity, and positive body
      image. BodiMojo will be tested in the current study with up to 90 adolescents with diabetes
      to determine feasibility and adherence to lifestyle goals, and to examine changes in
      self-efficacy. It is hypothesized that the experimental participants will report higher
      self-efficacy for healthy eating and physical activity, and greater adherence to lifestyle
      goals, compared to control participants. It is also anticipated that the study procedure,
      design, and intervention will be found to be feasible. In addition, our group at Joslin has
      previous experience utilizing text message reminders in adolescents and young adults with
      type 1 diabetes and demonstrated its acceptability and ease of use (Hanauer, 2006).

      Ninety adolescents with diabetes will be recruited to participate in an RCT with a pre- and
      post-test design to assess feasibility, self-efficacy, and adherence to goal setting.
      Following informed consent, participants will be randomized to the intervention group or
      control group and followed for 4 weeks.
    

Intervention name(s): Lifestyle text messages; Attention Control Group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Throughout the course of the four-week study, the experimental participants will receive one text message each morning related to general nutrition and exercise goals, and an additional "goal status update message" on Monday, Wednesday, and Friday evenings. The goal status update message will ask the participants about the status of attaining their nutrition or physical activity goals. Participants may log their progress toward attaining their goals by using the mobile health dashboard feature on BodiMojo.com from a computer or a web-enabled smartphone to indicate their goal status ("still working on it" or "completed it"). Participants will be encouraged, via the text messages, to look at information on the BodiMojo program found on the Bodimojo.com website.; Once participants randomized to the control group have completed the baseline assessment, they will be asked to write down two health goals with the RA. The same goals will be suggested for this group as for the Intervention group (see Appendix). They will take home a copy of the goals they have set. The participants will be also given a 16-page pamphlet from NIDDK "A Guide for Teenagers: Take Charge of Your Health!" to take home to read over.
Other intervention name(s): Experimental; Attention Control
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: adolescents text messages eating exercise self-efficacy diabetes