Perspectives and Views of Primary Care Professionals regarding a mHealth Intervention to Support Adherence to antidiabetic medication in People with Type 2 Diabetes in Spain: A Qualitative Study (Preprint)
Authors: Zamanillo-Campos Rocío , Serrano-Ripoll Maria Jesús , Taltavull-Aparicio Joana Maria , Gervilla-García Elena , Ripoll-Amengual Joana , Fiol-DeRoque Maria Antonia , Boylan Anne-Marie , Ricci-Cabello Ignacio 
Published: April 2021

BACKGROUND

Type 2 Diabetes (T2D) is a long-term condition affecting 9.3% of people worldwide. People with T2D are at high risk of developing serious complications (e.g., blindness, lower-limb amputations, kidney disease, cardiovascular disease), which reduce their quality of life and life expectancy. Antidiabetic medication, if taken appropriately, is effective in preventing diabetes-related complications. However, 40% of T2D patients do not adequately adhere to their medication regimes. Brief text messages (e.g., SMS) delivered at a wide-scale and low cost via digital health systems represent a promising approach to support medication adherence. However, the views and perspectives of primary care professionals (PCP) regarding this type of intervention have seldom been explored.

OBJECTIVE

To explore PCPs’ views and perspectives concerning the DiabeText intervention, a new text messaging intervention currently being developed to support medication adherence in people with T2D in Mallorca (Spain).

METHODS

In this qualitative study, we conducted four focus groups (n=28) and eight semi-structured interviews with a purposive sample of primary care doctors and nurses with previous experience in the provision of healthcare to patients with T2D. Data collection explored the acceptability and usefulness of the DiabeText intervention and the barriers and facilitators to its development and implementation. Data analysis was carried out by researchers independently and discussed in a series of six meetings and a workshop. All data were coded by the lead author following an iterative approach. Initial notes were made, followed by a process of categorization and theme development following Braun and Clark’s methodology.

RESULTS

Three main themes were identified: 1) text messaging interventions have the potential to effectively support diabetes self-management (DSM); 2) Involving PCP in the intervention would facilitate its design and implementation, and; 3) obtaining evidence supporting the cost-effectiveness is a key prerequisite for large scale implementation of the intervention. PCPs drew on their knowledge and experience treating T2D patients to identify facilitators and barriers for the design and implementation of the intervention. They also made suggestions about the content and format of the text messages. PCPs identified additional areas (diet, exercise, diabetes complications, appointment reminders) that the messaging intervention should address to further support adequate DSM.

CONCLUSIONS

The DiabeText intervention is perceived as useful and acceptable by PCPs provided its cost-effectiveness. Involving PCPs in the design and implementation of the intervention is a key factor to optimize the potential impact of the proposed intervention.