Type 2 Diabetes Mellitus and Mobile Health Technology: Associations with Engagement
Creators: name: Niblock, Franklin
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2017

description: I. Factors Associated with Engagement in Mobile Health Technology: A Systematic Review Background: There are now more mobile phones across the globe than there are people. Given the increasing incidence of type 2 diabetes (T2DM), mobile health (mHealth) has been proposed as a potential strategy to care for this population. In order to harness the benefits of mHealth patients must engage with this technology. The aim of this review is to answer the following question: Among patients with T2DM, what factors are associated with engagement in mobile health technology? Methods: Randomized controlled trials and prospective cohort studies published from March 1st, 1997 to March 1st, 2017 were identified from PubMed. One reviewer selected studies in English that incorporated mHealth in the care of patients with T2DM and also reported the associations between patient characteristics and engagement. Data were extracted and the quality of evidence was assessed. Results: Three studies (described in 4 publications) were included. Study interventions incorporated interactive voice response (IVR), text messaging, and mobile phone application components. Studies reported on heterogeneous measures of engagement, including mHealth favorability, response to mHealth prompts, and improvement in health outcomes. Studies identified disparities in engagement in mHealth based on patients’ age, gender, race, and education/health literacy; however, the magnitude and direction of this effect varied across studies. Conclusions: Few studies report on the influence of patient characteristics on engagement with mHealth. Inconsistent effects of patients’ age, gender, race, and health literacy were seen on mHealth engagement. The development of mHealth technology should be informed by understanding factors associated with engagement. -- II. Health Literacy and Engagement with an mHealth Intervention for Diabetes Background: Mobile health (mHealth) can be used to improve self-management support and communication between patients and providers. Patient characteristics have been shown to be associated with disparities in engagement in mHealth, but previous studies have not shown how these characteristics affect engagement long-term. Our goal is to answer the following question: Does health literacy status affect engagement in mHealth for patients with type 2 diabetes (T2DM)? Methods: In a nested cohort study, patients received enhanced once-daily self-monitoring of blood glucose (Enhanced SMBG). Patients recorded blood glucose measures and received tailored feedback prompting changes in lifestyle management and testing schedule according to personalized trends. Health literacy was measured at baseline using the Newest Vital Sign. Adherence to Enhanced SMBG and odds of responding to an mHealth prompt to change SMBG testing schedule was assessed at 52 weeks. Results: A total of 148 patients were randomized to receive enhanced SMBG including 37% with limited health literacy. There was no difference in mean adherence to Enhanced SMBG between patients with adequate health literacy compared to those with limited health literacy (adjusted mean difference 3.9%, 95% CI -14.4%, 6.5%). Results suggest patients with limited health literacy are less likely to respond to an mHealth prompt to change their SMBG testing schedule than those with adequate health literacy (Adjusted OR=0.44, 95% CI 0.16, 1.18). Patients with limited health literacy took longer to implement a change in testing schedule than patients with adequate health literacy (median 5 vs. 1 days, p = 0.004). Conclusions: We found no evidence that health literacy affects adherence to mHealth over one year. However, health literacy should be taken into consideration in the development of future mHealth interventions due to its potential effect on the interpretation of mHealth messages and subsequent behavior modification.