Development and Usability of REACH: A Tailored Theory-Based Text Messaging Intervention for Disadvantaged Adults With Type 2 Diabetes.
Development and Usability of REACH: A Tailored Theory-Based Text Messaging Intervention for Disadvantaged Adults With Type 2 Diabetes.
复制标题
DOI：
10.2196/humanfactors.6029
复制
发表时间：
2016-09-08
影响因子：
2.7
通讯作者：
Osborn, Chandra Y
中科院分区：
文献类型：
--
作者：
Nelson, Lyndsay A;Mayberry, Lindsay S;Osborn, Chandra Y
背景：在患有2型糖尿病(T2 DM)的成年人中，坚持推荐的自我护理活动是次要的，特别是在低收入的种族和少数民族中。自我护理不坚持与血糖控制更差和糖尿病并发症有关。短信干预正在改善成年T2 DM患者的自我护理，但很少有人在弱势人群中进行测试。目的：开发快速教育/鼓励和健康沟通(REACH)，这是一种定制的短信干预措施，基于信息-动机-行为技能模型，支持T2 DM弱势患者的自我护理坚持。然后，我们测试了REACH的可用性，以便在评估其效果之前进行改进。方法：我们使用基于经验和理论的方法、先前试点测试的干预结果以及我们跨学科研究团队的专业知识来开发REACH的内容和功能。我们从联邦合格的健康中心招募了36名患有T2 DM的成年人，参加了三轮可用性测试中的一轮。在两周的时间里，参与者每天都会收到评估和促进自我护理的短信，包括针对用户独特的坚持障碍的定制短信，以及每周一次带有遵守反馈的短信。结果：参与者平均年龄为52.4岁(SD 9.5)，56%(20/36)为女性，63%(22/35)为少数族裔，67%(22/33)的收入低于35,000美元。大约一半的人在服用胰岛素，平均血红蛋白A1c水平为8.2%(SD 2.2%)。我们发现了问题(例如，用户对消息措辞的关注，对响应评估消息的技术限制)，并在两轮测试之间进行了改进。总体而言，参与者在1-10分的范围内对促进自我保健的短信的易解性(平均9.6，SD 0.7)和帮助(平均9.3，SD 1.4)给予了积极的评价，对96%的评估短信做出了回复，并在1-10分的范围内对反馈短信8.5(SD 2.7)的帮助程度进行了评分。用户反馈使我们的研究登记过程得到了改进，以便用户理解消息时间的灵活性，并且发送消息的是计算机，而不是人。此外，研究助理对登记过程的反馈有助于提高参与者对研究程序的参与度。结论：测试由技术提供的干预措施对弱势成年人的影响揭示了这一人群特有的偏好和担忧。通过迭代测试和多个数据源，我们识别并回应了用户的干预偏好、技术问题和我们研究过程中的缺陷。
BACKGROUND: Among adults with type 2 diabetes mellitus (T2DM), adherence to recommended self-care activities is suboptimal, especially among racial and ethnic minorities with low income. Self-care nonadherence is associated with having worse glycemic control and diabetes complications. Text messaging interventions are improving the self-care of adults with T2DM, but few have been tested with disadvantaged populations.OBJECTIVE: To develop Rapid Education/Encouragement And Communications for Health (REACH), a tailored, text messaging intervention to support the self-care adherence of disadvantaged patients with T2DM, based on the Information-Motivation-Behavioral skills model. We then tested REACH's usability to make improvements before evaluating its effects.METHODS: We developed REACH's content and functionality using an empirical and theory-based approach, findings from a previously pilot-tested intervention, and the expertise of our interdisciplinary research team. We recruited 36 adults with T2DM from Federally Qualified Health Centers to participate in 1 of 3 rounds of usability testing. For 2 weeks, participants received daily text messages assessing and promoting self-care, including tailored messages addressing users' unique barriers to adherence, and weekly text messages with adherence feedback. We analyzed quantitative and qualitative user feedback and system-collected data to improve REACH.RESULTS: Participants were, on average, 52.4 (SD 9.5) years old, 56% (20/36) female, 63% (22/35) were a racial or ethnic minority, and 67% (22/33) had an income less than US $35,000. About half were taking insulin, and average hemoglobin A1c level was 8.2% (SD 2.2%). We identified issues (eg, user concerns with message phrasing, technical restrictions with responding to assessment messages) and made improvements between testing rounds. Overall, participants favorably rated the ease of understanding (mean 9.6, SD 0.7) and helpfulness (mean 9.3, SD 1.4) of self-care promoting text messages on a scale of 1-10, responded to 96% of assessment text messages, and rated the helpfulness of feedback text messages 8.5 (SD 2.7) on a scale of 1-10. User feedback led to refining our study enrollment process so that users understood the flexibility in message timing and that computers, not people, send the messages. Furthermore, research assistants' feedback on the enrollment process helped improve participants' engagement with study procedures.CONCLUSIONS: Testing technology-delivered interventions with disadvantaged adults revealed preferences and concerns unique to this population. Through iterative testing and multiple data sources, we identified and responded to users' intervention preferences, technical issues, and shortcomings in our research procedures.