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mHealth Diabetes Study Proves That the Right Message Matters

A large mHealth study conducted in China finds that simple SMS messages work better than personalized messages on short-term care management for people with diabetes.

Source: ThinkStock

By Eric Wicklund

- A new mHealth study of more than 1,000 people with diabetes finds that simple text messages work better than personalized messages in promoting care management – but the same can’t be said for avoiding hospitalizations.

Anindya Ghose, a professor at New York University’s Stern School of Business, reports that non-personalized SMS messages with general guidance about diabetes care proved 18 percent more effective in helping people reduce their blood glucose levels than personalized messages. But those targeted messages were more effective in reducing medical costs and hospital visits.

In “Empowering Patients Using Smart Mobile Health Platforms: Evidence from a Randomized Field Experiment,” Ghose concludes that an effective mHealth program for diabetes care management involves multiple messages at different times. It also means the right message and format have to be used at the right time.

Ghose and fellow researchers Beibi Li of Carnegie Mellon University’s Heinz College and Xitong Guo of the Harbin Institute of Technology’s School of Management in China chose a study conducted by a Chinese mHealth company and that country’s Office of Chronic Disease Management from the national Ministry of Health because it offered the largest testbed for diabetes research, with 156,120 active registered users and 9,970 affiliated physicians. From May 2015 to July 2016, they analyzed 9,251 unique responses from 1,070 diabetes patients.

The effectiveness of different types of messages surprised them, the researchers said.

“Interestingly, paired with all the health-management functions and resources provided by the mHealth platform, non-personalized SMS message interventions with general guidance about diabetes care demonstrate on average the highest effect on reducing patient glucose over time, 18.2 percent higher than personalized SMS message interventions with patient specific medical guidance and 7.9 percent higher than no mobile message intervention at all,” the study reported. “This finding is surprising and suggests personalized messaging may not always work in the context of mHealth, and the design of the mHealth platform is critical in achieving better patient health outcomes.”

In analyzing the value of different messaging strategies, the researchers said they noticed similar conclusions in other studies.

“Several recent studies have successfully piloted programs based on mobile SMS text messages, targeting patients with asthma, obesity, smoking, HIV/AIDS, and diabetes,” they reported. “They have found an impact from mobile SMS messaging on user health behavior; however, the content, intensity, and delivery mode of the SMS messaging seem to have a significant influence on the effectiveness of the mHealth interventions.”

For example, they said, a 2011 study on mobile SMS interventions for people with HIV in Kenya “found simple weekly reminder messages (without any additional counselling) can significantly improve adherence. But surprisingly, more frequent daily messages do not improve patient adherence, because of potential habituation or intrusion. They also found adding more personal words, such as words of encouragement, in the longer text messages was not more effective than either a short reminder or no reminder.”

On the other hand, the researchers reported that a personalized mHealth app with links to care coordinators does make a significant impact on a person’s self-management capabilities.

“This … suggests the potential of the mHealth app combined with personalized SMS messaging to reduce the medical and operational costs for diabetes patients and healthcare providers,” the study reported. “Although personalized messaging is not more effective in affecting patient health outcome than non-personalized messaging, it might facilitate a personal connection between patients and physicians, which can lead to increased patient trust in the mHealth platform, hence reducing patients’ need (or urge) to visit hospitals or take additional medication.”

“Understanding patient behavior and interaction with the platform, and incorporating this knowledge into designing more effective mHealth applications and platforms for patient engagement and empowerment, is important,” they concluded.

Overall, Ghose and his colleagues found that an mHealth platform of any type “demonstrates a statistically significant impact on reducing the blood glucose and glycated hemoglobin levels of diabetes patients over time,” showing a more than 21 percent improvement in health outcomes over a web-based platform.

“By assisting patients with behavior modification and disease self-management, mHealth platforms have tremendous potential for improving health outcomes and reducing medical costs,” Ghose said in a press release issued alongside the study. “With this research, companies have an opportunity to better understand patients’ interaction with mHealth technology and design elements that will be most effective for patient adoption and engagement.”

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