1076 Optimizing engagement in health behavior interventions: the role of patient activation and health literacy

Abstract

Improving health for pregnant patients with gestational or type 2 diabetes mellitus (DM) requires health education and behavior change support. The use of mobile health (“mHealth”) tools, such as behavior support “apps,” is a novel strategy to accomplish these needs. DM apps can deliver educational and motivational content, but little is known about how to optimize patient utilization of such interventions. We aimed to examine patient factors associated with user engagement with a novel app for DM support during pregnancy. In this secondary analysis of a usability trial, low-income pregnant women with DM used a novel mHealth app for 14 days. SweetMama was designed to provide women with educational, motivational, and goal-setting content on diet, exercise, medication management, glucose monitoring, and other health behaviors to support DM management during pregnancy. Upon enrollment, participants completed the Patient Activation Measure-13 (PAM) and the Newest Vital Sign (NVS) to assess patient activation and health literacy, respectively. User metrics (application episodes [log-ins], mean use time per episode, number of days of use, and total duration of use) were evaluated by DM type, PAM level, and NVS score. Pregnant patients (N=22) with DM accessed SweetMama frequently over this 14 day trial. Women with GDM had greater mean usage per episode (4.0 ± 2.9 vs 2.5 ± 0.9 minutes) and mean total duration of use (28.1 ± 17.0 vs. 18.2 ± 12.3 minutes) than women with T2DM (Table). Women with low-level patient activation had more frequent log-ins (median 11 [IQR 3-11] vs. 8 [IQR 6-9]) and greater number of days of use (median 13.2 [IQR 12.9-14.0] vs. 12.0 [IQR 9.9-13.0]). In contrast, no user metrics differed significantly by participant health literacy level. Early-phase usability findings suggest that use of a novel mHealth app for DM support during pregnancy was associated with patient activation and DM type. Next steps include understanding how to customize mHealth support and leverage patient engagement to optimize outcomes for pregnant women with DM.