Designing a Text Messaging Intervention to Improve Physical Activity Behavior Among Low-Income Latino Patients With Diabetes: A Discrete-Choice Experiment, Los Angeles, 2014-2015.

Magaly Ramirez,Shinyi Wu,Elizabeth Beale

doi:10.5888/pcd13.160035

Abstract

IntroductionAutomated text messaging can deliver self-management education to activate self-care behaviors among people with diabetes. We demonstrated how a discrete-choice experiment was used to determine the features of a text-messaging intervention that are important to urban, low-income Latino patients with diabetes and that could support improvement in their physical activity behavior.MethodsIn a discrete-choice experiment from December 2014 through August 2015 we conducted a survey to elicit information on patient preferences for 5 features of a text-messaging intervention. We described 2 hypothetical interventions and in 7 pairwise comparisons asked respondents to indicate which they preferred. Respondents (n = 125) were recruited in person from a diabetes management program of a safety-net ambulatory care clinic in Los Angeles; clinicians referred patients to the research assistant after routine clinic visits. Data were analyzed by using conditional logistic regression.ResultsWe found 2 intervention features that were considered by the survey respondents to be important: 1) the frequency of text messaging and 2) physical activity behavior-change education (the former being more important than the latter). Physical activity goal setting, feedback on physical activity performance, and social support were not significantly important.ConclusionA discrete-choice experiment is a feasible way to elicit information on patient preferences for a text-messaging intervention designed to support behavior change. However, discrepancies may exist between patients’ stated preferences and their actual behavior. Future research should validate and expand our findings.

Highlights

Automated text messaging can deliver self-management education to activate self-care behaviors among people with diabetes
A discrete-choice experiment is a feasible way to elicit information on patient preferences for a text-messaging intervention designed to support behavior change
We focused on text message interventions (TMIs) that may help to reduce disparities in the receipt of diabetes self-management education (DSME) and engagement in self-care behaviors among urban, low-income Latino adults with diabetes

Summary

Introduction

Automated text messaging can deliver self-management education to activate self-care behaviors among people with diabetes. We demonstrated how a discrete-choice experiment was used to determine the features of a text-messaging intervention that are important to urban, low-income Latino patients with diabetes and that could support improvement in their physical activity behavior. Available communication technologies, such as automated text messaging, are alternative methods for delivering DSME with the potential to reach, engage, and activate self-care behaviors among Latinos. Research is needed to design, implement, and evaluate the effectiveness of using technologies such as text messaging to provide health education to vulnerable racial and ethnic minorities and prompt their self-care behaviors [1,7]. A sensible approach to designing effective and engaging TMIs may be to incorporate both behaviorchange theory and patient preferences

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