Evaluation of a Text Messaging Intervention to Support Self-Management of Diabetes During Pregnancy Among Low-Income, Minority Women: Qualitative Study.

Lynn Yee,Melissa Simon,Shaneah Taylor,Maria Young,Makayla Williams,Charlotte Niznik

doi:10.2196/17794

Abstract

BackgroundGiven the growing burden of diabetes in underserved communities and the complexity of diabetes self-management during pregnancy, the development of interventions to support low-income pregnant women with diabetes is urgently needed.ObjectiveThis study aims to develop and pilot test a theory-driven curriculum of SMS text messaging for diabetes support and education during pregnancy.MethodsThis was a prospective pilot investigation of a novel SMS text messaging intervention offered to pregnant women with pregestational or gestational diabetes mellitus and publicly funded prenatal care. Prior work yielded a conceptual model of diabetes self-management barriers and support factors in this population, which was used to guide curriculum development along with health behavior theories. Participants received three supportive or educational one-way text messages per week during pregnancy. In-depth semistructured interviews were performed at study exit to solicit feedback on the program. Narrative data were analyzed using the constant comparative technique to identify themes and subthemes.ResultsParticipants (N=31 enrolled and n=26 completed both interviews) consistently reported that SMS text messaging provided enhanced motivation for diabetes self-care, reduced diabetes-related social isolation, increased perceived diabetes-associated knowledge, enhanced comfort with the health care team, and reduced logistical burdens of diabetes during pregnancy. Participants requested enhanced interactive and customizable features in future intervention iterations.ConclusionsPregnant women with diabetes who were enrolled in this pilot study of an SMS text messaging curriculum for diabetes support described enhanced motivation, knowledge, and comfort with diabetes self-care activities as a result of the health education intervention. The next steps include enriching the interactive features of the intervention and investigating the effect of the intervention on perinatal outcomes.

Highlights

Diabetes mellitus poses a significant health burden to pregnant women [1,2]
Pregnant women with diabetes who were enrolled in this pilot study of an SMS text messaging curriculum for diabetes support described enhanced motivation, knowledge, and comfort with diabetes self-care activities as a result of the health education intervention
We previously developed a model of barriers and facilitators to diabetes self-management, which informed our development of a theory-driven curriculum of SMS text messaging for diabetes support and education during pregnancy

Summary

Introduction

Diabetes mellitus poses a significant health burden to pregnant women [1,2]. Its prevalence has rapidly risen alongside the obesity epidemic, and it disproportionately affects low-income and minority women [3,4]. Diabetes significantly amplifies the requirements for self-care beyond normal pregnancy; these requirements may be burdensome among low-income and minority women, who face additional social and structural barriers. Technology support interventions for individuals with chronic diseases can improve knowledge, engagement, and self-management of health conditions [1,7]. Data suggest that emerging pregnancy-related mHealth interventions may positively affect women’s health attitudes and behaviors [27,28], but there is a gap in available evidence-based technologies to address the complex needs of pregnant women with diabetes, for low-income women. Given the growing burden of diabetes in underserved communities and the complexity of diabetes self-management during pregnancy, the development of interventions to support low-income pregnant women with diabetes is urgently needed

Methods

Results

Discussion

Conclusion