Individual differences in regulatory mode moderate the effectiveness of a pilot mHealth trial for diabetes management among older veterans.

Michelle Dugas,Timothy Xu,Ritu Agarwal,Nanette Steinle,Kenyon Crowley,Guodong Gordon Gao,Arie W Kruglanski,Noël C Barengo

doi:10.1371/journal.pone.0192807

Abstract

mHealth tools to help people manage chronic illnesses have surged in popularity, but evidence of their effectiveness remains mixed. The aim of this study was to address a gap in the mHealth and health psychology literatures by investigating how individual differences in psychological traits are associated with mHealth effectiveness. Drawing from regulatory mode theory, we tested the role of locomotion and assessment in explaining why mHealth tools are effective for some but not everyone. A 13-week pilot study investigated the effectiveness of an mHealth app in improving health behaviors among older veterans (n = 27) with poorly controlled Type 2 diabetes. We developed a gamified mHealth tool (DiaSocial) aimed at encouraging tracking of glucose control, exercise, nutrition, and medication adherence. Important individual differences in longitudinal trends of adherence, operationalized as points earned for healthy behavior, over the course of the 13-week study period were found. Specifically, low locomotion was associated with unchanging levels of adherence during the course of the study. In contrast, high locomotion was associated with generally stronger adherence although it exhibited a quadratic longitudinal trend. In addition, high assessment was associated with a marginal, positive trend in adherence over time while low assessment was associated with a marginal, negative trend. Next, we examined the relationship between greater adherence and improved clinical outcomes, finding that greater adherence was associated with greater reductions in glycated hemoglobin (HbA1c) levels. Findings from the pilot study suggest that mHealth technologies can help older adults improve their diabetes management, but a “one size fits all” approach may yield suboptimal outcomes.

Highlights

The number of American adults with diabetes has quadrupled since 1980 and associated costs have reached over 200 billion dollars annually[1], leaving both patients and health care workers in search of ways to improve diabetes management
That assessment and locomotion were associated with different patterns in adherence suggest that greater investigation of regulatory mode in the context of Mobile health (mHealth) behavioral intervention effectiveness is warranted
Our pilot study provided preliminary evidence that implementation of an mHealth behavioral intervention would differentially impact treatment adherence according to individual differences in regulatory mode, and treatment adherence was further associated with improvements in levels of HbA1C

Summary

Introduction

The number of American adults with diabetes has quadrupled since 1980 and associated costs have reached over 200 billion dollars annually[1], leaving both patients and health care workers in search of ways to improve diabetes management. Mobile health (mHealth) technologies use mobile and wireless devices to improve health, and are viewed as a promising medium to help patients overcome barriers and achieve their health goals[4,5], but most existing studies focus on average treatment effects that may not be experienced uniformly across target populations. Theories from social and personality psychology suggest that health interventions might provide a better fit for some individuals than others[6,7], offering potential insights into heterogeneous mHealth effects. The objective of the present pilot research was to explore the interplay of individual differences in regulatory mode and mHealth in motivating lifestyle change among older veterans, a population experiencing a heavy diabetes burden that is underrepresented in the mHealth intervention literature.

Objectives

Methods

Findings

Discussion

Conclusion