Diabetes Risk Awareness Research Articles

Tailoring of Health-Promotion Video Messaging for Reproductive-Aged Women at Risk for Developing Cardiometabolic Disease: Qualitative Focus-Groups Study.

Targeting reproductive-aged women at high risk for type 2 diabetes (T2D) provides an opportunity for prevention earlier in the life course. A woman's experiences during her reproductive years may have a large impact on her future risk of T2D. Her risk is 7 to 10 times higher if she has had gestational diabetes (GDM). Despite these risks, T2D is preventable. Evidence-based programs, such as the National Diabetes Prevention Program (DPP), can reduce the risk of developing T2D by nearly 60%. However, only 0.4% of adults with prediabetes have participated in the DPP to date and reproductive-aged women are 50% less likely to participate than older women. In prior work, our team developed a mobile 360° video to address diabetes risk awareness and promote DPP enrollment among at-risk adults; this video was not designed, however, for reproductive-aged women. This study aims to obtain feedback from reproductive-aged women with cardiometabolic disease risk about a 360° video designed to promote enrollment in the DPP, and to gather suggestions about tailoring video messages to reproductive-aged women. Focus groups and a qualitative descriptive approach were used. Women with at least 1 previous pregnancy, aged 18 to 40 years, participated in one of three focus groups stratified by the following health risks: (1) a history of GDM or a hypertensive disorder of pregnancy, (2) a diagnosis of prediabetes, or (3) a BMI classified as obese. Focus-group questions addressed several topics; this report shared findings regarding video feedback. The 3 focus-group discussions were conducted via Zoom and were recorded and transcribed for analysis. Deductive codes were used to identify concepts related to the research question and inductive codes were created for novel insights shared by participants. The codes were then organized into categories and themes. The main themes identified were positive feedback, negative feedback, centering motherhood, and the importance of storytelling. While some participants said the video produced a sense of urgency for health-behavior change, all participants agreed that design changes could improve the video's motivating effect on health-behavior change in reproductive-aged women. Participants felt a tailored video should recognize the complexities of being a mother and how these dynamics contribute to women's difficulty engaging in healthy behaviors without stirring feelings of guilt. Women desired a video with a positive, problem-solving perspective, and recommended live links as clickable resources for practical solutions promoting health behavior change. Women suggested using storytelling, both to describe how complications experienced during pregnancy impact long-term health and to motivate health behavior change. Reproductive-aged women require tailored lifestyle-change messaging that addresses barriers commonly encountered by this population (eg, parenting or work responsibilities). Moreover, messaging should prioritize a positive tone that harnesses storytelling and human connection while offering realistic solutions.

A feature optimization study based on a diabetes risk questionnaire.

The prevalence of diabetes, a common chronic disease, has shown a gradual increase, posing substantial burdens on both society and individuals. In order to enhance the effectiveness of diabetes risk prediction questionnaires, optimize the selection of characteristic variables, and raise awareness of diabetes risk among residents, this study utilizes survey data obtained from the risk factor monitoring system of the Centers for Disease Control and Prevention in the United States. Following univariate analysis and meticulous screening, a more refined dataset was constructed. This dataset underwent preprocessing steps, including data distribution standardization, the application of the Synthetic Minority Oversampling Technique (SMOTE) in combination with the Round function for equilibration, and data standardization. Subsequently, machine learning (ML) techniques were employed, utilizing enumerated feature variables to evaluate the strength of the correlation among diabetes risk factors. The research findings effectively delineated the ranking of characteristic variables that significantly influence the risk of diabetes. Obesity emerges as the most impactful factor, overshadowing other risk factors. Additionally, psychological factors, advanced age, high cholesterol, high blood pressure, alcohol abuse, coronary heart disease or myocardial infarction, mobility difficulties, and low family income exhibit correlations with diabetes risk to varying degrees. The experimental data in this study illustrate that, while maintaining comparable accuracy, optimization of questionnaire variables and the number of questions can significantly enhance efficiency for subsequent follow-up and precise diabetes prevention. Moreover, the research methods employed in this study offer valuable insights into studying the risk correlation of other diseases, while the research results contribute to heightened societal awareness of populations at elevated risk of diabetes.

DIABETES OCCURRENCE, RISK FACTORS, AND LIFESTYLE PATTERNS IN OLDER ADULTS ATTENDING SENIOR CENTERS

Abstract Diabetes risk and rates increase across age with prevalence rates of diagnosed diabetes of 24% and estimated pre-diabetes rates of 49% in adults 65 or older (2017-2020; CDC, 2020) underscoring the importance of understanding diabetes risk factors and lifestyle behaviors in older adults. Senior centers offer a unique opportunity to reach older adults to deliver health promotion interventions. The study purpose was to examine diabetes/pre-diabetes occurrence, risk factors, lifestyle behaviors, and preferences for promoting healthy lifestyles to reduce diabetes risk in older adults (>60). An anonymous cross-sectional self-report survey was administered in senior centers. It included questions regarding occurrence of diabetes, diabetes risk factors, and hypertension; self-reported health status; lifestyle behavior patterns; cognitive function; and social engagement. Open-ended questions obtained information on diabetes risk awareness and preferences for healthy lifestyle interventions delivered in senior centers. The sample included 159 adults: average age of 76 years (range: 60-96), 77% female, 83% White, and 14% African American. Reported health related patterns include: 89% rated health as good-excellent; 74% were at high risk for pre-diabetes; 64% had hypertension; and 20% were told by provider of diabetes and 32% pre-diabetes. Reported lifestyle patterns included: 73% get regular physical activity, 53% eat 5 daily fruits/vegetables, 7% smoke, and average 7 hours of sleep/night. The large proportion at high risk for pre-diabetes underscores the importance of focusing on diabetes prevention in older adults and potential for delivering healthy lifestyle interventions in senior centers. Presentation will describe the quantitative and qualitative results and implications for lifestyle interventions.

Perception and Awareness of Diabetes Risk and Reported Risk-Reducing Behaviors in Adolescents

Lifestyle change is central to diabetes risk reduction in youth with overweight or obesity. Feeling susceptible to a health threat can be motivational in adults. To evaluate associations between diabetes risk perception and/or awareness and health behaviors in youth. This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2011 to 2018. Participants included youths aged 12 to 17 years with body mass index (BMI) in the 85th percentile or higher without known diabetes. Analyses were conducted from February 2022 to February 2023. Outcomes included physical activity, screen time, and attempted weight loss. Confounders included age, sex, race and ethnicity, and objective diabetes risk (BMI, hemoglobin A1c [HbA1c]). Independent variables included diabetes risk perception (feeling at risk) and awareness (told by clinician), as well as potential barriers (eg, food insecurity, household size, insurance). The sample included 1341 individuals representing 8 716 794 US youths aged 12 to 17 years with BMI in the 85th percentile or higher for age and sex. The mean age was 15.0 years (95% CI, 14.9-15.2 years) and mean BMI z score was 1.76 (95% CI 1.73-1.79). Elevated HbA1c was present in 8.6% (HbA1c 5.7%-6.4%: 8.3% [95% CI, 6.5%-10.5%]; HbA1c ≥6.5%: 0.3% [95% CI, 0.1%-0.7%]). Nearly one-third of youth with elevated HbA1c reported risk perception (30.1% [95% CI, 23.1%-38.1%), while one-quarter (26.5% [95% CI, 20.0%-34.2%]) had risk awareness. Risk perception was associated with increased TV watching (β = 0.3 hours per day [95% CI, 0.2-0.5 hours per day]) and approximately 1 less day per week with at least 60 minutes of physical activity (β = -1.2 [95% CI, -2.0 to -0.4) but not with nutrition or weight loss attempts. Awareness was not associated with health behaviors. Potential barriers had mixed associations: larger households (≥5 members vs 1-2) reported lower consumption of non-home-prepared meals (OR 0.4 [95% CI, 0.2-0.7]) and lower screen time (β = -1.1 hours per day [95% CI, -2.0 to -0.3 hours per day), while public insurance (vs private) was associated with approximately 20 fewer minutes per day of physical activity (β = -20.7 minutes per day [95% CI, 35.5 to -5.8 minutes per day]). In this cross-sectional study including a US-representative sample of adolescents with overweight or obesity, diabetes risk perception and awareness were not associated with greater engagement in risk-reducing behaviors in youth. These findings suggest the need to address barriers to engagement in lifestyle change, including economic disadvantage.

Remotely Conducted App-Based Intervention for Cardiovascular Disease and Diabetes Risk Awareness and Prevention: Single-Group Feasibility Trial.

BackgroundCardiovascular disease and type 2 diabetes mellitus are two of the most prevalent chronic conditions worldwide. An unhealthy lifestyle greatly contributes to someone’s risk of developing these conditions. Mobile health is an emerging technology that can help deliver health promotion interventions to the population, for example, in the form of health apps.ObjectiveThe aim of this study was to test the feasibility of an app-based intervention for cardiovascular and diabetes risk awareness and prevention by measuring nonusage, dropout, adherence to app use, and usability of the app over 3 months.MethodsParticipants were eligible if they were aged 45 years or older, resided in Australia, were free of cardiovascular disease and diabetes, were fluent in English, and owned a smartphone. In the beginning, participants received an email with instructions on how to install the app and a user guide. After 3 months, they received an email with an invitation to an end-of-study survey. The survey included questions about general smartphone use and the user version of the Mobile Application Rating Scale. We analyzed app-generated and survey data by using descriptive and inferential statistics as well as thematic analysis for open-text comments.ResultsRecruitment took place between September and October 2021. Of the 46 participants who consented to the study, 20 (44%) never used the app and 15 (33%) dropped out. The median age of the app users at baseline was 62 (IQR 56-67) years. Adherence to app use, that is, using the app at least once a week over 3 months, was 17% (8/46) of the total sample and 31% (8/26) of all app users. The mean app quality rating on the user version of the Mobile Application Rating Scale was 3.5 (SD 0.6) of 5 points. The app scored the highest for the information section and the lowest for the engagement section of the scale.ConclusionsNonusage and dropouts were too high, and the adherence was too low to consider the intervention in its current form feasible. Potential barriers that we identified include the research team not actively engaging with participants early in the study to verify that all participants could install the app, the intervention did not involve direct contact with health care professionals, and the app did not have enough interactive features.

1113-P: Trends in Prevalence, Awareness, and Risk Perception among U.S. Adults with Prediabetes: NHANES 2005–2018

Introduction: Individuals with prediabetes (preDM) are at increased risk of developing type 2 diabetes and cardiovascular disease. Awareness and perceived risk of disease are key factors impacting lifestyle interventions. This study examined the prevalence, awareness, and perceived risk of preDM. Methods: This nationally representative cross-sectional analysis of 2005-2018 National Health and Nutrition Examination Survey data was conducted on nonpregnant adults (aged≥20 years) . PreDM was based on fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) definitions recommended by the American Diabetes Association. We used fasting sample weight to generate nationally representative estimates. Measures also include sociodemographic, awareness, and perceived risk for DM or preDM. Analyses were accounted for the complex sample design and performed using Stata 17. Results: Overall, among 15,968 adults, the weighted prevalence of PreDM increased from 31.5% (95%CI 28.5-34.4) in 2005-20to 47.2% (95% CI 43.7-50.7) in 2017-2018 with a significant linear trend (p<;0.001) . The weighted prevalence of awareness of preDM increased yearly from 5.6% in 20- 20to 12.6% in 2017-2018 based on FPG/HbA1c definition (p<;0.001) . Similarly, among those with preDM, the perceived risk increased from 28.2% in 20- 20to 32.9% in 20- 20 and plateaued at 36.9% in 2017-2018 without a significant linear trend (p=0.142) . Black and Mexican Americans had a higher prevalence of preDM than White. Education was positively associated with awareness and perceived risk, but the income was not. Women were less likely to have preDM but more likely to be aware of preDM than men. Overweight/obesity, hypertension, and depression were positively associated with preDM, awareness, and perceived risk. Conclusions: Findings suggest that from 20to 2018, the prevalence of preDM continues to rise. More national efforts are needed to raise awareness of diabetes risk and target those at higher risk. Disclosure A.Yan: None. Z.Shi: None.

App-based intervention for cardiovascular and diabetes risk awareness and prevention

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Centre for Primary Health Care and Equity, University of New South WalesAustralian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation Background Cardiovascular disease and type 2 diabetes mellitus are highly prevalent worldwide. They have similar risk factors, and people with diabetes have a two- to threefold increased risk of myocardial infarction and stroke. Many of the risk factors are lifestyle related. Hence, behaviour change interventions have the potential to decrease the risk for cardiovascular disease and type 2 diabetes mellitus. Purpose We aimed to develop and evaluate an app-based intervention for the primary prevention of cardiovascular disease and type 2 diabetes mellitus. Methods We developed our app using the methodology by Tombor and colleagues for the development of digital behaviour change interventions. We used the Behaviour Change Wheel and embedded 12 behaviour change techniques. The three core modules of the app consisted of i) risk scores for 5-year cardiovascular disease and type 2 diabetes mellitus; ii) goal setting and tracking functions for smoking, alcohol intake, diet, and physical activity; and iii) education about the diseases and risk factors. With the app prototype, we conducted usability testing via an iterative approach. We interviewed the participants and used their feedback to improve the app design. Next, we conducted a feasibility study with the new version to assess whether participants would use the app over three months. We were interested in drop-out from the intervention, adherence to app use, and usability of the app. We received ethics approval for both studies and written consent from all participants. Results The usability testing consisted of two rounds. For each round, we had five participants who were on average 57 years old. In the first round, three participants experienced a technical error that stopped them from completing the registration. From those who were able to register, five rated the app as above average according to the System Usability Scale. Overall, the participants found the app easy to use and indicated that they were interested to use it frequently. We included some additional features based on the preferences of the participants in the usability testing. For the feasibility study, we recruited 47 participants aged 45 years and older who were free of cardiovascular disease and type 2 diabetes mellitus at baseline, with a balanced distribution of age (45-64 years and ≥65 years) and gender. From those participants, four withdrew from the study immediately after providing consent and the remainder continued using the app for varying periods of time. Conclusions We ensured that the app is based on the theory of behaviour change and scientific evidence. We used a stepwise approach to improve the app design and to test the feasibility of the intervention. The next step will be to develop a framework for a larger trial that implements the intervention into the existing healthcare setting and investigates its effectiveness.

How patient and community involvement in diabetes research influences health outcomes: A realist review.

BackgroundPatient and public involvement in diabetes research is an international requirement, but little is known about the relationship between the process of involvement and health outcomes.ObjectiveThis realist review identifies who benefits from different types of involvement across different contexts and circumstances. Search strategies Medline, CINAHL and EMBASE were searched to identify interventions using targeted, embedded or collaborative involvement to reduce risk and promote self‐management of diabetes. People at risk/with diabetes, providers and community organizations with an interest in addressing diabetes were included. There were no limitations on date, language or study type.Data extraction and synthesisData were extracted from 29 projects using elements from involvement frameworks. A conceptual analysis of involvement types was used to complete the synthesis.Main resultsProjects used targeted (4), embedded (8) and collaborative (17) involvement. Productive interaction facilitated over a sufficient period of time enabled people to set priorities for research. Partnerships that committed to collaboration increased awareness of diabetes risk and mobilized people to co‐design and co‐deliver diabetes interventions. Cultural adaptation increased relevance and acceptance of the intervention because they trusted local delivery approaches. Local implementation produced high levels of recruitment and retention, which project teams associated with achieving diabetes health outcomes.Discussion and ConclusionsAchieving understanding of community context, developing trusting relationships across sectors and developing productive partnerships were prerequisites for designing research that was feasible and locally relevant. The proportion of diabetes studies incorporating these elements is surprisingly low. Barriers to resourcing partnerships need to be systematically addressed.

A Qualitative Exploration of Fijian Perceptions of Diabetes: Identifying Opportunities for Prevention and Management.

Rates of diabetes are high in many communities of Pacific Island peoples, including people from Fiji. This qualitative study explores knowledge and attitudes towards diabetes among i-Taukei Fijians to facilitate the cultural tailoring of diabetes prevention and management programs for this community. Fijians aged 26 to 71 years (n = 15), residing in Australia, participated in semi-structured interviews; 53% (n = 8) were male. Interviews were audio-recorded, transcribed verbatim, then thematically analyzed. Diabetes is recognized as an important and increasing health problem requiring action in the i-Taukei Fijian community. Widespread support for culturally appropriate lifestyle interventions utilizing existing societal structures, like family networks and church groups, was apparent. These structures were also seen as a crucial motivator for health action. Intervention content suggestions included diabetes risk awareness and education, as well as skills development to improve lifestyle behaviors. Leveraging existing social structures and both faith and family experiences of diabetes within the Fijian community may help convert increased awareness and understanding into lifestyle change. Ongoing in-community support to prevent and manage diabetes was also regarded as important. We recommend building upon experience from prior community-based interventions in other high-risk populations, alongside our findings, to assist in developing tailored diabetes programs for Fijians.

High Prevalence of Undiagnosed Hyperglycemia in Low-Income Overweight and Obese Hispanic Women in Oregon.

Overweight Hispanic women are at high risk for type 2 diabetes. A clinical diagnosis of hyperglycemia is often necessary to access interventions. We examined the prevalence of undiagnosed hyperglycemia among a group of low-income overweight or obese Hispanic women, who were receiving care at a Federally Qualified Health Center (FQHC). Among 196 overweight or obese Hispanic women (mean age 44 ± 10years, mean weight 86.8 ± 16.5kg, mean body mass index [BMI] 36.5 ± 6.4kg/m2) enrolled in a randomized clinical weight-loss trial, we compared A1C and fasting blood glucose (FBG) obtained at baseline with women's existing diabetes and prediabetes diagnoses in the medical record. According to the information in participants' medical records, 36% (70/196) had diagnosed diabetes, 20% (39/196) had a diagnosis of prediabetes, and the remaining 44% (87/196) had neither diagnosis. Among participants without a diagnosis of diabetes or prediabetes during the baseline screening for our study, 63% (55/87) had at least one test in the prediabetes range (baseline A1C and FBG were in prediabetes range for 39 and 55 participants, respectively), and 13% (11/87) had at least one test in the diabetic range (baseline A1C and FBG values in diabetes range for 3 and 11 participants, respectively). We found substantial prevalence of undiagnosed hyperglycemia among a sample of overweight and obese Hispanic women. It is possible that limited awareness of diabetes risk may be a barrier to patient compliance with screening recommendations.

Building Toward a Population-Based Approach to Diabetes Screening and Prevention for US Adults.

Evidence-based treatments for prediabetes can prevent and delay the development of type 2 diabetes in adults. In this review, we propose a framework for population-based diabetes prevention that links screening and prevention activities across key stakeholders. We also discuss gaps in current practice, while highlighting opportunities to improve diabetes screening and prevention efforts population-wide. Awareness of diabetes risk is low, and many adults with prediabetes are not identified through existing screening efforts. Accumulating evidence and policies support expansion of the Diabetes Prevention Program (DPP) into clinical and community settings. However, the infrastructure to facilitate referrals and promote data exchange among patients, clinical settings, and community-based DPP programs is lacking. Development of evidence-driven, scalable processes for assessing diabetes risk, screening eligible adults, and delivering preventive treatments are needed to effectively improve the glycemic health of the US adult population.

Prediabetes and Diabetes Screening in Dental Care Settings: NHANES 2013 to 2016.

Introduction:Early recognition of prediabetes may prevent progression to diabetes, yet not all adults are aware of their prediabetes risk. To reach all adults unaware of their risk, additional risk assessment strategies are warranted.Objectives:The objective of this study was to evaluate the potential scope of benefit from prediabetes risk assessment in the dental care setting and to identify characteristics of dental patients likely to unknowingly have prediabetes or diabetes.Methods:Data from 10,472 adults in the National Health and Nutrition Examination Survey from 2013 to 2014 and 2015 to 2016 were analyzed for associations among prediabetes/diabetes risk factors, health care use, and hemoglobin A1C levels according to chi-square tests and multivariate logistic regression.Results:A total of 7.73% of US adults had seen a dentist but not a medical provider in the past 12 mo. The composition of this subpopulation was significantly different from that who saw a medical provider, in ways that might affect their diabetes risk. In addition, 31.27% of this subpopulation would be identified as being at high risk for prediabetes according to the CDC Prediabetes Screening Test (Centers for Disease Control and Prevention), and 15.83% had hemoglobin A1C levels indicative of undiagnosed prediabetes or diabetes. Screening in a dental setting would have the highest odds of identifying someone unaware of his or her diabetes risk among those who were non-White, obese, or ≥45 y old.Conclusion:Extrapolation from this analysis indicates that screening for prediabetes at dental visits has the potential to alert an estimated 22.36 million adults of their risk for prediabetes or diabetes. Incorporating prediabetes or diabetes risk assessment into routine dental visits may enable 1) those with prediabetes to take action to decrease their risk of developing diabetes and 2) those with diabetes to engage in treatment to decrease their risk of diabetes-related complications.Knowledge Transfer Statement:Screening for prediabetes and diabetes during dental visits has the potential to raise patients’ awareness of diabetes risk and prevent prediabetes from progressing to diabetes. For some patients, the dental visit may be the only point of contact with the health care system, which heightens the importance of including diabetes risk assessment for patient well-being.

Validation of the German Diabetes Risk Score among the general adult population: findings from the German Health Interview and Examination Surveys

ObjectiveTo evaluate the German Diabetes Risk Score (GDRS) among the general adult German population for prediction of incident type 2 diabetes and detection of prevalent undiagnosed diabetes.MethodsThe longitudinal sample for...

Genetic Testing and Type 2 Diabetes Risk Awareness

The purpose of this study was to examine the motivational, attitudinal, and behavioral predictors of interest in genetic testing (GT) in those with and without awareness of their risk for type 2 diabetes (T2DM). A convenience sample of adults visiting emergency departments, libraries, or an online research registry was surveyed. Responses from adults without diabetes who reported 1 or more risk factors for T2DM (eg, family history, body mass index > 25) were included in the analyses (n = 265). Participants were 37 ± 11 years old, white (54%), and female (69%), with some college education (53%) and an annual income below $25 000 (44%). Approximately half (52%) expressed interest in GT for T2DM. Individuals were stratified by perceived risk for T2DM (risk aware or risk unaware). Among the risk aware, younger age (P < .04) predicted greater interest in GT. Among the risk unaware, family history of T2DM (P < .008) and preference to know genetic risk (P < .0002) predicted interest in GT. Both groups identified the need for low-cost GT. GT is an increasingly available and accurate tool to predict T2DM risk for patients. In this sample, GT was a salient tool for those with and without awareness of their T2DM risk. Financial accessibility is critical to use of this tool for both groups.

Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part I): Assessment of Participant Reach and Adoption

BackgroundThere are an estimated 25.8 million American children and adults, equivalent to 8.3% of the US population, living with diabetes. Diabetes is particularly burdensome on minority populations. The use of mobile technologies for reaching broad populations is a promising approach, given its wide footprint and ability to deliver inexpensive personalized messages, to increase awareness of type 2 diabetes and promote behavior changes targeting risk factors associated with type 2 diabetes. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing mobile health information service, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. Txt4health is a mobile health information service designed to help people understand their risk for type 2 diabetes and become more informed about the steps they can take to lead healthy lives.ObjectiveThe purpose of this investigation was to use the RE-AIM framework to document txt4health reach and adoption by focusing on enrollment and participant engagement in program pilots in Southeast Michigan and Greater Cincinnati.MethodsWe conducted a retrospective records analysis of individual-level txt4health system data from participants in Southeast Michigan and Greater Cincinnati to determine participant usage of txt4health and engagement with the program.ResultsResults from the retrospective records analysis revealed that 5570 participants initiated the 2-step enrollment process via 1 of 3 enrollment strategies: text message, website, or directly with Beacon staff who signed participants up via the website. In total, 33.00% (1838/5570) of participants completed the 2-step enrollment process and were fully enrolled in the program. All participants (100.00%, 1620/1620) who enrolled via text message completed the entire 2-step enrollment process versus 5.52% (218/3950) of participants who enrolled via website or a Beacon staff member. Of those who fully enrolled, 71.00% (1305/1838) completed the diabetes risk assessment and 74.27% (1365/1838) set an initial weight loss goal. Overall, 39.06% (718/1838) of participants completed all 14 weeks of the program and 56.26% (1034/1838) dropped out before completing all 14 weeks, with the bulk of dropouts occurring in the first 4 weeks. Length of participation varied greatly, ranging from 0-48.7 weeks (median 8.6, mean 15.8, SD 15.8). Wide variability of participant engagement in regards to weekly weight and physical activity was documented.ConclusionsAlthough broadly focused public health text message interventions may have the potential to reach large populations and show high levels of engagement among some users, the level of individual engagement among participants varies widely, suggesting that this type of approach may not be appropriate for all.

Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part II): Assessment of Participants' Perceptions on Efficacy

BackgroundAlthough there is great enthusiasm in both the public and private sector for the further development and use of large-scale consumer-facing public health applications for mobile platforms, little is known about user experience and satisfaction with this type of approach. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing, mobile phone-based health information service targeting type 2 diabetes, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. This program was marketed via large public health campaigns and drew many users within the respective communities.ObjectiveThe purpose of this investigation was to use the RE-AIM framework to document txt4health efficacy by focusing on perceptions of satisfaction, usage, and behavior change among individuals who used txt4health in pilot studies in Southeast Michigan and Greater Cincinnati.MethodsWe conducted a multimodal user survey with txt4health users recruited via text message through the program to understand participant perceptions of program use and satisfaction, as well as self-reported perceptions of behavior change as a result of using txt4health.ResultsTxt4health users reported very high levels of program satisfaction, with 67.1% (108/161) reporting satisfaction scores of ≥8 on a 10-point scale, with 10 equivalent to most satisfied (mean 8.2, SD 1.6). All survey participants agreed/strongly agreed that the messages included in txt4health were clear and easy to understand (100.0%, 160/160), and most found txt4health made them knowledgeable about their risk for type 2 diabetes (88.1%, 140/159) and made them conscious of their diet and physical activity (88.8%, 142/160). Most participants reported that txt4health helped them to make behavior changes related to diet; after having completed txt4health, most agreed/strongly agreed that they are more likely to replace sugary drinks, such as juice or soda, with water (78.0%, 124/159), have a piece of fresh fruit instead of dessert (74.2%, 118/159), substitute a small salad for chips or fries when dining out (76.1%, 121/159), buy healthier foods when grocery shopping (79.7%, 126/158), and eat more grilled, baked, or broiled foods instead of fried (75.5%, 120/159).ConclusionsResults from this study suggest that participants in txt4health, a large-scale, public health–focused text message program targeting type 2 diabetes, have positive perceptions of the program and that participation has led to positive behavior change.

Engaging Individuals to Promote Diabetes Risk Awareness with txt4health: A Program Evaluation of Beacon Community txt4health Pilots in Southeast Michigan and Greater Cincinnati

There are an estimated 25.8 million American children and adults, roughly 8.3% of the U.S. population, living with diabetes. Diabetes is particularly burdensome on minority populations where health disparities persist. Mobile technologies are an attractive method for reaching broad populations given the high penetration of cell phones across diverse groups, and may be a useful strategy for raising awareness of type 2 diabetes. To raise awareness of the risks associated with type 2 diabetes, pilots of txt4health, an automated 14-week text message program, were launched by the Southeast Michigan and Greater Cincinnati Beacon Communities. This investigation sought to evaluate the txt4health program pilot in Southeast Michigan and Greater Cincinnati through documenting participant usage of txt4health, as well as user perceptions of the program. In this two part evaluation, we conducted a retrospective records analysis of individual-level txt4health system usage data from participants in Southeast Michigan and Greater Cincinnati to determine usage of the program. We also conducted a multimodal user survey with 161 txt4health users recruited through the program to understand participant perceptions of program satisfaction, participant use, and self-reported perceptions of behavior change. Preliminary results from the retrospective records analysis reveal that across both pilots, 5,570 participants initiated enrollment in txt4health, of which 33% completed the two-step enrollment process. Once enrolled, the majority of participants set a weight loss goal (74%), and tracked their weight (89%) and physical activity (65%) at least once during the program; however 56% dropped out before the end of the program, with 70% of dropouts occurring before the end of the fourth week. Among program completers, rates of weekly weight tracking were low with 22% of participants logging weekly weights at least five times, yet rates of weekly physical activity tracker were greater with 49% logging weekly physical activity at least five times. Despite high attrition across the pilots, surveyed txt4health users report high levels of program satisfaction, with 67% reporting satisfaction scores of eight or higher on a ten point scale (10 most satisfied; M 8.2, SD 1.6). The majority of participants report that txt4health helped them make lifestyle and behavior changes related to diet and physical activity. While broadly focused public health text message interventions may have a great reach, individual engagement among participants widely varies, suggesting that this type of approach may not be appropriate for all, but is a feasible and acceptable delivery modality for a large subset of people. MHIMSS 2013 ABSTRACT #JOURNAL OF MOBILE TECHNOLOGY IN MEDICINE VOL. 2 | ISSUE 4S | DECEMBER 2013 14

Characteristics of American Young Adults With Increased Risk for Type 2 Diabetes

The purpose of the study was to examine the characteristics of American young adults with increased risk for type 2 diabetes (T2D). Participants ages 18 to 29, overweight/obese, and sedentary were recruited from the metro Atlanta area in the United States. Variables included demographics, anthropometric and clinical variables, and physical activity. Of 107 participants, 3 participants had undiagnosed diabetes and 1 participant did not complete the modifiable activity questionnaire. Thus, 103 young adults remained for the final data analysis. Most participants were females and African Americans. About 30% of participants had prediabetes, either impaired fasting glucose, an A1C of 5.7% to 6.4%, or both. Overall, prediabetes young adults were heavier and did less physical activity than Diabetes Prevention Program (DPP) trial participants. In addition, these young adults had a higher prevalence of parental T2D history and lower level of physical activity compared to young adults with normoglycemia. Physical activity and parent T2D history are key risk factors for identifying young adults with prediabetes. Multilevel strategies are necessary to raise awareness of diabetes risk and to prevent T2D in young adults.

Prediabetes awareness, healthcare provider’s advice, and lifestyle changes in American adults

PurposeThe purpose of this study was to examine whether persons who are aware of their prediabetes were more likely than persons with normal glycemia to report lifestyle changes (weight control, physical activity and fat/calories intake), and to determine the interactive effect of persons aware of their prediabetes and persons reporting doctor/health care provider’s (DHCP) advice on overall lifestyle change. MethodsData from the 2005 to 2006 and 2007 to 2008 US National Health and Nutrition Examination Surveys were used for this investigation. Odds ratio from multiple logistic regression analysis was used to determine whether persons who are aware of their prediabetes were more likely than persons with normal glycemia to report lifestyle changes. ResultsPersons who are aware of their prediabetes were more likely than persons with normal glycemia to report increased weight control (OR=1.72; 95% CI=1.34–2.20) and physical activity (OR=1.28; 95% CI=1.02–1.61), and reduced fat/calorie intake (OR=1.82; 95% CI=1.41–2.34), after adjusting for age, BMI, persons reported DHCP advice, race/ethnicity, sex, education and household income. Persons who reported DHCP advice were more likely than persons who did not report DHCP advice to report increased weight control (OR=1.87; 95% CI=1.67–2.09) and physical activity (OR=1.59; 95% CI=1.43–1.78), and reduced fat/calorie intake (OR=2.19; 95% CI=1.96–2.46), after adjusting for confounders. There was no significant interaction between persons aware of their prediabetes and persons that reported DHCP advice with reported overall lifestyle change. ConclusionsCreating diabetes risk awareness in at-risk groups and increased counseling of at-risk groups by doctors/health care providers may be the keys to prevent diabetes.

Diabetes Risk Awareness, Reduction Efforts Still Lacking

Diabetes Risk Awareness, Reduction Efforts Still Lacking