Effect of mobile phone text messaging self-management support for patients with diabetes or coronary heart disease in a chronic disease management program (SupportMe): A randomized controlled trial (Preprint)

Abstract

Maintaining engagement and support for chronic disease patients is challenging. Text-messaging programs have complemented patient care in a variety of situations. However such programs have not been widely translated into routine care.

We aimed to examine the implementation and utility of a customized text-message based support program for patients with type 2 diabetes (T2D) and/or coronary heart disease (CHD), within a chronic disease integrated care program.

We conducted a 6 month pragmatic parallel-group, single-blind randomized controlled trial which recruited people with T2D and/or CHD. The subjects were referred by clinicians participating in a chronic disease management program. Intervention subjects received 4 semi-personalized text-messages per week providing self-management support to supplement standard care. Pre-programmed algorithms customized content based on subject characteristics, and the messages were sent at random times of the day and in random order by a fully automated text messaging engine. Control participants received standard care, and only administrative text messages. The primary outcome was systolic blood pressure (sBP). T2D subjects were evaluated for HbA1c. Evaluations were conducted face-to-face whenever possible, by researchers blinded to the randomization. Participant reported experience measures were evaluated by questionnaire and focus groups.

Nine hundred and two participants were randomized (448 intervention, 454 control). Primary outcome data was available for 807 (89%) subjects. At 6 months, there was no difference in sBP between intervention and control arms (adjusted mean difference 0.9mmHg, 95%CI -1.1–2.1, p=0.38). Of 642 participants with T2D, there was no difference in HbA1c (adjusted mean difference 0.1%, 95%CI -0.1–0.3, p=0.35). Self-reported medication adherence was better in the intervention group (relative risk 0.82, 95%CI 0.68-1.00, p=0.045). Subjects reported the text-messages were useful (87%), easily understood (98%), and motivated change (63%). Unidirectional messaging was identified as a barrier.

The intervention did not improve blood pressure in this cohort, possibly due to high clinician commitment to improved routine patient care as part of the chronic disease management program, as well as favorable baseline metrics. There was high program engagement, acceptability and perceived value. Feasibility as part of an integrated care program was demonstrated. Text-messaging programs may supplement chronic disease management and support self-care.

Australian New Zealand Clinical Trials Registry: ACTRN12616001689460