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Evaluation of Patients’ Perception and Use of ‘Sweet Talk’ – Text Messaging Support for Young People with Diabetes. Victoria Franklin Maternal and Child Health Sciences University of Dundee. Enhancing Self Care - The Evidence Base Dundee, May 2006. Intensive Insulin Therapy.

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slide1

Evaluation of Patients’ Perception and Use of ‘Sweet Talk’ – Text Messaging Support for Young People with Diabetes

Victoria Franklin

Maternal and Child Health Sciences

University of Dundee

Enhancing Self Care - The Evidence Base

Dundee, May 2006

slide2

Intensive Insulin

Therapy

Intensive Personal

Support

(SIGN Guidelines, NICE Guidelines)

Intensive Diabetes

Management

slide3
Aim:

To develop a social support network to facilitate uptake of intensive insulin therapy in young people with diabetes

devising a diabetes social support network
Devising a Diabetes Social Support Network

Focus group to establish what patients would want from a social support network

  • Limited attendance
  • Idea of formal support group not popular
  • Text Messaging support met with positive response

What is meaningful to young people with diabetes?

hypothesis
Hypothesis:

a behavioural support intervention

delivered by text messaging

slide6

Goal

Setting

Theory

Goal Setting at Clinic Visits

Daily

Goal Related

Text-Message

Weekly

Text-Message

Goal Reminder

Sporadic

Text-Message

‘Newsletter’

Personal

Text-Message

Replies

Social

Support

Theory

Tangible Support

Companionship Support

Informational

Support

Emotional Support

Social

Cognition

Theory

Self-Efficacy

Adherence

Improved Glycaemic Control

Theoretical Basis of the ‘Sweet Talk’ Intervention

development of sweet talk
Development of ‘Sweet Talk’
  • Automated scheduling system
      • Minimal health professional input
  • Personalised encouragement and support
      • According to individual patient profiling
slide14

Diabetes Self Management Goals set in clinic

Text-Messages reinforce ‘Goals’, promoting diabetes self-management

‘Sweet Talk’ schedules messages according to patients ‘goal’ and profile

Patients receive daily goal

related text-messages.

Messages contain tips, reminders, advice, questions & ‘newsletters’

slide16

126 Eligible for Randomisation

126 Eligible for Randomisation

86 Ineligible for

Randomisation

81 Did not meet

inclusion criteria

5 Other

86 Ineligible for

Randomisation

81 Did not meet

inclusion criteria

5 Other

Enrolment

34 Declined

Participation

34 Declined

Participation

92 Randomised

Control Group

n=28

Sweet Talk &

Conventional

Insulin

Therapy (CIT)

n=33

Sweet Talk &

Intensive

Insulin

Therapy (IIT)

n=31

Allocation

212 Patients Assessed for Eligibility

mobile phones
Mobile Phones
  • Nokia 330 Mobile Phone given to all patients
  • Pay-As-You-Go Contract on Orange network
  • Text Messages between patients and ‘Sweet Talk’ free of charge
research questions
Research Questions

(1) How do patients use the ‘Sweet Talk’ text messaging system?

(2) What do patients think about the ‘Sweet Talk’ text messaging service?

number of text messages sent to sweet talk by patients
Number of Text Messages Sent to ‘Sweet Talk’ by Patients

20

18

16

14

Number of Patients

12

10

8

6

4

2

0

0

1-4

5-9

10-

15-

20-

30-

40-

70-

80-

130-

240-

14

19

29

39

49

79

89

139

249

Number of Messages Sent

content analysis of patients text messages
Content Analysis of Patients Text Messages
  • 7 main themes identified:
    • Blood Glucose Values (418)
    • Diabetes Information and Questions (124)
    • Practical Use of the ‘Sweet Talk’ system (63)
    • Social Messages (75)
    • Technical Issues (86)
    • Message Errors (19)
    • Response to ‘Sweet Talk’ messages (472)
patients blood glucose values 35
Patients’ Blood Glucose Values (35%)
  • 56% of messages had BG figure only
  • 2 boys sent 81% of the BG messages
diabetes information and questions 11
Diabetes Information and Questions (11%)

60

50

40

30

20

10

0

Diet

Pump

Goals

Other

Insulin

HbA1c

Exercise

Emergency

Blood Glucose

Diabetes Information

Carbohydrate Counting

slide27

Wen ur in the bath or shower, wot happens if anythng get in2 the infusion set even with the clip on?

slide28

Re: Question about infusion set – the cannula is self-sealing, so with or without clip nothing gets in

message responses 40

I no I am tryin

Message Responses (40%)

‘ur goal is 2 eat less sugary things 2 get ur bloods down!’

did sweet talk help you look after your diabetes

100

80

79.4%

60

Percentage of Patients

40

20

0

17.5%

No response

Yes

No

3.1%

Did ‘Sweet Talk’ help you look after your diabetes?
would you like messages to continue after the study

100

87.3%

80

60

Percentage of Patients

40

20

7.9%

3.2%

1.6%

0

No

Response

Yes

No

Equivocal

Would you like messages to continue after the study?
social support themes identified from semi structured interviews
Social Support Themes Identified from Semi-Structured Interviews
  • Social Support Categories
    • Tangible
    • Informational
    • Companionship
    • Emotional
tangible support
Tangible Support
  • Goal Related Messages
      • ‘Reminding me to take my jags and that’
      • ‘Made me more active during the year’
      • ‘Stopped eating as much chocolate’
      • ‘Made me test my blood sugars more’
  • Contact with Diabetes Team
      • ‘I thought it was good, a lot quite useful. If you had a question it was answered very quickly.’
  • Clinic Reminders
      • ‘That was helpful. One time I forgot I even had clinic so it reminded us’
informational support
Informational Support
  • ‘Before I didn’t know you weren’t meant to inject through clothes and everything……I used to do that’
  • ‘Good, it helped me and told me what to do’
  • ‘Some of stuff I knew and didn’t do anyway – No change’
  • ‘Boring, I knew about it half the time’
companionship support
Companionship Support
  • ‘Stuff about what people say is interesting, you think it’s just what you feel, but then you think they’ve got that as well’
  • ‘You got to ask questions and hear results from everyone else as well’
emotional esteem support
Emotional/Esteem Support
  • ‘I think it is encouragement to keep going’
  • ‘Did make you want to reach the goal you set for yourself’
  • ‘Really happy because they were trying to look after me’
  • ‘Got me to keep in line I suppose’
limitation of text messaging service
Limitation of Text Messaging Service
  • Message Frequency
      • 90% felt current frequency (~2/day) good
      • 2 patients wanted messages less frequently
      • 1 patient wanted no messages
  • Message Timing
      • 89% happy with timing
      • Some did not like 8am messages, esp. at w/e
      • Some did not want messages during school hours
  • Messages Understandable
      • 87% experienced no problems
      • Some found newsletters confusing
limitation of text messaging service43
Limitation of Text Messaging Service

‘Did you find any messages annoying?’

  • 67% happy with content
  • 20 patients found some annoying
    • Repeated Messages (n=12)
    • Specific Messages (n=3)
      • Eat 4 ur health
      • Remember to take insulin
      • Message about TV character with diabetes
    • Irrelevant Messages (n=1)
    • Patronising Messages(n=1)
    • Obvious Messages(n=1)
    • Abbreviations(n=1)
    • Cannot Remember(n=1)
suggestions for improvement of the sweet talk system
Suggestions for Improvement of the ‘Sweet Talk’ System
  • Specific ideas for message content
      • ‘More varied topics, more generalised topics’
      • ‘Updates on progress with research’
      • ‘Alarms for pump patients – what to do’
  • Increasing messages sharing peoples experience of diabetes
      • ‘More about what other people are feeling. I think it helps to know that other people are feeling the same as yourself’
  • Video Messages
discussion
Discussion
  • Patients’ Use of the ‘Sweet Talk’ System
      • Minority of patients sent regular messages (<8%)
      • Majority thought that ‘Sweet Talk’ helped their diabetes self management (82%) and wanted to continue receiving messages (90%)
      • Most patients are therefore ‘Lurkers’
discussion sweet talk push support
Discussion -‘Sweet Talk’ – ‘Push Support’
  • Provides a unique form of ‘Push’ Support
    • Patients receive behavioural intervention without need to actively access it
    • Intervention not limited to the motivated patients
discussion sweet talk patient centred support
Discussion – ‘Sweet Talk’ – Patient Centred Support

versus

‘Intimacy’

‘Intrusiveness’

discussion sweet talk an imagined community
Discussion – ‘Sweet Talk’ - An Imagined Community
  • Derive benefit from experiences of others
    • Without expending time and effort
    • Without having to align themselves with other ‘diabetics’
    • Without having to have ‘therapy’ or join a ‘support group’
  • Safety
    • Protected from inappropriate chat room contacts
    • Professional moderation of information content and peer experiences
slide49

Potential for Dissemination

  • Widespread interest in ‘Sweet Talk’
  • User-centred design
  • Minimal labour intensity
  • Low cost intervention
  • Adaptable message content
  • 73% uptake of study
  • 82% felt that it had helped their diabetes self-management
  • 90% wanted messages to continue

REACH

EFFICACY

ADOPTION

IMPLEMENTATION

MAINTENANCE

conclusions

Intensive Personal

Support

Intensive Diabetes

Management

NICE guidelines, 2004:

Intensive Insulin

Therapy

Intensive Personal

Support

Supports Intensive Insulin Therapy

Low Cost Intervention

Engages young people

Fulfils ‘RE-AIM’ Criteria

Conclusions
acknowledgements
Acknowledgements
  • Dr Steve Greene & Dr Claudia Pagliari
  • Diabetes UK
  • Dr Annalu Waller & Stuart Gibson, Applied Computing
  • Dr Alex Greene & Helen Street, St Andrews University
  • OrangeTM & The Sea
  • Minimed-Medtronic
  • Tayside Paediatric Diabetes Team
  • The ‘Sweet Talk Study’ patients
results mean change in psychological measures

Self Efficacy

for Diabetes

Self-Reported

Adherence

Perceived Support

from Diabetes Team

*

*

*

4

*

20

2

0

4

10

-2

2

-4

0

0

-6

-2

-8

-10

-4

Group 1

CT

Group 1

CT

Group 1

CT

Group 2

CIT & ST

Group 2

CIT & ST

Group 2

CIT & ST

Group 3

IIT & ST

Group 3

IIT & ST

Group 3

IIT & ST

-6

-20

-8

Results: Mean Change in Psychological Measures

* p<0.05

results mean change in glycaemic control

*

Results: Mean Change in Glycaemic Control

1.0

  • P<0.02

0.5

0.0

-0.5

Mean Change in HbA1c

-1.0

-1.5

-2.0

1

2

3

\'Sweet Talk\' Groups

Linear Regression adjusted for baseline HbA1c - reduction of 1.1%

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