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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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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 l.jpg

Intensive Insulin Talk’ – Text Messaging Support for Young People with Diabetes

Therapy

Intensive Personal

Support

(SIGN Guidelines, NICE Guidelines)

Intensive Diabetes

Management


Slide3 l.jpg

Aim: Talk’ – Text Messaging Support for Young People with Diabetes

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


Devising a diabetes social support network l.jpg
Devising a Talk’ – Text Messaging Support for Young People with DiabetesDiabetes 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 l.jpg
Hypothesis: Talk’ – Text Messaging Support for Young People with Diabetes

a behavioural support intervention

delivered by text messaging


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Goal Talk’ – Text Messaging Support for Young People with Diabetes

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 l.jpg
Development of ‘Sweet Talk’ Talk’ – Text Messaging Support for Young People with Diabetes

  • Automated scheduling system

    • Minimal health professional input

  • Personalised encouragement and support

    • According to individual patient profiling


  • Slide10 l.jpg

    Don’t 4get 2 inject! Talk’ – Text Messaging Support for Young People with Diabetes





    Slide14 l.jpg

    Diabetes Self Management Goals set in clinic healthy snax

    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 l.jpg

    126 Eligible for Randomisation healthy snax

    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 l.jpg
    Mobile Phones healthy snax

    • 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 l.jpg
    Research Questions healthy snax

    (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 l.jpg
    Number of Text Messages Sent to healthy snax ‘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 l.jpg
    Content Analysis of Patients Text Messages healthy snax

    • 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 l.jpg
    Patients’ Blood Glucose Values (35%) healthy snax

    • 56% of messages had BG figure only

    • 2 boys sent 81% of the BG messages


    Diabetes information and questions 11 l.jpg
    Diabetes Information and Questions (11%) healthy snax

    60

    50

    40

    30

    20

    10

    0

    Diet

    Pump

    Goals

    Other

    Insulin

    HbA1c

    Exercise

    Emergency

    Blood Glucose

    Diabetes Information

    Carbohydrate Counting



    Slide26 l.jpg

    Coming off the pump healthy snax


    Slide27 l.jpg

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


    Slide28 l.jpg

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


    Slide29 l.jpg

    Realy? That’s good its been at the bak of my mind 4 ages! self-sealing, so with or without clip nothing gets in



    Social messages sent to sweet talk 6 l.jpg

    At a dancing feis today so I’ll need to check my BG a lot!;-)

    Social Messages Sent to ‘Sweet Talk’ (6%)


    Practical use of sweet talk 5 l.jpg

    We r runing out of resivos and siloettes. Cn we hav sum more plz?

    Practical Use of ‘Sweet Talk’ (5%)


    Messages sent in error 2 l.jpg

    Nyt Nyt Dad more plz?

    Messages Sent in Error (2%)


    Message responses 40 l.jpg

    I no I am tryin more plz?

    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 l.jpg

    100 more plz?

    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 l.jpg

    100 more plz?

    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 l.jpg
    Social Support Themes Identified from Semi-Structured Interviews

    • Social Support Categories

      • Tangible

      • Informational

      • Companionship

      • Emotional


    Tangible support l.jpg
    Tangible Support Interviews

    • 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 l.jpg
    Informational Support Interviews

    • ‘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 l.jpg
    Companionship Support Interviews

    • ‘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 l.jpg
    Emotional/Esteem Support Interviews

    • ‘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 l.jpg
    Limitation of Text Messaging Service Interviews

    • 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 l.jpg
    Limitation of Text Messaging Service Interviews

    ‘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 l.jpg
    Suggestions for Improvement of the ‘Sweet Talk’ System Interviews

    • 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


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    Discussion Interviews

    • 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 l.jpg
    Discussion -‘Sweet Talk’ – ‘Push Support’ Interviews

    • 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 l.jpg
    Discussion – Interviews ‘Sweet Talk’ – Patient Centred Support

    versus

    ‘Intimacy’

    ‘Intrusiveness’


    Discussion sweet talk an imagined community l.jpg
    Discussion – Interviews‘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 l.jpg

    Potential for Dissemination Interviews

    • 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 l.jpg

    Intensive Personal Interviews

    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 l.jpg
    Acknowledgements Interviews

    • 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


    Slide52 l.jpg

    Thank you! Interviews


    Results mean change in psychological measures l.jpg

    Self Efficacy Interviews

    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 l.jpg

    * Interviews

    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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