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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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Enhancing Self Care - The Evidence Base Dundee, May 2006

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    1. 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

    2. Intensive Insulin Therapy Intensive Personal Support (SIGN Guidelines, NICE Guidelines) Intensive Diabetes Management

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

    4. 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?

    5. Hypothesis: a behavioural support intervention delivered by text messaging

    6. 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

    7. Development of ‘Sweet Talk’ • Automated scheduling system • Minimal health professional input • Personalised encouragement and support • According to individual patient profiling

    8. Don’t 4get 2 inject!

    9. Why not try another BG meter – check out with the team next time ur in clinic

    10. Fruit,celery or carrot sticks, pretzels, plain popcorn make healthy snax

    11. Boost ur daily activity – play ur favourite music and dnz!

    12. 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’

    13. The Randomised Controlled Trial

    14. 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

    15. 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

    16. 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?

    17. 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

    18. Patients’ Use of the ‘Sweet Talk’ functions

    19. 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)

    20. Patients’ Blood Glucose Values (35%) • 56% of messages had BG figure only • 2 boys sent 81% of the BG messages

    21. 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

    22. Cld DiaBT’s get their belly pierced?

    23. Coming off the pump

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

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

    26. Realy? That’s good its been at the bak of my mind 4 ages!

    27. I’m recvng ‘Sweet Talk’ msgs but costs 10p – thought this was foc Technical Messages (7%)

    28. At a dancing feis today so I’ll need to check my BG a lot!;-) Social Messages Sent to ‘Sweet Talk’ (6%)

    29. We r runing out of resivos and siloettes. Cn we hav sum more plz? Practical Use of ‘Sweet Talk’ (5%)

    30. Nyt Nyt Dad Messages Sent in Error (2%)

    31. I no I am tryin Message Responses (40%) ‘ur goal is 2 eat less sugary things 2 get ur bloods down!’

    32. 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?

    33. 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?

    34. Social Support Themes Identified from Semi-Structured Interviews • Social Support Categories • Tangible • Informational • Companionship • Emotional

    35. 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’

    36. 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’

    37. 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’

    38. 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’

    39. 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

    40. 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)

    41. 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

    42. 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’

    43. 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

    44. Discussion – ‘Sweet Talk’ – Patient Centred Support versus ‘Intimacy’ ‘Intrusiveness’

    45. 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

    46. 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

    47. 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