scholarly journals Text Messages and Financial Incentives for Physical Activity: Insights from Virtual Group Interviews of Adolescents with Prediabetes and Type 2 Diabetes (Preprint)

2021 ◽  
Author(s):  
Mary Ellen Vajravelu ◽  
Talia Alyssa Hitt ◽  
NaDea Mak ◽  
Aliya Edwards ◽  
Jonathan Mitchell ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Clinical Trial ◽  
Financial Incentives ◽  
Text Messaging ◽  
Text Messages ◽  
Physically Active ◽  
Group Interviews ◽  
Text Messaging Intervention

BACKGROUND Despite recommendations that physical activity be a major component of treatment for adolescents with obesity and prediabetes or type 2 diabetes, physical activity is especially low in this population. OBJECTIVE To obtain end-user feedback on text message content and to assess acceptability of a planned text messaging intervention with financial incentives to motivate youth with prediabetes or type 2 diabetes to increase physical activity METHODS Adolescents with overweight or obesity and prediabetes or type 2 diabetes who attended a large academic pediatric endocrinology clinic were recruited to participate in group interviews (2-4/group) via videoconferencing. Participants were asked to share their thoughts about use of text messages and financial incentives to remind and motivate individuals like themselves to be more physically active. They rated and provided feedback on specific messages to be used in a clinical trial. To explore attitudes about the use of financial incentives for physical activity, participants were asked about their personal experience with rewards to motivate behavior change, as well as their anticipated reactions to rewards provided for goal attainment (gain-framing) versus provided and then taken away if a goal was not met (loss-framing). Interviews were conducted by two trained facilitators and an observer/recorder. Content analysis was used to explore themes. RESULTS Focus groups were completed in 20 participants (11 female; 15 type 2 diabetes/5 prediabetes) of mean age 15 years (range 12-18) and body mass index range of 32-52 kg/m2 (>95th percentile for age/sex). The majority were Non-Hispanic Black (70%), and 2 were Hispanic (10%). Fifty-three percent (n=8) of participants with type 2 diabetes were prescribed insulin. All agreed that text messages would serve as good reminders to be physically active, and there was strong consensus about the need for short messages. Favorable content included references to what they will likely to be doing when the messages are sent (e.g., homework, watching television), as well as messages that were encouraging or informative. Specific physical activity suggestions were rated favorably, but participants differed in the perceived utility of including links to exercise videos. Attitudes about financial incentives varied, with approximately half reporting that loss-framed incentives could be highly motivating in order to avoid the frustration of loss. CONCLUSIONS Adolescents with obesity and diabetes or prediabetes endorsed support for text messages that are short, encouraging, and informative for physical activity promotion. Participants were familiar with the concept of rewards for behavior change, but only half expected that loss-framed incentives would be motivating. A text messaging intervention employing financial incentives to motivate youth with prediabetes or type 2 diabetes to be more physically active is theoretically acceptable, but the impact on actual activity level in this population requires prospective evaluation in a clinical trial.

scholarly journals Mixed-Methods Randomized Evaluation of FAMS: A Mobile Phone-Delivered Intervention to Improve Family/Friend Involvement in Adults’ Type 2 Diabetes Self-Care

2020 ◽  
Author(s):  
Lindsay S Mayberry ◽  
Cynthia A Berg ◽  
Robert A Greevy ◽  
Lyndsay A Nelson ◽  
Erin M Bergner ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Mobile Phone ◽  
Self Efficacy ◽  
Text Messaging ◽  
Intervention Group ◽  
Self Care ◽  
Treatment As Usual ◽  
Text Messaging Intervention

Abstract Background Family and friends have both helpful and harmful effects on adults’ diabetes self-management. Family-focused Add-on to Motivate Self-care (FAMS) is a mobile phone-delivered intervention designed to improve family/friend involvement, self-efficacy, and self-care via monthly phone coaching, texts tailored to goals, and the option to invite a support person to receive texts. Purpose We sought to evaluate how FAMS was received by a diverse group of adults with Type 2 diabetes and if FAMS improved diabetes-specific family/friend involvement (increased helpful and reduced harmful), diabetes self-efficacy, and self-care (diet and physical activity). We also assessed if improvements in family/friend involvement mediated improvements in self-efficacy and self-care. Methods Participants were prospectively assigned to enhanced treatment as usual (control), an individualized text messaging intervention alone, or the individualized text messaging intervention plus FAMS for 6 months. Participants completed surveys at baseline, 3 and 6 months, and postintervention interviews. Between-group and multiple mediator analyses followed intention-to-treat principles. Results Retention, engagement, and fidelity were high. FAMS was well received and helped participants realize the value of involving family/friends in their care. Relative to control, FAMS participants had improved family/friend involvement, self-efficacy, and diet (but not physical activity) at 3 and 6 months (all ps < .05). Improvements in family/friend involvement mediated effects on self-efficacy and diet for FAMS participants but not for the individualized intervention group. Conclusions The promise of effectively engaging patients’ family and friends lies in sustained long-term behavior change. This work represents a first step toward this goal by demonstrating how content targeting helpful and harmful family/friend involvement can drive short-term effects. Trial Registration Number NCT02481596.

scholarly journals A Study Using Power Cycling on the Affective Responses of a Low-Volume High-Intensity Interval Training to Male Subjects with Type 2 Diabetes in Different Physical Activity Status

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Jun Li ◽  
Ruichen Jiang ◽  
Wei Cheng ◽  
Haifeng Ma
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Interval Training ◽  
Emotional Reactions ◽  
Effective Response ◽  
Physically Active ◽  
Power Cycling ◽  
Low Volume ◽  
High Intensity Interval

High-intensity interval training (HIIT) has been shown in studies to enhance glucose management and cardiovascular well-being in patients with type 2 diabetes. In this study, we used power cycling to assess the physical activity levels of men with type 2 diabetes during a single low-volume HIIT session. First, fifty-six men with type 2 diabetes volunteered to take part in the study, and they were split into two groups based on the International Physical Activity Scale Short Form (IPA). To the first 1–4 labor bouts, both the sufficiently physically active and insufficiently physically active groups exhibited equal positive emotional reactions ( p > 0.05 ). However, over time (about 5–10 times), both of them showed reduced emotional reactions, with a significant difference ( p < 0.01 ). The insufficiently physically active group had lower mean emotional response, lowest effective response, and maximum effective response values than the sufficiently physically active group ( p < 0.001 ), while the difference in RPE between the two groups was not statistically significant ( p > 0.05 ). From the standpoint of emotional response, the proposed model shows that HIIT or reduced volume HIIT exercise prescriptions should be utilized with caution in physical activity programs for novices and less active and chronically sick persons. The frequency, intensity, and effects of low-volume HIIT on individuals’ emotional reactions and health conditions in the T2DM group are also investigated. Furthermore, this low-volume HIIT program can be successfully applied in the real-world setting of people who are not physically active enough or who are chronically unwell.

scholarly journals Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH RCT

2020 ◽  
Author(s):  
Lyndsay A. Nelson ◽  
Robert A. Greevy ◽  
Andrew Spieker ◽  
Kenneth A. Wallston ◽  
Tom A. Elasy ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Self Efficacy ◽  
Text Messaging ◽  
Self Care ◽  
Baseline Hba1c ◽  
Median Response ◽  
Text Messaging Intervention

<b>Objective:</b> Text messaging interventions have high potential for scalability and to reduce health disparities; however, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. <p><b>Research Design and Methods:</b> Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized trial, assigned to receive REACH (Rapid Education/Encouragement and Communications for Health) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence, and non-tailored texts supporting other self-care behaviors. Outcomes included HbA1c, diabetes medication adherence, self-care, and self-efficacy. </p> <p><b>Results:</b> Participants (N=506) were approximately half racial/ethnic minority and half were underinsured, had annual household incomes <$35,000 USD and ≤ high school education; 11% were homeless. <a>Average baseline HbA1c was 8.6%±1.8%; 70.0±19.7 mmol/mol) with n<i>=</i>219 having HbA1c≥8.5% (69 mmol/mol)</a> and half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI [-0.61%, -0.02%]) was greater among those with baseline HbA1c≥8.5% (-0.74%; 95% CI [-1.26%, -0.23%]), and there was not evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months, and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. </p> <p><b>Conclusions:</b> REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain effects. </p>

An Adaptive, Algorithm-based Text Message Intervention to Promote Health Behavior Adherence in Type 2 Diabetes: Treatment Development and Proof-of-Concept Trial

2021 ◽  
pp. 193229682110650
Author(s):  
Christopher M. Celano ◽  
Christina Massey ◽  
Jessica Long ◽  
Sonia Kim ◽  
Olivia Velasquez ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Adaptive Algorithm ◽  
Controlled Trial ◽  
Text Message ◽  
Self Care ◽  
Well Being ◽  
Psychological Outcomes ◽  
Text Messages

Background: Most individuals with type 2 diabetes (T2D) struggle to adhere to one or more health behaviors. Text message interventions (TMIs) have the potential to improve adherence but have had mixed effects on diet and activity in T2D. We developed an eight-week, adaptive, algorithm-driven TMI to promote physical activity, diet, self-care, and well-being. Then, in a single-arm trial, we assessed its feasibility, acceptability, and preliminary efficacy in 15 individuals with T2D and suboptimal adherence. Methods: Participants received daily text messages and were asked to rate the utility of each message (0=not helpful, 10=very helpful). These ratings were used by an algorithm to select subsequent messages based on each participant’s prior ratings. We assessed intervention feasibility by rates of message transmission/response and acceptability through ratings of message utility and burden. Finally, we examined pre-post changes in diabetes self-care, diet, physical activity, and psychological outcomes and calculated effect sizes (Cohen’s d). Results: All text messages were delivered, and participants provided ratings for 79% of messages, above our a priori thresholds for feasibility. Participants rated the individual messages and overall TMI as subjectively useful (utility: 8.1 [SD=2.1] and 7.8 [SD=2.0], respectively) and not burdensome (burden: 0.8 [SD=1.8]). The intervention led to significant, medium- to large-sized improvements in self-care ( d=0.77), diet ( d=0.99), and activity ( d=0.61) but minimal change in psychological outcomes. Conclusions: The TMI was feasible and well-accepted, and it led to promising improvements in adherence-related outcomes. These findings should be confirmed in a larger randomized controlled trial.

scholarly journals Effects of a Tailored Text Messaging Intervention Among Diverse Adults With Type 2 Diabetes: Evidence From the 15-Month REACH Randomized Controlled Trial

Diabetes Care ◽  
2020 ◽  
Vol 44 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Lyndsay A. Nelson ◽  
Robert A. Greevy ◽  
Andrew Spieker ◽  
Kenneth A. Wallston ◽  
Tom A. Elasy ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Randomized Controlled Trial ◽  
Text Messaging ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Text Messaging Intervention

scholarly journals Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH RCT

2020 ◽  
Author(s):  
Lyndsay A. Nelson ◽  
Robert A. Greevy ◽  
Andrew Spieker ◽  
Kenneth A. Wallston ◽  
Tom A. Elasy ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Self Efficacy ◽  
Text Messaging ◽  
Self Care ◽  
Baseline Hba1c ◽  
Median Response ◽  
Text Messaging Intervention

<b>Objective:</b> Text messaging interventions have high potential for scalability and to reduce health disparities; however, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. <p><b>Research Design and Methods:</b> Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized trial, assigned to receive REACH (Rapid Education/Encouragement and Communications for Health) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence, and non-tailored texts supporting other self-care behaviors. Outcomes included HbA1c, diabetes medication adherence, self-care, and self-efficacy. </p> <p><b>Results:</b> Participants (N=506) were approximately half racial/ethnic minority and half were underinsured, had annual household incomes <$35,000 USD and ≤ high school education; 11% were homeless. <a>Average baseline HbA1c was 8.6%±1.8%; 70.0±19.7 mmol/mol) with n<i>=</i>219 having HbA1c≥8.5% (69 mmol/mol)</a> and half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI [-0.61%, -0.02%]) was greater among those with baseline HbA1c≥8.5% (-0.74%; 95% CI [-1.26%, -0.23%]), and there was not evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months, and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. </p> <p><b>Conclusions:</b> REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain effects. </p>

scholarly journals Development and Usability of REACH: A Tailored Theory-Based Text Messaging Intervention for Disadvantaged Adults With Type 2 Diabetes

2016 ◽  
Vol 3 (2) ◽  
pp. e23 ◽  
Author(s):  
Lyndsay A Nelson ◽  
Lindsay S Mayberry ◽  
Kenneth Wallston ◽  
Sunil Kripalani ◽  
Erin M Bergner ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Text Messaging ◽  
Text Messaging Intervention
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