Designing a Diabetes Text Messaging Protocol

Background and Problem Statement: High rates of diabetes complications in the United States impact the hospitalization rates and costs of services to manage this population. The Veterans Administration (VA) Office of Connected Care is field testing a text messaging application called the Annie App which contains a diabetes educational/motivational text messaging protocol to support patient engagement in self-care. The purpose of this project was to determine text message preferences of patients with Type 2 diabetes related to perceived usefulness of content and message structure in order to inform the redesign of the diabetes educational/motivational text message protocol with a goal to positively influence patients' intention to use this protocol. Methods: Interviews were conducted to identify text message preferences that relate to perceived usefulness of content and message structure. Evaluation included a thematic analysis of data obtained from the interview sessions. Results: Themes included message structure, message framing, perceived usefulness, user attitude, and behavioral intention to use the text messaging protocol. Recommendations: Modification of text message protocol content and structure based on patient preferences and in alignment with current evidence to be reviewed by the VA Office of Connected Care for use at the local medical center. Further research is recommended to evaluate the effects of gain-framing versus loss-framing within health messaging. Further quality improvement efforts are recommended to include determining patient perceptions of the diabetes educational/motivational text messaging protocol after the protocol is in use for a period of time, as well as the measurement of clinical outcomes.