Engaging Individuals to Promote Diabetes Risk Awareness with txt4health: A Program Evaluation of Beacon Community txt4health Pilots in Southeast Michigan and Greater Cincinnati

Abstract

There are an estimated 25.8 million American children and adults, roughly 8.3% of the U.S. population, living with diabetes. Diabetes is particularly burdensome on minority populations where health disparities persist. Mobile technologies are an attractive method for reaching broad populations given the high penetration of cell phones across diverse groups, and may be a useful strategy for raising awareness of type 2 diabetes. To raise awareness of the risks associated with type 2 diabetes, pilots of txt4health, an automated 14-week text message program, were launched by the Southeast Michigan and Greater Cincinnati Beacon Communities. This investigation sought to evaluate the txt4health program pilot in Southeast Michigan and Greater Cincinnati through documenting participant usage of txt4health, as well as user perceptions of the program.

In this two part evaluation, we conducted a retrospective records analysis of individual-level txt4health system usage data from participants in Southeast Michigan and Greater Cincinnati to determine usage of the program. We also conducted a multimodal user survey with 161 txt4health users recruited through the program to understand participant perceptions of program satisfaction, participant use, and self-reported perceptions of behavior change. Preliminary results from the retrospective records analysis reveal that across both pilots, 5,570 participants initiated enrollment in txt4health, of which 33% completed the two-step enrollment process. Once enrolled, the majority of participants set a weight loss goal (74%), and tracked their weight (89%) and physical activity (65%) at least once during the program; however 56% dropped out before the end of the program, with 70% of dropouts occurring before the end of the fourth week. Among program completers, rates of weekly weight tracking were low with 22% of participants logging weekly weights at least five times, yet rates of weekly physical activity tracker were greater with 49% logging weekly physical activity at least five times. Despite high attrition across the pilots, surveyed txt4health users report high levels of program satisfaction, with 67% reporting satisfaction scores of eight or higher on a ten point scale (10 =most satisfied; M=8.2, SD=1.6). The majority of participants report that txt4health helped them make lifestyle and behavior changes related to diet and physical activity. While broadly focused public health text message interventions may have a great reach, individual engagement among participants widely varies, suggesting that this type of approach may not be appropriate for all, but is a feasible and acceptable delivery modality for a large subset of people.

Air Aware: A smartphone app to increase awareness of environmental factors triggered for symptoms of breathing-related illnesses

Abstract

Breathing-related chronic illnesses such as asthma and chronic obstructive pulmonary disorder (COPD) affect millions of people. People with these conditions are especially impacted by environmental and weather-related factors that contribute to symptom exacerbation. This includes worsening dyspnea, anxiety, fatigue and depression. Self-monitoring of symptoms is becoming an increasingly popular tool in treatment for these illnesses. One such tool is being developed by the Department of Medical Social Sciences (MSS) at Northwestern University Feinberg School of Medicine. This tool is an iOS based mobile application that incorporates validated measures from the NIH PROMIS system with publicly available environmental and weather-related data through RSS and API interfaces. The application associates a person’s dyspnea, anxiety and fatigue symptoms with environmental variables such pollution and pollen levels and weather related data such as temperature and humidity levels for a given GPS location. These variables are obtained by calling publicly available web services that take GPS data as inputs. The GPS readings are obtained through the GPS API available in the iOS devices. Since a person’s sensitivity to these external factors is highly individualized, the application first prompts users to complete a short battery of PROMIS computer adaptive tests (CAT) under a variety of environmental conditions and then calculates correlation coefficients. These prompts are enabled through the notification system available in the iOS platform. CATs reduce patient burden by administering highly targeted items to the user and stops when enough information is received. Once the application has collected enough data to determine if a correlation(s) exists, it will alert the user when environmental or weather conditions are at a level that would indicate a symptom is likely to occur. Since correlation does not equate causation, the application does not provide specific treatment recommendations for the symptoms; instead it aims to increase awareness of the existing conditions and how it may affect one’s immediate well-being. User acceptance and effectiveness will be evaluated in a future feasibility study. This will aid in the refinement of criteria for determining the alert mechanism based on historical stored data.

Experience with mobile technology among patients with tuberculosis in San Diego, California and Tijuana, Mexico

Abstract

Each year, nearly 9 million cases of tuberculosis (TB) occur worldwide, resulting in 1.4 million deaths. While curable, long treatment regimens (6–24 month) negatively impact adherence for many patients, resulting in ongoing illness, continued transmission, and development of drug-resistant TB. Directly observed therapy (DOT) is recommended for improving adherence. DOT consists of TB providers watching their patients ingest each medication dose. However, DOT is costly, labor intensive and impractical in remote or resource-poor settings. To reduce these barriers, we developed the “Video DOT” (VDOT) system, whereby patients use mobile phones to record and send daily videos of themselves taking medications, which are then viewed remotely by DOT workers. To gauge feasibility of this technology-based approach, we assessed prior experience with mobile phones and willingness to adopt mHealth interventions in a sample of TB patients in the US/Mexico border region.

VDOT was pilot-tested in a single-arm trial among TB patients in San Diego, CA (n= 43) and Tijuana, Mexico (n=9). Participants were interviewed before and after using VDOT for an average of 5.5 months (range 1–11 months). Ages ranged from 18–86 years old, 50% of patients were male and 50% were Hispanic. Education ranged from 24% completed primary education or less to 57% completing at least some college. Prior to study enrollment, 94% of participants owned a cell phone (55% were smartphones), of which most reported experience sending photos (72%) or videos (57%) from a cell phone, and 64% reported sending text messages daily. Age was the only factor significantly associated (p-values < .05) with owning a cell phone, owning a smart phone, sending pictures and videos, and daily text messaging. Experience with technology was similar between San Diego and Tijuana participants. Compared to baseline ranking on a 10-point scale, participants felt more comfortable using cell phones (+.77, p=0.008), phone cameras (+1.43, p=0.006), phone video cameras (+1.68, p=0.009), internet (+.68, p=0.100), email (+.72, p=0.226) and text messaging (+.29, p=0.299) at follow-up.

Cell phone use was very common among a demographically-diverse sample of TB patients. Younger patients had the most experience with smartphones prior to study enrollment, making this demographic especially prepared to adopt mHealth interventions. The experience of using smartphones for VDOT also led to an increase in comfort using mobile phone functions in both low and high-resource settings. These findings suggest that smartphones provide a feasible platform for TB treatment monitoring applications.

MobileCARE- Innovative Approaches for Combat Trauma Education and Documentation

Abstract

Learning Objectives:

1. Participants will identify the successes and challenges of developing and implementing a total mobile data management system in a level 1 trauma center.
2. Participants will demonstrate the value of integrated solutions combining mobile devices, electronic medical records, education and telemedicine/decision-support for when decisions are most critical.
3. Participants will appreciate the importance of the user experience and acceptance when selecting appropriate technology for their mobile health projects

Mobile technologies harbor the potential to transform healthcare by improving clinician workflow and decision-making, which ultimately enhances quality of care and patient outcomes. The time sensitive nature inherent in trauma and critical care requires physicians to quickly access information to make correct decisions. In the past 5 years, we have been developing a mobile software platform and data management system that combines clinical documentation, education and telemedicine/decision-support. The goal is to provide clinicians with an integrated system of tools to facilitate the process of care. MobileCARE delivers a suite of integrated applications that completely supports a physician’s workflow. Clinicians are able to create documentation, view test results, medical notes and surgical documentation in real time. It also provides access to a mobile learning trauma and critical care curriculum and the ability to communicate through telemedicine with other team members. To better understand the use of mobile technologies in the clinical environment, we conduct usability and user acceptance testing as a guide to implementation. We also have conducted knowledge and skill acquisitions tests of the learning modules.The system are currently being evaluated in the trauma intensive care unit of a busy urban Level 1 trauma center. Physicians use it to document patient admissions and daily patient status with the information immediately available to all users across multiple platforms. Knowledge and skill acquisition tests have demonstrated that the mobile learning modules are equivalent to traditional classroom lectures (Figure 1), and that their use improved performance in the simulated environment (Figure 2). MobileCare is a complete software solution that provides significant functionality in the clinical environment. The impact on the safe and efficient delivery of care will continue to be realized. This technology is especially beneficial where continuity of care is required, as with patients with chronic disease or multiple acute conditions.

Figure 1

Figure 2

Monitoring MAMA: Gauging the Impact of MAMA South Africa

Abstract

Introduction In South Africa a number of Millennium Development Goals relating to maternal health have been worsening while the use of mobile phones to support health services (mHealth) has been shown to improve health outcomes in the developing world. South Africa is one of the focus countries for the Mobile Alliance for Maternal Action (MAMA) which also includes Bangladesh and India. MAMA South Africa (MAMA-SA) uses a multi-channel mHealth approach to communicate healthy pregnancy and newborn child support behaviours, with a country specific focus on prevention of mother to child transmission (PMTCT) of HIV. This presentation provides an overview of MAMA-SA’s five mHealth communication channels and details the monitoring and evaluation (M&E) that is being conducted on each.

Methods MAMA SA’s five ‘channels’ are SMS, USSD, Mobi, MXit (a South African mobile phone-based chat platform) and voice. With such a variety of communication methods on offer, a detailed M&E plan was necessary to gauge MAMA-SA’s impact on women within the country. To ensure similar levels of M&E across multiple countries, MAMA-Global (MAMA’s global coordination team) supported the initial M&E planning. This process established standardized indicators for all MAMA countries, while leaving room for adding additional indicators for country specific circumstances. Building on the standardized indicators, South Africa has added a number of additional indicators, some of which are based on national PMTCT indicators. Automated and manual data collection methods have been implemented, as well as focus group discussions and user feedback and testing.

Results Since the launch, over 20,000 unique users have interacted with MAMA SA which translates into over 67,000 unique page views, hundreds of mobi-site comments, and more than 110,000 SMS’s and 8500 USSD messages being sent thus far. Most registered mobi-site users (73.01%) have already delivered and are looking for information to care for him/her, while the rest (26.99%) have yet to deliver. A large portion of SMS users (21.88%) opted to receive HIV-related messages, while this is lower than the national HIV rate which currently stands at 29.5%. Focus groups and user testing has shown that users of the service have found MAMA-SA valuable.

Conclusions Preliminary MAMA-SA data indicates high acceptability and satisfaction with the project. Detailed planning of M&E for such a diverse mHealth service offering has been essential. Service uptake has been satisfactory, but strategies for greater publicity are necessary. Further research is necessary (and planned) to ascertain health outcomes of HIV-positive women.