How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study.
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2014-11-11
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Abstract
PURPOSE The purpose of this study was to investigate the behavioral effects of a theory driven mobile phone based intervention that combines automated text messaging and remote nursing using an automated interactive text messaging system METHODS This was a mixed methods observational cohort study Study participants were members of the University of Chicago Health Plan UCHP who largely reside in a working class urban African American community Surveys were conducted at baseline 3 months mid intervention and 6 months postintervention to test the hypothesis that the intervention would be associated with improvements in self efficacy social support health beliefs and self care In addition in depth individual interviews were conducted with 14 participants and then analyzed using the constant comparative method to identify new behavioral constructs affected by the intervention RESULTS The intervention was associated with improvements in 5 of 6 domains of self care medication taking glucose monitoring foot care exercise and healthy eating and improvements in 1 or more measures of self efficacy social support and health beliefs perceived control Qualitatively participants reported that knowledge attitudes and ownership were also affected by the program Together these findings were used to construct a new behavioral model CONCLUSIONS This study s findings challenge the prevailing assumption that mobile phones largely affect behavior change through reminders and support the idea that behaviorally driven mobile health interventions can address multiple behavioral pathways associated with sustained behavior change