What do people with type 2 diabetes want from a brief messaging system to support medication adherence?
Received 31 May 2019
Accepted for publication 27 August 2019
Published 30 September 2019 Volume 2019:13 Pages 1629—1640
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Yvonne Kiera Bartlett,1 Nikki Newhouse,2 Hannah A Long,1 Andrew J Farmer,2 David P French1
1Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK; 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Correspondence: Yvonne Kiera Bartlett
Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester M13 9PL, UK
Tel +44 161 306 5436
Fax +44 161 275 2588
Background: Many people with type 2 diabetes do not take their treatment as prescribed. Brief messages to support medication use could reach large numbers of people at a very low cost per person, but current interventions using brief messages rarely adequately describe the content of the messages, nor base these messages on explicit behavior change principles. This study reports the views of people with type 2 diabetes concerning the acceptability of 1) a messaging system and 2) proposed messages based on behavior change techniques (BCTs) and beliefs and concerns around taking medication.
Methods: The proposed system and brief messages were discussed in focus groups of people with type 2 diabetes recruited through general practices in England. Transcripts were analyzed thematically.
Participants: Twenty-three participants took part in one of five focus group discussions. All participants were over 18 years, were taking tablet medication for their diabetes, and had access to a mobile phone. Key exclusion criteria were recent hospitalization for hyper- or hypoglycemia or diagnosis with a terminal illness.
Results: Four themes were identified as relating to the acceptability of the messaging system: “opportunities and limitations of technology”, “us and them (who is the system for?)”, “responsibility for adherence”, and “diabetes management beyond medication”. Participants recognized the benefit of using technology. Those with high confidence in their ability to adhere were keen to make a distinction between themselves and those who did not adhere; participants were more comfortable taking responsibility for medication than diet and exercise. Acceptability of the messages hinged on avoiding “preaching to the converted”.
Conclusions: These findings show that brief messaging could be acceptable to the target population for a range of diabetes-related behaviors but highlight the need for such a system to be perceived as personally relevant. Acceptable messages would need to maintain novelty for the target population.
Keywords: diabetes, mHealth, health psychology, behavior change, qualitative, focus groups