Gender differences in diabetes self-management: a mixed-methods analysis of a mobile health intervention for inner-city Latino patients

The following is a review of Burner et al. on the observed gender differences in diabetes self-management through the utilization of an mHealth intervention.

Introduction

MHealth technology is a promising tool with diverse features such as improving the self-management of patients suffering from chronic diseases. Diabetes has been a notorious and prominent public health problem affecting the diverse american population, especially African Americans and Hispanics. Although it has become an acclaimed tool for the implementation of follow-up treatments and self-management in patients, few is known about the factors which contribute to it's utilization such as Socio-economic status (SES). Berner et al. explore the impact of diabetes management among low-income Latino patients through the Trial to Examine Text Message for Emergency Department Patients with Diabetes (TExT-MED) a text message-based program designed to improve disease knowledge, self-efficacy, and glycemic control among low-income Latinos.

Methods

23 Diabetic patients recruited for the study were selected from the emergency department at Los Angeles County Hospital at the University of Southern California; largest public safety-net hospital in Los Angeles County serving a predominantly Latino population.

A three-phase framework was established for the conduction of the study:

• Phase I (Completed, May 2011) - Tested feasibility and acceptability among the target population.

- 1-month bilingual (English and Spanish) diabetes curriculum of text messages - Three messages/day in preferred language: (1) educational and motivational messages (67%), (2) trivia questions (12%), (3) healthy-behavior challenge (14%)

• Phase II (The study) - Qualitative analysis of the program.

- Assembled two focus groups of 90-min duration—one in English and one in Spanish from the pool of Phase I participants. Moderator delivered consistent probes between groups. - Including: (1) how they sought health information, (2) how trustworthy and valid they found the information from TExT-MED, (3) whether they sought further information after receiving a text message, and (4) with whom they shared the TExT-MED information. - Conversations were recorded and transcribed for further analysis.

• Phase III (Ongoing) - Randomized and Controlled trials.

Results

App Identification: From the top 200 free and grossing apps only 4 were recovered. Two were exercise apps and two were diet-focused apps; Interestingly, none of the results were specific to diabetes.

App Categorization: Five categories were yielded from the vast list of apps including Healthy eating, Physical activity, Self-monitoring, Problem solving, and Healthy coping. With Healthy eating and Physical activity been the categories with the most apps. Scores from the BTS were significantly low, since the max possible score was a 100 been 24.4 the mean total score.

App Patient Needs: The third step consisted on basically allocating the patient into the different categories established by step two; There was no single common patient-need specific to a single category the results indicated that indeed patient needs couldn't be associated to a category.

Conclusion

Most of the applications provided in their content general information and assistance to their users, but were limited in assessment, feedback, or tailored assistance. Results also show that apps incorporated some degree of interaction with the users as an intervention strategy, but the emotional and cognitive areas were very underdeveloped or simply not present, an aspect believed to be crucial for the motivation of the use of technology by men. Although the study suggest that the chronic treatment of a patient would improve significantly by customizing the application to the patients-needs it wouldn't be feasible for the app developer to materialize a software so exclusive since it would also affect the range in the market for him. Also, it’s incredible the degree of evolution in applications in categories such as social media, news, games, business or education while sadly having no substantial development in the category of Health applications, specifically for the improvement of chronic health illnesses. Perhaps, it is indeed an unexplored new market with many flaws, but it is also a digital realm which potentially can allow us to monitor and improve a patient’s life expectancy. Focusing and shifting the interest of developers into applications truly functional with an emotional component and of friendly-use for users will play a crucial role in the health service delivered to our patients in a not so distant future.