Vanderbilt Study Proves Value of mHealth in Care Management, Engagement

A new study out of Vanderbilt University finds that mHealth messages can not only help care providers maintain engagement with chronic care patients, but maintain a high level of engagement over a longer period of time.

The study, recently published in JMIR Health and uHealth, come at a critical time. With the coronavirus pandemic sharply restricting visits to the doctor’s office, many care providers are worried that patients aren’t following care management routines that promote health and wellness. They’re now looking at telehealth and mHealth tools to re-establish connections and get their patients back on track.

The study, called REACH (Rapid Education/Encouragement And Communications for Health), tested a personalized text-messaging platform on a group of racially and socioeconomically diverse patients living with type 2 diabetes. For the first six months, they received daily text messages on self-care and medication adherence, with feedback encouraged, and half also received phone calls. At the six-month mark the coaching ended, with patients given the option to still receive texts, though not every day.

The research team, led by Lyndsay Nelson, PhD, of the Vanderbilt University Medical Center’s Department of Medicine, found that more than 90 percent of those involved in the study responded to the messages over the 12 months, though engagement did decline a little bit over time. They also found that nearly half wanted to continue receiving daily messages after the six-month mark.

“Participants who continued daily text messages said they wanted to continue experiencing benefits to their health, whereas those who chose fewer texts said that the daily texts had helped them create routines and they no longer needed them as often,” Nelson and her colleagues said. “Engagement was not impacted by receiving coaching or by participants’ chosen text frequency.”

In an interview with Physicians Weekly, Lindsay Mayberry, MS, PhD, another member of the research team, said the engagement rate for well-designed text messages was much higher than research has shown for other connected health channels, like mHealth apps and online portals. She also noted that rate remained high across all types of patients.

“Our findings indicate that well-designed text messaging interventions can engage traditionally hard-to-reach patients over the long term,” she said.. “Programs that support adherence through interactive text messages may engage a diverse group of patients in their self-care between clinic visits. Participants in our study reported increased adherence and feeling accountable as a result of receiving these types of messages.”

The research team noted that this particular platform might be ideal in reaching underserved patients who lack access to smartphones or the internet.

They “also tend to have worse health outcomes, (and) the spread of apps and other internet-dependent technologies may unintentionally widen health disparities,” the team reported. “Compared with other forms of mHealth technology, text messages offer key advantages given their ubiquity and potential for scalability. This study contributes to evidence for the case that these interventions may help create equity if implemented in clinical care.”

Future research, Nelson and her colleagues said, will include examining how fresh promotion strategies over time affect continued engagement, and how gamification might help. They also want to study how this platform might affect clinical outcomes, including HbA1c levels and medication adherence.