JMIR Publications

ABSTRACT

Background:

Depression is an often under-diagnosed and therefore untreated comorbidity for low-income, racially or ethnically diverse patients with a chronic illness such as diabetes. Recent update of the U.S. Preventive Services Task Force guideline in 2016 recommends assessing depression for every adult. Short Message Service (SMS) is an inexpensive, private, and scalable approach to provide depression screening and monitoring, and it can alleviate many barriers such as transportation, childcare, and clinical visit time faced by low-income population to receive depression diagnosis. Current evidence is inconsistent in comparing technology-mediated assessment vs. interviewer (INTW) assessment in collecting sensitive health information, as some studies suggest technology encourages self-disclosure while the other studies show the opposite effect.

Objective:

The proposed study will test using SMS to assess depression and its related conditions, including functional disability, pain, and anxiety, in low-income, culturally diverse safety-net primary care populations with diabetes. The study will examine the concordance between SMS and INTW assessments and evaluate test-retest reliability.

Methods:

The proposed study is a randomized trial with 200 patients with four study groups: SMS/INTW, INTW/SMS, SMS/SMS, INTW/INTW. The first two groups will be used to examine the concordance between SMS and INTW assessments. The third and fourth groups will be used to evaluate test-retest reliability. Participants of the study will be recruited from the participants of the prior Diabetes-depression Care-management Trial, a large comparative effectiveness research in collaboration with the Los Angeles County Department of Health Services (LAC-DHS). Concordance between SMS and INTW assessments will be evaluated by interclass correlation coefficient and Kappa statistic. Test-retest reliability will be measured by Cronbach’s alpha. Missing data patterns will be explored to understand whether participants are willing to self-disclose such information in SMS assessment.

Results:

Recruitment of participants was conducted from June, 2017 to November, 2017. A total of 206 participants were enrolled: 52 in SMS/INTW, 53 in SMS/SMS, 49 in INTW/SMS, 52 in INTW/INTW. Average age of the participants was 57.1. 57.8% (119/206) were female. 93.2% (192/206) were Latinos. And, 77.7% (160/206) chose Spanish as their preferred language. Test of the SMS assessment shows the cost of distributing the 16 questions is about $0.50 per person per time. Full results of the study will be reported elsewhere.

Conclusions:

The study is anticipated to establish feasibility of using SMS to assess depression and its related conditions in low-income, culturally diverse safety-net primary care populations with diabetes. We also expect to generate knowledge about whether patients in the targeted population are willing to reply and self-disclose the sensitive information about depression and its related conditions through SMS assessments.