JMIR Publications

ABSTRACT

Background:

Access to diabetes education and resources for diabetes self-management are limited in rural communities, despite higher rates of diabetes in rural populations compared to urban populations. Technology and mobile health (mHealth) interventions can reduce barriers and improve access to diabetes education in rural communities. Screening, Brief Intervention, and Referral to Treatment (SBIRT) and financial incentives can be used together with mHealth interventions to increase the uptake of diabetes education; however, studies have not examined their combined use for diabetes self-management in rural settings.

Objective:

This two-phase Stage 1 feasibility study used a quasi-experimental design to examine the feasibility and acceptability of a mHealth diabetes education program combining SBIRT and financial incentives to engage rural residents.

Methods:

Phase 1 aimed to develop, adapt and refine the intervention protocol. In Phase 2, a 3-month quasi-experimental study was conducted with individuals from two rural communities in south Texas. Study participants were residents who attended free diabetes screening events in their community. Those with low or medium risk received health education materials, whereas those with high risk or previous diagnosis of diabetes participated in motivational interviewing and enrolled in the 6-week mHealth Diabetes Self-Management Education Program under either an unconditional or aversion incentive contract. The participants returned for a 3-month follow-up. Feasibility and acceptability of the intervention were assessed by participant recruitment and retention, the fidelity of program delivery and compliance, and participant’s satisfactionof the intervention program.

Results:

Of 98 screened rural community residents in South Texas, 72 met the study eligibility and 62 agreed to enroll in the study. The sample was predominately female and Hispanic with an average age of 52.6 years, and 27.4% had a diagnosis of diabetes. The feedback from study participants indicated high levels of satisfaction with the mHealth diabetes education program. In the post-study survey, the participants reported high levels of confidence to continue lifestyle modifications, i.e. physical activity and diet. The retention rate was 50% at the 3-month follow-up. Participation in the intervention was high at the beginning and dissipated in the later weeks regardless of the incentive contract type. Positive changes were observed in weight (-2.64 (SD=6.01), P < .05) and glycemic control index (-.30, P >.05) in all participants from the baseline to the follow-up.

Conclusions:

The finding showed strong feasibility and acceptability of study recruitment and enrollment. The participants’ participation and retention were reasonable given the unforeseen events that impacted the study communities during the study period. Utilizing a mHealth to deliver diabetes education has potential to reach rural individuals with diabetes. However, engagement with the mHealth intervention can be enhanced by a “blended” approach through human touch via community health workers. Clinical Trial: N/A