Accepted for/Published in: JMIR Human Factors
Date Submitted: Aug 16, 2021
Date Accepted: Dec 9, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Development and Usability of a Text Messaging Program for Women with Gestational Diabetes: Mixed Methods Study
ABSTRACT
Background:
Gestational diabetes mellitus (GDM) affects 5-10% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM.
Objective:
This study aimed to perform user experience testing and assess usability and acceptability of a text messaging program (Text 4 Success) for women with GDM.
Methods:
An automated two-way texting program was developed. It included: 1) reminders to check blood glucoses, 2) positive feedback to user-reported glucoses, 3) weekly educational messages and 4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semi-structured interviews. For women in the usability study, glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percent of recommended SMBG checks performed (a secondary outcome).
Results:
Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (>90%). In comparing the week prior to the trial to the two weeks during the trial, there was a small but statistically insignificant difference in the percentage of recommended SMBG performed (median 93% [5 to 95 percentile 82-100%] vs median 97% [83-100%]).
Conclusions:
Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have a low adherence to self-monitoring of blood glucose at baseline. Adaptations to the program will be made based on user suggestions. Further study of text messaging to improve SMBG in GDM is needed.
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