Accepted for/Published in: JMIR Formative Research
Date Submitted: Jun 28, 2023
Date Accepted: Aug 18, 2023
Warning: This is an author submission that is not peer-reviewed or edited.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 of HypoPals: A Mobile Health Text Messaging Program Providing Hypoglycemia Symptom Detection Training and Hypoglycemia Psychoeducation to Improve Hypoglycemia Self-Management
ABSTRACT
Background:
Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in T1D advanced diabetes technology users.
Objective:
To develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in T1D advanced diabetes technology users.
Methods:
Based on user-centered design principles, a multidisciplinary team (including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycemia behavioral intervention program. Five iterative steps were taken: 1) conceptualization of hypoglycemia self-management processes and relevant interventions; 2) identification of text message themes and message content development; 3) message revision; 4) patient partner assessments for message readability, language acceptability, and trustworthiness; and 5) message finalization and integration with a CGM data–connected mHealth text message delivery platform. An mHealth web-based text message delivery platform that communicates with a CGM glucose information sharing platform was also developed.
Results:
The mHealth text messaging hypoglycemia behavioral intervention program “HypoPals”, directed by patients’ own CGM data, delivers personalized intervention messages to 1) improve hypoglycemia symptom detection and 2) elicit self-reflection, provide fact-based education, and suggest practical health behaviors to address unhelpful hypoglycemia beliefs and promote hypoglycemia self-management. The program is designed to message patients up to four times per day over a 10-week period.
Conclusions:
A rigorous conceptual framework, a multidisciplinary team (including patient partners), and behavior change techniques were incorporated to create a scalable, personalized mHealth text messaging behavioral intervention. This program was systematically developed to improve hypoglycemia self-management in T1D advanced diabetes technology users. A clinical trial is needed to evaluate the program’s efficacy for future clinical implementation. Clinical Trial: N/A
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