JMIR Publications

ABSTRACT

Background:

Depression and diabetes are highly co-morbid and are major causes of global disabilities, particularly among individuals with low income or from racial/ethnic minority backgrounds. While digital interventions offer promise for managing these chronic conditions (such as via lifestyle modification), there is also emerging evidence that digital support may strengthen or complement existing healthcare relationships. In particular, digital interventions can also secondarily impact patient perceptions of healthcare communication and connection with their providers. However, there is a lack of rigorous RCT evidence on how digital interventions influence patient-provider communication, particularly in marginalized communities.

Objective:

To conduct a secondary analysis of RCT data to examine the effectiveness of an adaptive mobile health (mHealth) texting-based intervention on patient perceptions of communication and overall connectedness with their healthcare provider(s) among patients with chronic diseases.

Methods:

This study utilized data from the ‘Diabetes and Mental Health Adaptive Notification Tracking and Evaluation’ (DIAMANTE) trial, a prospective, randomized controlled trial that varied text messaging strategies to encourage physical activity to support both mental and physical health for patients with diabetes and depression. Patients were recruited from safety net clinics in San Francisco and social media during the COVID-19 pandemic and randomized into three groups: 1) personalized text messaging about physical activity via an adaptive learning algorithm, 2) randomly selected messaging about physical activity, and 3) a control group without messaging. As a secondary outcome, we examined pre-post changes in patient-reported healthcare communication, assessed via surveys with the validated Consumer Assessment of Healthcare Providers and Systems (CAHPS) communication subscale. Bivariate comparisons first examined CAHPS score changes by age, gender, preferred language, race/ethnicity, nativity, marital status, and education. Our primary analysis used mixed-effects modeling in an intent-to-treat analysis to determine differences in the patient-reported communication outcome by trial arm.

Results:

156 patients with complete survey data were included in the analysis. Overall, there was a substantive but non-significant decrease in the average CAHPS score over the DIAMANTE clinical trial period of six months (-2.6, p=0.11), with similar decreases across patient demographic subgroups. When we evaluated healthcare communication across the three RCT arms, there were no significant differences in patient-provider communication by RCT arm.

Conclusions:

Digital health interventions are likely to impact how patients perceive their ongoing care and relationships with their providers. While our study found no significant changes in patient-provider communication by RCT arm, the temporal implications of the COVID-19 pandemic on patient-provider communication during the DIAMANTE study period are still unclear and should be further studied. This study is the first of its kind to examine the influence of an adaptive mHealth intervention on patient-reported healthcare communication, with insights that might be important as digitally-enabled chronic care management rapidly expands. Clinical Trial: ClinicalTrials.gov registration identifier: NCT03490253