Accepted for/Published in: JMIR Human Factors
Date Submitted: Oct 4, 2024
Date Accepted: Mar 12, 2025
Adapting a text messaging intervention to improve diabetes medication adherence in a Spanish-speaking population: A qualitative study
ABSTRACT
Background:
Latino adults with type 2 diabetes (T2D) have higher rates of diabetes medication non-adherence than non-Hispanic White adults. REACH is a text message-based platform based on the Information-Motivation-Behavioral skills (IMB) model that addresses barriers to adherence and was shown to improve adherence and hemoglobin A1c (HbA1c), but it is only available in English.
Objective:
To report the multiphase, stakeholder-driven adaptation of the REACH barriers to diabetes medication adherence content to a Latino population (REACH-Español).
Methods:
Latino adults with T2D were invited to participate in one of five focus groups conducted in Spanish between April 13th and November 9th, 2023. Focus groups 1-3 centered on identifying the most relevant barriers to diabetes medication adherence in the study population. Focus groups 4-5 centered on translations and cultural modifications of the original text message content associated with each of the REACH barriers. Barriers were mapped onto IMB constructs. Focus groups were audio-recorded, professionally transcribed, and analyzed with thematic content analysis using NVivo.
Results:
Twenty-two participants attended one of five focus groups. Mean age was 63.2 years, 55.0% were female, and mean HbA1c was 8.5%. All participants were born in Latin America or the Caribbean and spoke Spanish as their preferred language, and 54.5% had completed middle school education or less. Among 40 barriers to diabetes medication adherence from REACH and the extant literature, participants ranked 18 barriers as most relevant; among the top 10 ranked barriers, 50% corresponded to information, 20% to social motivation, 20% to behavioral skills, and 10% to personal motivation. Personal motivation barriers (medication burden and fear of side effects) and behavioral skills (forgetting to take medication) emerged as important themes in the focus groups.
Conclusions:
A stakeholder-driven approach to intervention adaptation identified and prioritized relevant barriers to diabetes medication adherence among Latino adults with type 2 diabetes and facilitated adapting of the REACH platform to a Spanish-speaking population.
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