JMIR Publications

ABSTRACT

Background:

Poor adherence to oral medications for type 2 diabetes can increase the risk of health complications. Digital interventions can affect people’s experiences of self-managing a chronic condition and text messages may provide an effective delivery method for an intervention. The SuMMiT-D (Support Through Mobile Messaging and Digital Health Technology for Diabetes) intervention uses evidence-based SMS messages to support people with type 2 diabetes with regular and consistent use of diabetes medication.

Objective:

This process analysis, conducted alongside a randomised controlled trial of SuMMiT-D aimed to explore i) the contextual factors which may interact with the SuMMiT-D intervention and ii) the self-reported mechanisms by which change in behaviour or attitude might occur.

Methods:

A nested qualitative process study was conducted within Primary Care in England, UK. Forty-three trial participants diagnosed with type 2 diabetes, who were assigned to receive the SuMMiT-D intervention and taking oral glucose-lowering treatment, blood pressure–lowering treatment, or lipid-lowering treatment either alone or in combination, and who had access to a mobile phone, took part in semi-structured telephone interviews. Data were analysed using inductive thematic analysis.

Results:

Two overarching themes were developed, exploring relevant contextual factors and potential mechanisms of change. The system exerted a range of holistic benefits and supported the cognitions, beliefs and behaviours necessary for longitudinal self-management. The perceived value of the messages was fluid and linked to contextual need. Appraisal of the system was influenced by existing routines, lifestyle disruption, people’s understanding of type 2 diabetes, relationships with other people, and subjective attitudes to living with type 2 diabetes in contemporary society.

Conclusions:

This work demonstrates the value of engaging people longitudinally in thinking about their general health, the importance of interrogating context and the holistic benefit of health messaging. Many people perceived wide-ranging and unexpected benefits from using the intervention over time, challenging assumptions about who might be expected to appraise the system more positively, and who should be offered access to it.