Improved Diabetes Care Management Through a Text-Message Intervention for Low-Income Patients: Mixed-Methods Pilot Study
Open accessAbstract
BACKGROUND: Diabetes is a major contributor to global death and disability. Text-messaging interventions hold promise for improving diabetes outcomes through better knowledge and self-management. OBJECTIVE: The aim of this study was to examine the implementation and impact of a diabetes text-messaging program targeted primarily for low-income Latino patients receiving care at 2 federally qualified health centers (FQHCs). METHODS: A mixed-methods, quasi-experimental research design was employed for this pilot study. A total of 50 Spanish or English-speaking adult patients with diabetes attending 2 FQHC sites in Los Angeles from September 2015 to February 2016 were enrolled in a 12-week, bidirectional text-messaging program. A comparison group (n=160) was constructed from unexposed, eligible patients. Demographic data and pre/post clinical indicators were compared for both the groups. Propensity score weighting was used to reduce selection bias, and over-time differences in clinical outcomes between groups were estimated using individual fixed-effects regression models. Population-averaged linear models were estimated to assess differential effects of patient engagement on each clinical indicator among the intervention participants. A sample of intervention patients (n=11) and all implementing staff (n=8) were interviewed about their experiences with the program. Qualitative data were transcribed, translated, and analyzed to identify common themes. RESULTS: , relative to patients who were less engaged, controlling for demographic characteristics (P<.001). Qualitative analyses revealed that many participants felt supported, as though "someone was worrying about [their] health." Participants also cited learning new information, setting new goals, and receiving helpful reminders. Staff and patients highlighted strategies to improve the program, including incorporating patient responses into in-person clinical care and tailoring the messages to patient knowledge. CONCLUSIONS: . Patients who were more engaged demonstrated greater improvement. Program improvements, such as linkages to clinical care, hold potential for improving patient engagement and ultimately, improving clinical outcomes.
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Smartphone ubiquity makes digital health interventions valuable in resource-limited or geographically remote settings.
“Smartphone ubiquity makes DHIs valuable in resource-limited or geographically remote settings (32).”
From The effectiveness of digital health intervention on glycemic control and physical activity in patients with type 2 diabetes: a systematic review and meta-analysis (2025) · cites this paper as [32]
The Discussion (Principal Findings and Comparison With Prior Findings; page unavailable) says text messaging made diabetes education more feasible for a resource-limited clinic by reaching many patients at once. The paper does not establish smartphone ubiquity or address geographically remote settings; its intervention used text messages in a low-income clinic population. (LLM, conf=0.87)
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BackgroundDiabetes Text-Message Self-Management Support Program (SMS4BG): A Pilot Study
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- Authors
- Watterson, J. L., Rodriguez, H. P., Shortell, S. M., & Aguilera, A.
- Affiliations
- University of California, Berkeley (US)
- Corresponding author
- Watterson, Jessica L
- Venue
- JMIR Diabetes
- Publisher
- JMIR Publications Inc.
- Published
- 2018-10-30
- Volume
- 3
- Issue
- 4
- Pages
- e15
- ISSN
- 2371-4379 (ISSN-L)
- PMC
- PMC6238849
- OpenAlex
- W2899258524
- Cited by
- 43
- References
- 5
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 4 · 2023: 5 · 2022: 10 · 2021: 3 · 2020: 10 · 2015: 1
- FWCI
- 4.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Diabetes (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Figshare (submittedVersion)
- Funders
- University of California Berkeley
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- diabetes care management, text messaging intervention, low-income patients, Hispanic patients, federally qualified health centers, patient engagement, diabetes self-management, patient-provider communication, clinical outcomes, mobile health
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