Effective message strategies for mobile text messaging interventions targeting type 2 diabetes self-management




Sahin, Cigdem

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Type 2 diabetes is a life-threatening condition, and it is rapidly growing in the world. If patients receive adequate education and support, they can manage their diabetes-related tasks effectively and reduce the severe complications of this disease. However, traditional self-management education and practices were not very effective in stimulating behaviour change and addressing patients’ diversified needs and expectations. Mobile text messaging is a promising method for type 2 diabetes self-management as it can provide continuous and customized support to these patients. However, there is a lack of knowledge about the optimal approach to designing and delivering mobile text messages. Hence, this dissertation aimed to define effective message strategies for mobile text messaging interventions targeting type 2 diabetes self-management. This manuscript-based dissertation consists of three complementary studies. The first manuscript includes a systematic review and a meta-analysis of tailored mobile text messaging interventions on type 2 diabetes self-management. It examines the tailoring strategies, message content, and structure and identifies the moderators of effectiveness in these interventions. The second manuscript includes a systematic review and a meta-synthesis of qualitative evidence on patients’ experiences and perspectives of mobile text messaging studies. The third manuscript consists of a prospective qualitative study to explore the text messaging design and delivery preferences of patients. In the first and second studies, the comprehensive search strategy included major electronic databases, key journal searches, and hand searches of the reference lists of related systematic reviews and meta-analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Collaboration's guidelines and recommended tools were used for data extraction, risk of bias and critical appraisal assessments, data analysis and reporting. Within a social marketing framework, the third study included semi-structured interviews and a thematic analysis of the main findings. In the first manuscript, 13 eligible trials were included for the systematic review and 11 eligible trials were further analyzed in the meta-analysis. This study concluded that tailored mobile text messaging interventions could improve glycemic control in patients with type 2 diabetes. The subgroup analyses revealed the importance of some moderators such as message delivery, message direction, message frequency, and using multi-modalities. In the second manuscript, the systematic review included 14 eligible studies, and the thematic synthesis included 13 eligible studies. Patients emphasized the importance of tailored text message design and delivery. They felt “supported” by using text messaging and improved their communication with family/friends and care providers. Mobile text messaging increased patients’ self-awareness, knowledge and control of diabetes. The third study explored that mobile text messages could be more effective if they are gain-framed and written in a standard format. Patients favoured the text messages that included simple and direct tone and provided statistical evidence. The findings demonstrated patients’ needs and expectations for advanced tailoring strategies in both message content and delivery. Together, the manuscripts fill a significant gap and inform research and practice for the development of more effective message strategies that could lead to reducing the spread of type 2 diabetes worldwide.



type 2 diabetes, self-management, health behaviour change, text messaging, mobile health, systematic review, meta-analysis, meta-synthesis, qualitative study