impact of texting & predictive potential of health literacy on medication adherence in type 2...
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Impact of Texting & Predictive Potential of
Health Literacy on Medication Adherence in
Type 2 Diabetes
Kevin A. Clauson, PharmD
Shara Elrod, PharmD
Angela Garcia, PharmD
Elizabeth Sherman, PharmD
Paula Eckardt, MD
Fadi Alkhateeb, BSPharm, MBA, PhD
Support from Mobilizing for Healthsm grant program (Disclosure)
Acknowledgments
Objectives
• Review fundamentals of diabetes, health literacy, and mobile health (mHealth)
• Explore decision points that informed study design in this research-in-progress interventional SMS study
• Discuss hurdles experienced and future directions
$174 billion annual cost burden of diabetes
Popul Health Metr 2010;8:29.
Insulin escorts _________ into the cells
Insulin escorts _________ into the cells
Healthy People 2010
“degree to which individuals have the capacity to obtain,
process, and understand basic health information and services
needed to make appropriate health
decisions”
Health Literacy
eHealth Literacy Lily Model
J Med Internet Res 2006;8(2):e9.
mHealth is the use of mobile devices and global networks to
deliver health services and information
mHealth Devices
o Phones
o iPad/TabletPC
o Glowcap
o Raisin
o USB
o Fitbit
o Greengoose
Who uses mobile phones?
82% of American
adults owns a cell phone*
*Range: 57% (65+) to 90% (18-29) Pew Cell Phones and American Adults 2010
Owns
Does not own
87% of blacks and Hispanics own a
cell phone*
P
ew I
nte
rnet
Mo
bil
e A
cces
s 2
010
*Compared to 80% of whites
Hispanics use their phone to go online and to text more frequently than
any other group*
P
ew I
nte
rnet
Mo
bil
e A
cces
s 2
010
*English-speaking Hispanics
Improve medication adherence in diverse, underinsured population in USA
with T2DM via text message reminders
Primary Study Objective
Examine predictive potential of health
literacy for adherence
Secondary Study Objective
Why choose simple SMS as an
intervention?
GoLiveSMS
Methods (aka why did we
make the decisions we did in the study)
Randomized, open-label trial Allocation method where all subjects have equal chance of study group assignment
Detect a significant difference
(two treatment arms)
Consumers would most prefer to receive a medication reminder via:
0 20 40 60 80 100
41.1
20.3
19.5
15.2
2.5
1.3 Phone call
Buzzing drug vial
Phone alarm
App
Text message/SMS
Source: Consumer Health Information Corporation, April 2011 (n=395)
Percent
Smartphone OS Share
38%
27%
21%
9%
2% 3%
Android
iPhone
BlackBerry
Windows
HP webOS
Other
Source: Nielsen Mobile Insights 2011
People will stop doing almost anything to check their text messages
Annu Rev Public Health 2011;32:399-416.
Mobile allows targeting of populations historically associated with health disparities
Study of 130 adult patients with type 2 diabetes
enrolled for 6 month intervention period
Recruitment from 5 Memorial Primary Care Centers
How is medication adherence being
measured?
How is medication adherence being
measured?
Morisky Medication Adherence Scale
Hemoglobin A1C
Surveys and measurement
REALM-SF Diabetes Knowledge Test
Satisfaction/fatigue
What hurdles are we trying to overcome?
Integrating a Tablet For data collection
Security Privacy Legality
J
AM
A 2
00
9;3
02
(11):
115
9-6
0.
Honk if you love Jesus if you’re ready Text to meet Him!
Images
• http://www.mhs.net/
• http://www.ucwv.edu/
• http://www.mckesson.com/en_us/McKesson.com/
• http://www.quickpwn.com/2010/06/iphone-4.html
• http://cdn.pocketnow.com/html/portal/news/0000015324/incredible-s-screen.jpg
• http://www.atakos.com/wp-content/uploads/2011/04/Blackberry-8800.jpg
• http://www.mobirolla.com/wp-content/uploads/Windows-Phone-7.png
• http://mobihealthnews.com/7074/vitality-taps-telit-for-glowcap-connectivity/
• http://online.wsj.com/article/SB124934548487503195.html
• http://www.vidagranola.com/wp-content/uploads/2010/03/fitbit.gif
• http://news.cnet.com/i/tim/2011/02/23/IMG_2143_610x458.JPG
Images
• http://cowbgonaca.blogspot.com/2011/06/wallpaper-for-android-mobile.html
• http://www.mac-wallpapers.com/Apple-Wallpapers/white-apple-logo-wallpaper/
• http://www.laptopsteria.com/wp-content/uploads/2011/06/blackberry-logo.jpg
• http://www.iphonewallpaperblog.com/wp-content/uploads/2010/12/Windows-7black-iphone4Walpaper.jpg
• http://www.mhs.net/locations/PrimaryCareCenters.cfm
• http://h10010.www1.hp.com/wwpc/pscmisc/vac/us/product_pdfs/Slate_500_Tablet_Datasheet.pdf
Images without citations are licensed stock photography
Hot-Button Issues
• Will privacy and legal challenges stifle innovation and the delivery of mobile-mediated care to at-risk patient populations?
• Could better decisions have been made about study design given the available information at the time?
• Will our research result in findings consistent with our research hypotheses and mHealth model assumptions?
Burning Questions
clauson@nova.edu www.unhub.com/kevinclauson
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