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

Email

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