The extent to which users engage with an intervention can reveal why and when it is effective. However, studies reporting on engagement with text messaging interventions are often short-term and frequency/dose varies widely. Further, limited research has examined engagement in diabetes text-based interventions with racially and socioeconomically diverse patients. We examined engagement with a 12-month text messaging intervention for T2D as part of a larger RCT. We recruited adults with T2D from community health centers and primary care clinics. At baseline, patients completed a survey and an A1c test. Patients randomized to intervention received daily one-way and interactive texts for the first 6 months, and then had the option to receive fewer texts (i.e., low-dose) for the remaining 6 months. We examined associations between patient characteristics and low-dose choice, and the association between choice and subsequent engagement, as measured by odds of response to interactive texts. The sample (N=250) had a mean age of 55.9±9.8 years, was 55% female, and 52% non-white; 41% had ≤ a high school degree, 41% had incomes <$25K, and mean A1c was 8.6±1.8%. On average, patients responded to 81% (IQR: 75-96%) of texts over 12 months. At 6 months, 44% chose to continue receiving daily texts, whereas 56% chose low-dose for the remaining 6 months. No patient characteristics were associated with choice, and choice was not associated with later engagement (b=-0.20, p=0.52). Odds of responding was lower over time in both groups (p<.001) but did not differ across groups. Average response rate was 73% (61-97%) in months 8-12. Among diverse patients with T2D, engagement with text messages remained high over 12 months. Almost half the sample elected to continue receiving daily texts for the entire 12 months. Engagement was similar in both groups in the final 6 months. Our findings support using texts to engage diverse patients in mobile health interventions. Providing an option for text frequency may help sustain engagement.


L.A. Nelson: None. R.A. Greevy: None. A.J. Spieker: None. K. Wallston: None. L.S. Mayberry: None.


National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100694); Center for Diabetes Translational Research (P30DK92986)

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