Disseminating Diabetes Information Through Text Messages: Results From the Message Refinement Phase of the Mdiabetes Initiative

Background:  Currently 61 million people in India live with diabetes and the disease claims 1 million lives per year. By 2030 it is estimated that 101 million Indians will have diabetes. According to the World Health Organization, a healthy diet, exercise and avoiding tobacco can prevent 80% of cases of type 2 diabetes. In the Diabetes Prevention Program, changes in diet- and physical activity-related behaviors reduce risk of diabetes by 58% in those at high risk. Furthermore, there are over 900 million mobile phone subscribers in India (73% of the population), suggesting cell phones as a promising avenue for fostering health behavior change.

Program background:  In partnership with Arogya World’s mDiabetes Initiative, Emory University’s Diabetes Training and Technical Assistance Center (DTTAC) was asked to develop six months of mobile text messages for Nokia phone users in India. Messages were limited to 180 characters, addressed one of five content areas (medical, fitness, nutrition, lifestyle, reflection), and were designed for a general audience who choose to receive diabetes messages. Messages were designed across the stages of change, with greater emphasis on contemplation and action stages.

Evaluation Methods and Results:  As part of the message refinement phase, a user acceptability study of 25 text messages of the mDiabetes initiative was conducted with 791 respondents via telephone survey. Sixty four percent of respondents recalled the specific message being tested.  Ninety eight percent of respondents found the messages easy to understand, and 86% were willing to share the information with others.  Strong clarity and comprehension of messages was confirmed by key takeaways reported by 60% of respondents.

Conclusions:  The text messages appear to be clear, comprehensible, and useful to Indian consumers.  Consumers preferred action-oriented messages and a message length that fits within the cell phone screen without the user having to scroll.

Implications for research and/or practice:  This research tested the acceptability of these text messages developed for diabetes prevention for an Indian audience.  Based on the lessons learned here, messages could be developed for other health conditions and for dissemination in other countries.