Using Mobile Technology to Engage the Most-At-Risk and Vulnerable Populations

Background: Diabetes is one of the largest, costliest, and most rapidly growing public health challenges facing Louisiana. Approximately, 10% of Louisiana residents have been diagnosed with diabetes by a physician (BRFSS 2010). The total annual cost of diabetes in Louisiana is $2.4 billion. For every two persons with diagnosed diabetes, there is another undiagnosed person with this disease. Undiagnosed type 2 diabetes is a serious condition causing increased risk for stroke, coronary heart disease, peripheral vascular disease, dyslipidemia, hypertension, and obesity. Consequently, targeted screening of at risk patients is extremely important.

Program background: The Louisiana Public Health Institute (LPHI) officially launched txt4health in January 2012. Txt4health is a diabetes risk awareness and prevention campaign that leverages mobile technology (SMS) to engage the most-at-risk populations (for type 2 diabetes) in the Greater New Orleans area. The ultimate goal of txt4health is to improve health outcomes by driving awareness about type 2 diabetes and empowering people with information to support healthy lifestyle choices. By texting the word ‘HEALTH’ to ‘300400’ participants can: a) take a free diabetes risk assessment, b) set weight loss and physical activity goals, c) receive evidence-based, culturally-appropriate health information, and d) obtain information on local care and resources.

Evaluation Methods and Results: De-identified consumer data collected throughout the 14-week cyclical program was used to analyze specific campaign measures. As of March 2013, over 1,700 people enrolled into the program – 75% were obese or overweight and 67% set a personal weight loss goal after having completed a diabetes risk assessment and learning about their personal risk for diabetes. The average number of days participants were enrolled was 83. A pre/post campaign population-based evaluation design was applied to assess the effectiveness of the social marketing campaign within Greater New Orleans. There was a significant increase in awareness of the campaign, especially among respondents who have type 2 diabetes in their family (4% to 19%), are black (8% to 29%), or are under 30 (9% to 29%). We also administered a program satisfaction survey among participants to assess user satisfaction and patient activation. Approximately 90% of respondents were either extremely satisfied or satisfied with the program. Furthermore, 87% of respondents said the messaging kept them motivated to accomplish their goals. 

Conclusions: The txt4health pilot campaign is one of the largest population-based mobile health programs in the United States focused on type 2 diabetes prevention. The Louisiana Public Health Institute was successful in sustaining (and scaling) a government-funded mHealth pilot program. The statewide expansion of txt4health is scheduled to launch during the third quarter of 2013 with significant support from public and private sector partners.  

Implications for research and/or practice: New strategies and innovations in care are required to stem the increasing burden of chronic diseases such as type 2 diabetes and cardiovascular disease. Effective mobile technology solutions should be integrated into public health communication and education campaigns as another channel to engage at-risk populations. Testing mHealth programs at the population-level for conditions like type 2 diabetes is therefore imperative.