University of Virginia

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Call2Health Program

Location: Charlottesville, Virginia

This randomized study compared the impact of daily inspirational text messages with and without the addition of a diabetes self-management support program on the health outcomes of rural, underserved African-American women with diabetes. While improvements in clinical outcomes were modest for both groups and differences between the groups were not statistically significant, participants reported that the daily text message inspiration motivated them to practice healthy behaviors.

Context

The University of Virginia’s Call2Health program sought to determine if daily text messages alone, or daily text messages coupled with a comprehensive diabetes self-management support program, could improve the health outcomes of underserved African-American women with diabetes.  African-American women diagnosed with Type 2 diabetes and receiving care at the University Medical Associates (UMA), part of the University of Virginia (UVA) medical system in Charlottesville, Virginia, were eligible for participation.  The patient base of UMA is largely rural, uninsured and with limited access to primary care and health resources.  Mobile phone-based technology offers the benefit of personalized behavior support in settings where access to regular clinical care or internet-based health tools may be limited.

Action

The core component of the Call2Health program was customized daily text messages to assist women in the self-management of their diabetes.  Women in the treatment group of this study received daily text message reminders (for example, “Eat less. Move more”; “Believe in the impossible”; “God loves you”) as well as monthly group visits emphasizing a strengths-based approach to self-care, and social and community supports.  Women in the control group received daily text message reminders and usual diabetes care at the clinic.  Monthly group visits for the treatment group provided social support, opportunity for problem solving and an educational component.  Health education topics presented included healthy grocery shopping, stress reduction, laughter yoga, getting fit without a gym and blood sugar control.

Learnings

This study sought to test the impact of daily text messages on diabetes self-management among a specific population of African-American women.  Learnings from the project include:

  • Structured diabetes self-management group visits with educational and self-empowerment components were beneficial to the study participants. The women in the Call2Health intervention greatly valued the diabetes self-management and wellness information provided during the group sessions and also benefitted from the social connections established during the group sessions.
  • Daily customized text messages were very popular and women in both groups of the study appreciated the daily gentle reminders to stay focused on their own health and well-being. The text messages were a convenient and helpful mode of delivering healthy reminders.

Most women preferred spiritual or Bible-based text messages.  Spirituality is important to this group of women and including God and faith in the intervention was an important aspect of addressing health and chronic disease among the women.