Presentation at Stanford Medicine 2.0 in September, 2011.

1. Impact of Texting &
Predictive Potential of
Health Literacy on
Medication Adherence in
Type 2 Diabetes
Kevin A. Clauson, PharmD

2. Acknowledgments
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)

3. 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

4. $174 billion
annual cost
burden of
diabetes
Popul Health Metr 2010;8:29.

5. Insulin escorts _________ into the cells

6. Insulin escorts _________ into the cells

7. Health Literacy
“degree to which
individuals have the
capacity to obtain,
process, and
understand basic health
information and services
needed to make
appropriate health
decisions”
Healthy People 2010

8. eHealth Literacy
Lily Model
J Med Internet Res 2006;8(2):e9.

9. mHealth is the use of
mobile devices and
global networks to
deliver health services
and information

10. mHealth Devices
o Phones
o iPad/TabletPC
o Glowcap
o Raisin
o USB
o Fitbit
o Greengoose

11. Who uses mobile phones?

12. 82% of
American
adults owns a
cell phone*
Owns
*Range: 57% (65+) to 90% (18-29)
Pew Cell Phones and American Adults 2010 Does not own

13. Pew Internet Mobile Access 2010
87% of blacks and
Hispanics own a
cell phone*
*Compared to 80% of whites

14. Pew Internet Mobile Access 2010
Hispanics use their
phone to go online
and to text more
frequently than
any other group*
*English-speaking Hispanics

15. Primary Study Objective
Improve medication adherence in
diverse, underinsured population in USA
with T2DM via text message reminders

16. Secondary Study Objective
Examine predictive
potential of health
literacy for adherence

17. Why choose
simple SMS as an
intervention?
GoLiveSMS

18. Methods
(aka why did we
make the decisions
we did in the study)

19. Randomized, open-label trial
Allocation method where all subjects
have equal chance of study group
assignment

20. Detect a significant
difference
(two treatment arms)

21. Consumers would most prefer to receive a
medication reminder via:
Phone call 1.3
Buzzing drug vial 2.5
Email 15.2
19.5
Phone alarm
20.3
App
41.1
Text message/SMS
0 20 40 60 80 100
Percent
Source: Consumer Health Information Corporation, April 2011 (n=395)

22. Smartphone OS Share
2% 3%
9%
38% Android
iPhone
21% BlackBerry
Windows
HP webOS
Other
27%
Source: Nielsen Mobile Insights 2011

23. People will stop doing almost anything to
check their text messages

24. Mobile allows targeting of populations
historically associated with health disparities
Annu Rev Public Health 2011;32:399-416.

25. Study of 130 adult patients
with type 2 diabetes
enrolled for 6 month
intervention period

26. Recruitment from 5 Memorial Primary Care Centers

27. How is medication
adherence being
measured?

28. How is medication
adherence being
measured?
Morisky Medication
Adherence Scale
Hemoglobin A1C

29. Surveys and measurement
REALM-SF
Diabetes Knowledge Test
Satisfaction/fatigue

30. What hurdles are we trying to overcome?

32. Integrating a Tablet
For data collection

34. Security
Privacy
Legality

35. JAMA 2009;302(11):1159-60.
Honk ififyou loveready
Jesus
Text to meet Him!
you’re

36. 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

37. 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

38. 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?

39. Burning Questions
clauson@nova.edu www.unhub.com/kevinclauson