Diabetes Program Utilizes Texting

August 15, 2019

YSN faculty member Robin Whittemore PhD, APRN, FAAN felt drawn to the culture of Mexico early on in her first RN job in San Diego, California. She has made myriad trips since that first one many years ago, and during her recent sabbatical she combined a research focus on preventing and treating type 2 diabetes with science, global health, and technology. 

Whittemore designed a scientific study for low-income adults with type 2 diabetes in Mexico City. The purpose of the study was to evaluate the feasibility and acceptability of pictorial text messages based on the evidence-based Healthy Action Process Approach (HAPA) model, which supplemented a group-based program “¡Sí, Yo Puedo Vivir Sano Con Diabetes!(Yes, I Can Live Healthy with Diabetes)!” 

Operating within Mexican culture posed a challenge, because the health care system focuses more on treatment than prevention. The health literacy rate is fairly low in adults with low socioeconomic status, and the diabetes mortality rate nearly doubled from 2000 to 2012. By the time diabetes is diagnosed, the cases are more advanced and more complex, and the news can feel like a death sentence. 

The ¡Sí, Yo Puedo Vivir Sano Con Diabetes!program consisted of seven weekly group sessions at Seguro Popular clinics in Mexico and daily text messages for six months. Participants cheered each other’s successes in the group setting, which also fostered a sense of empowerment and independence. Graphic artist Allison Conway created positive, motivating images for the daily texts, which included reminders and goal-setting prompts. 

“People loved the text messages!” Whittemore said. Participants felt seen and cared about with their daily reminders and expressed more motivation for day-to-day aspects of diabetes self-management when paired with playful, accessible encouragement. “[The texts] gave me a lot of encouragement to take care of me,” one patient said. “They helped me realize that I have to take care of and love myself.”

“I thought more positively,” one participant said of the text messages. “They reminded me that you can live long and healthy.” 

Another participant echoed this sentiment. “They helped me change the negative ideas I had about diabetes.”

Not everyone had access to a smart phone, so Whittemore also provided hard copy booklets of the 180 text messages to the participants. In a pilot study funded by the National Institute of Nursing Research (NR015856), participants in the ¡Sí, Yo Puedo Vivir Sano Con Diabetes!program showed significant improvement in self-management, diabetes self-efficacy, and metabolic control compared to a wait-list control group.

While students at YSN, Denise Marron ’18 MSN and Rosabelle Conover ’18 MSN helped conduct interviews and analyze results, simultaneously combining their bilingual skills and global health interests.

Whittemore’s international and interprofessional team also included a partnership with Rafael Pérez-Escamilla, PhD at the Yale School of Public Health, Mireya Vila-Compte, PhD and Ana Bertha Pérez-Lizaur, MCS from Universidad Iberoamericana Ciudad de Mexico, and Ninfa Pena-Purcell, PhD, MCHES from Texas A&M AgriLife Extension Service.

Eventually, Whittemore hopes to share her scientific discoveries by disseminating this program to Latino communities in the United States. It would be one more opportunity to share her nursing research with another member of the global community.