• Lyndsay A Nelson, Andrew Spieker, Robert Greevy, Lauren M LeStourgeon, Kenneth A Wallston, and Lindsay S Mayberry.
• Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
• JMIR Mhealth Uhealth. 2020 Jul 21; 8 (7): e17534.

BackgroundText message-delivered interventions are a feasible and scalable approach for improving chronic disease self-care and reducing health disparities; however, information on long-term user engagement with these interventions is limited.ObjectiveThe aim of this study is to examine user engagement in a 12-month text message-delivered intervention supporting diabetes self-care, called REACH (Rapid Education/Encouragement And Communications for Health), among racially and socioeconomically diverse patients with type 2 diabetes (T2D). We explored time trends in engagement, associations between patient characteristics and engagement, and whether the addition of a human component or allowing patients to change their text frequency affected engagement. Qualitative data informed patients' subjective experience of their engagement.MethodsWe recruited patients with T2D for a randomized trial evaluating mobile phone support relative to enhanced treatment as usual. This analysis was limited to participants assigned to the intervention. Participants completed a survey and hemoglobin A1c (HbA1c) test and received REACH text messages, including self-care promotion texts, interactive texts asking about medication adherence, and adherence feedback texts. For the first 6 months, texts were sent daily, and half of the participants also received monthly phone coaching. After 6 months, coaching stopped, and participants had the option to receive fewer texts for the subsequent 6 months. We defined engagement via responses to the interactive texts and responses to a follow-up interview. We used regression models to analyze associations with response rate and thematic and structural analysis to understand participants' reasons for responding to the texts and their preferred text frequency.ResultsThe participants were, on average, aged 55.8 (SD 9.8) years, 55.2% (137/248) female, and 52.0% (129/248) non-White; 40.7% (101/248) had ≤ a high school education, and 40.7% (101/248) had an annual household income ConclusionsWell-designed interactive text messages can engage diverse patients in a self-care intervention for at least 1 year. Variation in and reasons for frequency preference suggest that offering a frequency choice may be important to users' engagement.©Lyndsay A Nelson, Andrew Spieker, Robert Greevy, Lauren M LeStourgeon, Kenneth A Wallston, Lindsay S Mayberry. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 21.07.2020.

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