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Support through mobile messaging and digital health technology for diabetes.

NIHR PGfAR: RP-PG-1214-20003
Supporting people with type 2 diabetes in effective medicine use through mobile health technology integrated with clinical care.

Type 2 diabetes affects 2.9 million people in the UK. Treatments to reduce risks of complications from type 2 diabetes are effective if taken as intended. Concerns about medicines and difficulties in taking them regularly, whether intentional or unintentional, are common.  In addition to the burden of preventable death and disability, the cost of non-adherence with diabetes treatments has been estimated at £100 million a year in avoidable treatment costs. Some services to help support people with making better use of their medicines are available, but evidence of their effectiveness and cost-effectiveness is weak. Understanding and improving this situation could make a major contribution to health and NHS costs. 
   There is some evidence that using brief messages to support people with better use of their medicines can be effective. This is especially in the context of tailored and personalised interventions using electronic health record data. However, more work is needed to develop such messages, embed them in health care delivery systems, and test whether they work when used at a wide scale.
   This programme of work will bring together an interdisciplinary team to deliver a series of linked studies to address the way that digital technologies can be linked to state-of-the-art health psychology for personalised support in type 2 diabetes. Patients, clinicians and experts in behaviour change will be asked what sort of messages are likely to be relevant and acceptable for people starting and continuing taking a diabetes medicine. Predictors of non-adherence in a retrospective primary-care cohort will be examined using routinely collected electronic health record data. Qualitative methods will be used to explore the added value of tailored messages based on personal preferences, the type of medication prescribed, duration of treatment and timing of medication collection using real-time electronic health record data. The intervention will be tested in a randomised clinical trial and linked health economic study to estimate the extent of benefit and costs. A process evaluation, using mixed methods will inform understanding of how the intervention might work and be implemented within health care.
If effective, this technology could reduce the burden of complications and increased costs associated with under-use of diabetes medicines. A coordinated system for interacting with patients, including automated and personalised support messages could improve satisfaction with health services and offer a model for technology-based self-management. This approach could be extended to other aspects of diabetes care, and other long-term conditions.

Aims and Objectives
To develop and test a mobile-device based system delivering automated, tailored brief messages to offer support for medicine use alongside usual care to people with type 2 diabetes. This will include developing and refining the content of messages targeted at a wide range of medication adherence behaviours, and developing and optimising the system for delivering them. The programme will explore the extent to which the messages can be tailored by personal characteristics and response to earlier messages, and by routinely collected NHS data.