Use of Gamified Social Media with Home Telemonitoring for Patient Self-Management in Poorly Controlled Medicaid Diabetics: A Pilot Study of Health Outcomes, Social Influences, and Habit Formation

State University Of New York At Buffalo, Buffalo NY

Investigators

Abstract

? DESCRIPTION (provided by applicant): Diabetes is a prevalent disease that causes significant morbidity, mortality and costs. While there is no known cure, complications from diabetes can be minimized by lifestyle and medical interventions. To be maximally impactful both lifestyle and medical interventions require lifelong, daily actions by patients for self-management of their disease condition, including taking prescribed medications on time and testing their blood sugar levels. The proposed pilot study investigates whether gamified social media with a competitive game element that is used in conjunction with home telemonitoring can be effective in enhancing patients' self-management of diabetes, thereby reducing their HgbA1C levels and increasing their diabetes self-efficacy. 60 adult Medicaid patients with poorly controlled diabetes (HgbA1C >7.0%) will be recruited for the study from a partnering urban teaching hospital that operates primary care clinics. Informed consent will be obtained by researchers, and data on blood glucose/HgbA1C levels, demographic, clinical, social networks, and other behavioral and psychosocial variables will be collected at various times during the study through surveys and blood testing. An innovative community health care provider partner will install home telemonitoring equipment (glucometer with Bluetooth connection to a wireless tablet), and centrally monitor daily fasting blood glucose levels. Patients will be randomized equally to control and intervention groups. All patients will be asked to perform daily fasting blood glucose testing throughout the eight-month study period, and compliance with this task along with actual daily blood glucose levels will be monitored. All patients will also receive a social media app on their tablets that will provide self-management reminders to perform glucometry during the first two-month baseline period. Gamification will then be added to patients' tablets in the intervention group only for the second three-month intervention period. On a daily basis, intervention patients will receive anonymous visualizations of their compliance and actual blood glucose levels compared to others in the intervention group for the previous day. Winners will be announced for best performance in the intervention group. Finally, both groups of patients will have their social media app (and gamification) removed from the tablets for the third and final three-month withdrawal period, but be asked to continue performing daily blood glucose testing. Data will be analyzed to investigate whether the gamified social media app used in conjunction with home telemonitoring improves blood glucose levels, HgbA1C levels, and diabetes self-efficacy. We will also investigate whether social influence from patients social networks around their diabetes acts as an antecedent of usage of the proposed technology, and/or as a moderator of the impact of the technology intervention on outcomes. Finally, outcomes from the third three-month withdrawal period will be evaluated to determine whether the intervention resulted in positive habit formation. Demonstration of beneficial health behavior habit formation from the gamified social media app could prove to be a cost-effective strategy to combat this prevalent disease.