Experiences of using the DiabeText mobile text messaging intervention to support diabetes self-management for people living with type 2 diabetes: Post-hoc process evaluation.

OBJECTIVE: Poor adherence to prescribed treatment for people with type 2 diabetes increases the risk of complications, mortality, and associated healthcare costs. Mobile phone text-messaging interventions such as DiabeText can support diabetes self-management and improve health outcomes. This study aimed to explore patients' experiences with the DiabeText intervention and the contexts and mechanisms through which behavioral change might occur. METHODS: A post-hoc process evaluation using a mixed-methods design was conducted within primary care settings in Spain. The analysis combined a questionnaire-based study with 371 participants, aimed at rating the behavior change techniques embedded in the text messages, and a qualitative interview study with 19 participants. Quantitative data were analyzed descriptively, while qualitative data underwent thematic analysis. RESULTS: Participants reported predominantly positive experiences with the intervention, highlighting increased support, motivation, and self-care capacity. They valued the reliable and practical content as well as the user-friendly format, which were perceived as facilitating healthier lifestyle changes and supporting medication adherence. However, participants also suggested incorporating greater personalization to enhance acceptability. The mechanisms through which the intervention may foster behavioral change likely relate to the inclusion of behavior change techniques (BCTs) previously associated with positive outcomes-and which participants rated as highly helpful in supporting change. Nevertheless, further research is needed to determine the specific active ingredients that would maximize DiabeText's overall impact. CONCLUSION: DiabeText was well received by individuals with T2DM to support self-care. Introducing personalized features and messages that utilize BCTs previously associated with better outcomes could be a good starting point for better outcomes.