By Jennifer Dyer, MD
Believe it or not, I didn’t send out my first text message until 2007. My younger cousin was going away to college and wanted a convenient way to keep in touch. Texting with her led me to think that it was a tool I could use to reach out to my patients with treatments and reminders, not just family. This theory was confirmed when I read the results of a 2009 study in Pediatrics. Researchers at Mt. Sinai Hospital in New York conducted a study where they used an automated texting program created by CareSpeak to remind teenage liver transplant patients to take their medications so that their bodies would not reject the liver. I saw my own teenage patients the next day and realized that a lot of them did not understand that skipping their meds because of their busy schedules has repercussions later in life.
However, you can’t use fear to motivate people. I knew that my patients liked to text, so I decided to send them texts once a week, with the permission of their parents, reminding them to take their meds. Every Thursday at 5:00 pm, my patients knew I was going to be texting and that they should be available to text me back. I called it “friendly nagging.” I began by asking my patients a personal question like, “How was prom?” or “How was motocross practice?” which were characteristics about them that I had noted in my appointment notes to help me to build my personal relationship with each of them. Then I would ask, “How are you doing with checking your blood sugar?” and other medication-related questions, then finishing the conversation about something positive going into the next week to keep them motivated.
The weekly texting protocol worked for the first three months to improve their insulin medication adherence. I began programming an app to automate the weekly texting protocol soon after. However, after weekly texts for several additional months, my patients told me that they needed an extra kick, motivation, more support, and more frequent communication reminders, leading me to draw additional inspiration from BJ Fogg’s models of persuasive health behaviors. Fogg believes in designing technology for health behavior change, heavily focused on positive motivation and incentives in order to get people to change their health behaviors for the better—this was how the EndoGoddess App was born (released in the App Store for iOS and Android in 2011).
The EndoGoddess App provides points upon journaling glucoses into the app and translates into iTunes download rewards. The app makes diabetes easier by making glucose journaling rewarding. If a patient meets their goal of checking their blood sugar four times a day, they get a certain amount of points, which can be cashed in for iTunes downloads once a week. They know that when they accumulate their points, they will be able to get an award. It is a positive, direct way to incentivize teens; leaving them with a positive memory or association. The new app does not feature texting but does have alarm reminders that can be set by each teen and changed according to their busy schedules.
The feedback from patients and their parents has been very positive to date. There are some small glitches; we received a grant recently to iron them out and to complete the functionality for iTunes downloading. Additionally, we are hoping to create a new app called EndoGoddess Kids as younger patients tell me they want an app specially tailored for them. I’m really excited to expand the development on EndoGoddess App to enable my younger patients to utilize this technology.
Every case of diabetes is unique. Even though it’s the same disease, it has a different place in every patient’s life. I want to motivate people by meeting them where they are, not asking them to change but creating a technology that fits for them.
—Jennifer Dyer is a pediatric endocrinologist and the founder of the EndoGoddess App for diabetes information organization. A social media enthusiast, she can be reached at @EndoGoddess and firstname.lastname@example.org.