What do people with type 2 diabetes want from a brief messaging system to support medication adherence?

Figures & data

Table 1 Categories, category descriptions, and component behavior change techniques (BCTs) with example text messages

Taxonomy category	Strategy title (if different from taxonomy category): Description given to participants	Component BCTs	Example text message
1. Goals and planning*	Planning and problem-solving: Messages that support and encourage you to plan to take your medication as intended, along with messages that encourage you to solve problems to help you achieve those goals	1.2 Problem solving 1.4 Action planning	Plan when, where, and how you are going to take your medication
2. Feedback and monitoring*	Self-monitoring: Messages that suggest monitoring how often you take your medication	2.3 Self-monitoring of behavior	Make a note of when you take your medication so you know that you have not forgotten
3. Social support*	Messages that encourage and support you to get help from friends, relatives, or services around you. This could be in terms of practical help such as taking you to the pharmacist, or emotional help such as supporting you when you feel fed up	3.1 Social support (unspecified) 3.2 Social support (practical) 3.3 Social support (emotional)	Struggling with medication? Can your friends and family help? You’re welcome to bring someone with you to your practice team appointments
4. Shaping knowledge*	Messages that help you to understand how to take your medication and what might affect you taking your medication	4.1 Instruction on how to perform behavior 4.2 Information about antecedents	Are you out and about today? Remember that you still need to take your medication as prescribed in order to control your blood sugar
5. Natural consequences*	Messages that either provide or remind you of information about what may happen if you do not take your medication, in terms of your health, feelings, and the effect on society and the people around you	5.1 Information about health consequences 5.3 Information about social and environmental consequences 5.5 Anticipated regret 5.6 Information about emotional consequences	Even when you are not experiencing diabetes symptoms, your tablets are still needed to maintain your health
6. Comparison of behavior	Messages that encourage you to think about your medication taking in the context of others around you, for example by comparing it with others or considering what others think of your medication taking	6.2 Social comparison 6.3 Information about others’ approval	Compare yourself to other people who are taking diabetes medication. Are you more or less likely than them to take your meds as prescribed?
7. Associations* presented together with 12. Antecedents*	Prompting: Messages that prompt you to take your medication or encourage you to place things around you that may prompt you to take your medication	7.1 Prompts/cues 12.1 Restructuring the physical environment	Why not set a reminder on your phone to prompt you to take your medication?
8. Repetition and substitution*	Habits: Messages that help you to make good habits around medication taking	8.3 Habit formation	Why not take your meds at the same time as something you do every day? For example, when you are brushing your teeth or after a meal
9. Comparison of outcomes	Thinking about the pros and cons of taking medication regularly and comparing what may happen if you do, or do not. Where does the information for these decisions come from?	9.1 Credible source 9.2 Pros and cons 9.3 Comparative imaginings of future outcomes	List the benefits of taking your medication as prescribed against the reasons for not wanting to take it
10. Reward and threat	Reward: Messages that congratulate you when you take medication as intended	10.5 Social reward
11. Regulation	Managing negative emotions: Messages that help you manage any worries you may have around taking your diabetes medication as intended	11.2 Reduce negative emotions	Give yourself one less thing to worry about. Take your diabetes medications as prescribed and take control
13. Identity*	Messages that help you to think about how your health and medication fit with your sense of who you are	13.5 Identity associated with changed behavior	Make successfully managing your medication part of who you are
15. Self-belief	Messages that help to improve your confidence in your ability to take your medication as intended	15.1 Verbal persuasion about capability 15.2 Mental rehearsal of successful performance 15.4 Self-talk	If you are struggling with your diabetes meds, then don’t worry you will be able to master it in time. You will get on top of it
Dealing with side effects*	Messages that help you address the side effects of taking diabetes medication	NA	Some diabetes medication can give you an upset stomach, if this doesn’t settle speak to your Dr or nurse
Concerns with health care system and medications*	Messages that address concerns people have around the health care system and taking medications generally	4.1 Instruction on how to perform a behavior	Questions about your diabetes medications? Make the most of your next appointment by writing down the questions you want to ask

Note: *Indicates a category that was introduced spontaneously by participants, eg, before the moderator had introduced it and shown example messages.

Table 2 Participant demographics and time since diagnosis with type 2 diabetes

	N (%)/Mean (SD)^a
Age	68.11 (7.25)
Female	3 (16.7%)
Years since diabetes diagnosis	10.78 (5.94)
Ethnicity White British	15 (83.3%)

Note: ^an=18. Attendees at 1 of the 5 groups did not complete the questionnaire.

Figure 1 Themes identified related to the proposed system and the proposed messages.