Gender differences in diabetes self-management: a mixed-methods analysis of a mobile health intervention for inner-city Latino patients

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The following is a review of Burner et al. on the observed gender differences in diabetes self-management through the utilization of an mHealth intervention. [1]


MHealth technology is an emerging field that uses devices that many patients already own and use to improve health. This promising tools have diverse features such as improving the self-management of patients suffering from chronic diseases. Diabetes has been a notorious and prominent public health problem affecting the diverse american population, especially African Americans and Hispanics. Although it has become an acclaimed tool for the implementation of follow-up treatments and self-management in patients, few is known about the factors which contribute to it's utilization such as Socio-economic status (SES). Berner et al. explore the impact of diabetes management among low-income Latino patients through the Trial to Examine Text Message for Emergency Department Patients with Diabetes (TExT-MED) a text message-based program designed to improve disease knowledge, self-efficacy, and glycemic control among low-income Latinos.


23 Diabetic patients recruited for the study were selected from the emergency department at Los Angeles County Hospital at the University of Southern California; largest public safety-net hospital in Los Angeles County serving a predominantly Latino population.

A three-phase framework was established for the conduction of the study:

  • Phase I (Completed, May 2011) - Tested feasibility and acceptability among the target population.

- 1-month bilingual (English and Spanish) diabetes curriculum of text messages - Three messages/day in preferred language: (1) educational and motivational messages (67%), (2) trivia questions (12%), (3) healthy-behavior challenge (14%)

  • Phase II (The study) - Qualitative analysis of the program.

- Assembled two focus groups of 90-min duration—one in English and one in Spanish from the pool of Phase I participants. Moderator delivered consistent probes between groups. - Including: (1) how they sought health information, (2) how trustworthy and valid they found the information from TExT-MED, (3) whether they sought further information after receiving a text message, and (4) with whom they shared the TExT-MED information. - Conversations were recorded and transcribed for further analysis.

  • Phase III (Ongoing) - Randomized and Controlled trials.


  • Phase I - 20 patients were able to follow-up for data collection at trial completion.

- Men’s average scores on the Diabetes Knowledge Questionnaire decreased slightly (8.4 to 6.8), while women’s knowledge increased (8.5 to 10.5).

- Self-efficacy measured by the Diabetes Empowerment Scale improved for men, with a minimal change for women (30 to 33.4 for men and 34.2 to 34.0 for women).

- Checking food labels did not change for men or women, while percent of patients who ate a fruit or vegetable each day improved for men (from 43% to 82%) but did not change for women.

- Medication adherence and exercise behaviors improved for both gender groups.

- Women increased the number of times they checked their blood sugar and feet, while men exhibited no change in blood sugar checks and decreased the number of times they checked their feet.

  • Phase II - 8 patients returned for focus groups

From the qualitative analysis three major factors were identified as prominent differences between genders:

(1) Dietary self-efficacy - Male subjects felt that their knowledge on diet and ability to prepare their own meals, affected their self-management of diabetes.

(2) Health information sources - Males: Mainly obtained their knowledge either from physicians or media (TV, radio, internet) - Females: Mainly obtained their knowledge from family or fiends advises

(3) Desired content of further educational materials - Males: Erectile dysfunction was a prominent topic among all of them - Females: Prevention of yeast infection and menopause


Analysis through the TExT-MED shows that low-income Latino patients will accept text messages as a behavioral intervention. This mHealth intervention acts as a behavioral trigger rather than an education platform. Although the sample size in this study is low, we shouldn't consider it a failure. The work conducted in the study by Burner et al. shows that indeed perzonalization would be a task required in mHealth if further improvement of self-management of diabetes and chronic diseases wants to observed.


Proper education and management of chronic diseases such as diabetes is important to improve quality of life. The search for innovative, accessible and cost effective tools is essential for patients of all ethnic groups. mHealth is a technology that will benefit many patients.


  1. Burner, E., Menchine, M., Taylor, E., & Arora, S. (2013). Gender differences in diabetes self-management: a mixed-methods analysis of a mobile health intervention for inner-city Latino patients. Journal of diabetes science and technology, 7(1), 111-118.