The Development of a Text Messaging Platform to Enhance aYouth Diabetes Prevention Program:Observational Process Study

Background: Approximately 1 in 5 adolescents in the United States has prediabetes, and racially and ethnically minoritizedyouths are disproportionately impacted. Unfortunately, there are few effective youth diabetes prevention programs, and in-personinterventions are challenging because of barriers to access and engagement. Objective: We aimed to develop and assess the preliminary feasibility and acceptability of a youth-informed SMS text messagingplatform to provide additional support and motivation to adolescents with prediabetes participating in a diabetes preventionworkshop in East Harlem, New York City, New York, United States. We collaborated with our youth action board and a technologypartner (mPulse Mobile) to develop and pilot-test the novel interactive platform. Methods: The technology subcommittee of our community action board (comprising youths and young adults) used the resultsfrom focus groups that we had previously conducted with youths from our community to develop 5 message types focused onhealthy eating and active living: goal setting, behavior tracking, individually tailored guidance, motivational messages, and photodiary. We used an iterative process to develop and pilot the program with our internal study team, including youths from ourcommunity action board and mPulse Mobile developers. We then conducted a pilot of the 12-week SMS text messaging programwith 13 youths with prediabetes. Results: Participants (aged 15-21 years; 10/13, 77% female; 3/10, 23% Black and 10/13, 77% Hispanic or Latinx) received anaverage of 2 automated messages per day. The system correctly sent 84% (2231/2656) of the messages at the time intended; theremaining 16% (425/2656) of the messages were either sent at the incorrect time, or the system did not recognize a participantresponse to provide the appropriate reply. The level of engagement with the program ranged from 1 (little to no response) to 5(highly responsive) based on how frequently participants responded to the interactive (2-way) messages. Highly responsive participants (6/13, 46%) responded >75% (1154/1538) of the time to interactive messages sent over 12 weeks, and 69% (9/13)of the participants were still engaged with the program at week 12. During a focus group conducted after program completion,the participants remarked that the message frequency was appropriate, and those who had participated in our in-person workshopsreflected that the messages were reminiscent of the workshop content. Participants rated goal setting, behavior tracking, andtailored messages most highly and informed planned adaptations to the platform. Participants described the program as: "interactive,informative, enjoyable, very convenient, reliable, motivational, productive, and reflective. Conclusions: We partnered with youths in the initial content development and pilot testing of a novel SMS text messagingplatform to support diabetes prevention. This study is unique in the triple partnership we formed among researchers, technologyexperts, and diverse youths to develop a mobile health platform to address diabetes-related disparities