Summary: In a secondary analysis of the DIAMANTE trial in patients with diabetes and depression, an adaptive text-messaging intervention did not improve patient-reported communication with their healthcare providers compared with control, with a non-significant decline over the trial.
PICO Summary
| Element | Detail |
|---|---|
| Population | 156 patients with diabetes and depressive symptoms from safety-net clinics; San Francisco, during COVID-19. |
| Intervention | Adaptive (algorithm-personalised) or randomly selected physical-activity text messages. |
| Comparison | Control group receiving no text messages. |
| Outcome | No significant difference in patient-provider communication (CAHPS subscale) across the three arms. Overall a substantive but non-significant decrease in CAHPS score over 6 months (-2.6; p=0.11), with similar trends across demographic subgroups. |
Adaptive texting and patient-provider communication
RCT secondary analysis · diabetes + depression · 6 months
Adaptive activity text messages did not improve patient-reported communication with providers; overall CAHPS scores declined slightly (-2.6, p=0.11) with no difference between arms, in a pandemic-era trial.
Expert Commentary
This is a worthwhile negative secondary analysis, and I value the question behind it. Digital health is usually judged on clinical metrics, but the hypothesis here, that a texting programme might also strengthen patients’ sense of connection with their care team, is a thoughtful one, especially for underserved patients who face language, geography, and time barriers. The finding that it did not move patient-reported communication, and that scores drifted slightly downward, is honest and useful. The interpretation has to be cautious in an unusual way, though: this ran during the COVID-19 pandemic, when patient-provider relationships were disrupted for reasons that had nothing to do with the intervention, so a flat or declining communication score may reflect the era as much as the texts. It is also a secondary outcome with a modest sample. Can I use this with my patients? As a corrective to over-expectation. It reminds me that automated messaging, whatever its merits for behaviour change, is not a substitute for the human relationship, and should be positioned as a complement to, not a replacement for, direct contact. The pandemic context means the door is not fully closed, and the question deserves re-testing in calmer times.
References
Leng L, Arévalo Avalos MR, Aguilera A, Lyles CR. The impact of an adaptive mHealth intervention on improving patient-provider health care communication: secondary analysis of the DIAMANTE trial. JMIR Mhealth Uhealth. 2025;13:e64296. doi:10.2196/64296