Evaluation of Study Engagement With an mHealth Intervention (THR1VE) to Treat Diabetes Distress in Teens With Type 1 Diabetes: Randomized Clinical Trial

Document Type

Journal Article

Publication Date



JMIR pediatrics and parenting






adolescents; age; chronic health conditions; device; diabetes; distress; engagement; ethnicity; mHealth; mobile health; parental positive messaging; positive psychology; race; sex; teens; text; type 1 diabetes mellitus


BACKGROUND: Positive psychology interventions demonstrate improvements in diabetes self-management and quality of life among adults with chronic health conditions, but few interventions for adolescents use this approach. OBJECTIVE: This study describes engagement with a positive psychology intervention delivered via automated SMS text messages aimed at treating diabetes distress and improving diabetes outcomes. In addition, demographic and clinical predictors of intervention engagement were examined. METHODS: Adolescents with type 1 diabetes (ages 13-17 years) who reported at least moderate diabetes distress were randomized to receive either the education or positive affect + education intervention, comprising 8 weeks of automated SMS text messages. Engagement was assessed as the response to the SMS text messages. Adolescents completed satisfaction surveys 3 months post intervention, and a subset of participants from both intervention groups completed exit interviews. RESULTS: Adolescents in both groups reported high levels of satisfaction with the study, with 95% (163/172) reporting that they would participate again. Engagement with the SMS text messages was high; on average, adolescents in the positive affect + education group responded to 92.5% of intervention messages, and their caregivers responded to 88.5% of messages. There were no significant differences in rates of engagement related to adolescents' sex, age, device use, or race/ethnicity. CONCLUSIONS: A positive psychology intervention for adolescents delivered via automated SMS text messages was feasible and acceptable across genders, ages, and racial/ethnic groups, suggesting potential for wider dissemination.


Psychiatry and Behavioral Sciences