Reducing Barriers to Type 2 Diabetes Therapy With Interactive Text Quizzes

06/24/2016 by CareSpeak

Key Insight

An SMS based quiz is a scalable and effective way to identify patient and caregiver knowledge gaps in the treatment and management of type 2 diabetes.


The prevalence of type 2 diabetes is increasing globally. It's a chronic disease associated with serious complications and co-morbidities. Less than 15% of adults with type 2 diabetes simultaneously meet goal values for glucose, blood pressure and LDL cholesterol, the three important components of diabetes care.1

Unsatisfactory medical outcomes reflect not only the patients’ lack of self-management but also the health care providers’ failure to appropriately initiate or adjust therapy.2

An abstract by Anderson et al. shows that the less individuals know about diabetes, the less likely they are to develop strong attitudes toward managing their condition and its required self-care.3


Treatment barriers are a common challenge across all therapeutic areas, and educating patients and caregivers in a scalable and effective way is difficult.

Type 2 diabetes is an especially complicated disease influenced by many individual and environmental factors that determine the treatment success for patients. Finding an effortless way to educate patients and their caregivers, while making it measureable and affordable for the pharmaceutical manufacturer or managed care plan is a challenge.


CareSpeak leveraged its Quiz Module to engage patients and their caregivers through a text messaging quiz. Patients and caregivers were given the choice to receive a quiz once or twice a month. Each text message would ask the user a multiple-choice question with four answer options (A through D). The user would then respond with the desired letter. If the response was correct, the CareSpeak system would send a message confirming the correct response. If the response was incorrect, a text message would be sent to the patient with educational content. In some cases, the text messages sent back to patients contained a link for additional text or video content.

CareSpeak worked with outpatient diabetes educators to develop the content. Given that the targeted patients and caregivers were Spanish speakers, extra attention was given to working with diabetes educators who were native speakers and familiar with the patient demographics. The educational content was based on the American Diabetes Association’s guidelines and adjusted to the actual interaction experiences of the patients and diabetes educators.


  • 29% of participants and 17% of caregivers registered to receive the quiz
  • For both groups, approximately ¼ of the participants opted to receive the quiz once a month and ¾ twice a month
  • A "knowledge gap" was defined as a question where over 25% of the respondents answered incorrectly
  • For patients, 9 knowledge gaps were identified and 7 for caregivers
  • Based on this information, the client created targeted communication points for patients, caregivers and health care providers


Text messaging is a simple yet effective method of direct patient communication. CareSpeak interactive quizzes for patients and caregivers provide actionable insight for diabetes treatment; in addition to delivering educational material on the disease state, the quizzes also identify knowledge gaps and yield measurable results.

These quizzes can be personalized to fit both the disease state and the patients’ and caregivers’ demographics. They benefit healthcare providers, pharmaceutical companies, and health plans in charge of patient care, and most importantly, the patients and caregivers themselves.

  1. Minnesota Community Measurement. Minnesota health scores. [accessed 01.06.09].
  2. Aljasem LI, Peyrot M, Wissow L, Rubin RR. The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes. Diabetes Educ 2001;27:393–404.
  3. Anderson RM, Donnelly MB, Dedrick RF. Measuring the attitudes of patients towards diabetes and its treatment. Patient Educ Couns 1990;16:231–45.