Adapting a Text Messaging Intervention to Improve Diabetes Medication Adherence in a Spanish-Speaking Population: Qualitative Study

Background: Latino adults with type 2 diabetes (T2D) have higher rates of diabetes medication nonadherence than non-Hispanic White adults. REACH (Rapid Encouragement/Education And Communications for Health) is a text message platform based on the information-motivation-behavioral skills model that addresses barriers to adherence and was shown to improve adherence and glycated hemoglobin (HbA1c) levels, but it is only available in English. Objective: This study aimed to report the multiphase, stakeholder-driven adaptation of the REACH barriers to diabetes medication adherence content to a Latino population (REACH-Español). Methods: This was a qualitative study using focus groups. We identified potentially eligible patients (≥18 y old, Latino ethnicity, Spanish-language preference, and T2D diagnosis) using a Mass General Brigham Hospital query. Eligible patients were invited to participate in a focus group conducted in Spanish between April 13 and November 9, 2023. A total of 5 focus groups were conducted. Focus groups 1‐3 centered on ranking 40 barriers to diabetes medication adherence (derived from REACH and the extant literature), whereas focus groups 4‐5 centered on translation and cultural modifications of the original SMS text message content associated with each of the REACH barriers. Barriers were mapped onto information-motivation-behavioral constructs. We used descriptive statistics to summarize participant characteristics. Focus groups were audio-recorded, professionally transcribed, and analyzed with thematic content analysis using NVivo (Lumivero). Results: In total, 22 participants attended the focus groups. The mean (SD) age was 63.2 (11) years, 55% (n=10/22) were female, and the mean HbA1c level was 8.5%. All participants were born in Latin America or the Caribbean and spoke Spanish as their preferred language, and 54.5% (12/22) had completed middle-school education or less. Among the top 10 ranked barriers, 50% (n=5) corresponded to information, 20% (n=2) to social motivation, 20% (n=2) to behavioral skills, and 10% (n=1) to personal motivation. Personal motivation barriers (medication burden and fear of side effects) and behavioral skills (forgetting to take medication) emerged as important themes in the focus groups. Conclusions: A stakeholder-driven approach to intervention adaptation identified and prioritized relevant barriers to diabetes medication adherence among Latino adults with T2D and facilitated the adaptation of the REACH platform to a Spanish-speaking population.