# mHealth to address diabetes control among homeless adults

> **NIH NIH R21** · GEORGE WASHINGTON UNIVERSITY · 2022 · $1

## Abstract

Annually, millions of Americans experience homelessness. Prevalence of Diabetes (DM) is the same among
persons experiencing homelessness (PEH) who are mostly minorities compared to the general population.
However, 43.9% of PEH with DM have uncontrolled DM compared to 22.8% of domiciled adults from
underserved communities. PEH face multiple barriers to therapeutic lifestyle changes (TLCs) that complicate
their DM care. Strategies that support DM self-management education and target self-care behaviors and
counseling to reinforce adherence and lifestyle changes contribute to better control of chronic diseases.
However, these strategies are not available or accessible to the PEH. For patients, educational and behavioral
support by continuing patient contact over several months are effective in the management of chronic
diseases. For the general and minority populations, mHealth strategies including short messaging service
(SMS) texting have been feasible and acceptable, enhanced self-care and adherence, and improved control of
chronic disease including DM. Majority of the PEH have access to mobile phones that can receive and send
SMS texts. Considering mobility of the PEH, we propose that an mHealth strategy using SMS texting could
provide an alternative tool to offer better communication and information management for DM control,
improve targeted outreach, facilitate care coordination, explore barriers and activate patient education,
support behavior changes, and improve DM self-care. The mHealth strategies for DM have not been tested in
the PEH despite the growing evidence of their effectiveness in DM care and the accessibility of mobile phones
among PEH. This study will test this strategy and pave the way for its utilization in the health settings where
PEH seek care. The study will be implemented in shelter-clinics in New York City (NYC) and in collaboration
with a community organization making sustainability of the intervention effects and its scalability feasible. We
propose a mixed methods study: Aim 1: To evaluate the efficacy of a 6-month SMS text program for DM
management (INT) versus an attention control (CL) on changes in HbA1c and adherence to DM self-care
activities, medications, and appointments at 9 months in PEH with uncontrolled DM age ≥ 21 (n=100). H1) The
INT group (n=50) will exhibit an average of 1.1 percentage point reduction in HbA1c compared to the CL group
(n=50) at 9 months. H2) PEH in the INT will exhibit better self-care activities and adherence to medications and
appointments compared to those in the CL group. HbA1c and adherence to self-care activities (SDSCA),
medications (PDC & unannounced pill counts), and appointment will be measured at 0,3,6,&9 months in
shelter-clinics. Randomization will be at the individual level in the clinics. Aim 2: To assess patients’ and
providers’ attitude, acceptability, and experience of a 6-month SMS text strategy for DM management in the
PEH with uncontrolled DM in shelter-clinics. We...

## Key facts

- **NIH application ID:** 10526937
- **Project number:** 1R21MD016951-01A1
- **Recipient organization:** GEORGE WASHINGTON UNIVERSITY
- **Principal Investigator:** Ramin Asgary
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $1
- **Award type:** 1
- **Project period:** 2022-09-22 → 2022-09-23

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10526937

## Citation

> US National Institutes of Health, RePORTER application 10526937, mHealth to address diabetes control among homeless adults (1R21MD016951-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10526937. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*