When patients entered their blood sugar, the system sent a confirmation message. Any results below 70 or greater than 400 were flagged and routed for further intervention by a registered nurse dedicated to the study. Additionally, the patient received appointment reminder messages at 7 days, 3 days, and 1 day prior to their scheduled appointment. The system asked for a "yes" or "no" response as to whether the patient planned to attend the appointment. The system then acknowledged the response and indicated that it was received (Fischer, et. al., 2012). At the conclusion of the study, outcome measures included appointment attendance rates and response rates to blood sugar text messages. More than three-fourths (79%) of the participants responded to more than 50% of their prompts. Two-thirds (65%) of patients provided glucose readings when prompted during the study, as opposed to 12% who responded at two preceding clinic visits. All participants viewed the study favorably and wanted the messaging to continue. Additionally, they said they would recommend it to others. The participants felt that they were more connected with their provider, since the providers had more understanding of what was happening with their diabetes.

A sense of community, friendship, and family plays a large role in life during the adult years. Incorporating the developmental stages of Erik Erikson with lifestyle changes illustrate that both young and middle adulthood are prime age groups on which to focus when trying to improve the health of a community. This is due in large part to the fact that in young adulthood, one of the main tasks to accomplish is to achieve mutually satisfying relationships through family and friends. Young and middle-aged adults are motivated by social relationships to meet a need for association and friendship, and are also nearly "tied" to their smartphones and other electronic devices. The significant relationships of young adults involve spouse and friends, and middle adults focus on relationships within the workplace, the community, and the family. When focusing on patients from age 18 to 55, they are more apt to make changes if their friends are making changes, as well (Harder, 2012).

Methods

This professional paper based on the scholarship of teaching will examine ways to combine the technology of the smartphone with the education of primary care patients. Interaction in this way will help to form a virtual bond for patients trying to live more healthful lives and the healthcare providers who are helping them, especially where it concerns eating, exercise, and stress.

A Pew poll conducted in 2011 estimates that 35% of American adults own a smartphone device. The data is based on a survey conducted in May, which found that 83% of U.S. adults have a cell phone, and 42% of those people have a smartphone (MacManus, 2011). Smart phone technology allows for quick access to widely dispersed materials, such as text messages.

Patients of a family practice group who desire to participate in the project can begin by completing a brief questionnaire regarding diet and exercise habits. See Appendix a. This survey is designed to obtain basic information regarding diet habits, and is designed to be repeated at a later date to ascertain if habits have improved, deteriorated, or stayed the same. This survey is being tested in this study, since it has not been vetted in the past and must be examined for reliability and validity as a part of the study itself.

While the study is being conducted, the results of the survey will also help to indicate whether the survey is appropriate for the information desired to send valuable text messages to patients. If the survey is found to ask for too little or too much information, future studies will need to utilize other types or styles of surveys in order to collect adequate information for text messages as it relates to health care. To this end, the researcher may undertake the development of a survey instrument in the future if the current survey being used is unsuccessful.

After completing the survey, the patient's mobile phone number where they receive text messaging is entered into a data base. When the patient becomes a member of the group, he or she will receive daily messages via text messaging. The study will be completed within the setting of a primary care office in Lake County, Florida, and would be offered to all patients of the practice.

Limitations

Given that Lake County, Florida is one of the top five locations in the country for Medicare recipients, patients over 65 may not be as willing to participate in a study involving mHealth. While technologically savvy, they tend to use their desktop computers more than mobile devices for research and communication. As Smartphones gain popularity and text messaging gains more prevalence, this practice may change in the future.

While it is rare, some patients do not have cellular phones that can receive text messages. Further, some cellular phone plans do not have unlimited text messaging, and these factors may deter some patients who cannot, or do not wish to receive daily messages. In that case, these patients could still participate in the study by email if this was offered by the patient's care provider in lieu of text messaging.

Future Study and Application...

For example, a nurse midwife could sent out texts with tips and frequently asked questions to follow patients through conception, pregnancy, delivery, and postpartum issues. A cardiology practitioner could include tips that remind patients to weigh themselves and be mindful of salt. In this way, smartphones could be used as an innovative method of health care teaching. Patients may appreciate the reminders, as well as be inspired to conduct further research on their own. Additionally, the tips may open up a dialogue between the practitioner and the patient to further discuss specific health care concerns and issues and promote a higher degree of wellness for the patient.
Summary

While mobile health is a relatively new technology, it is taking the world by storm. In reviewing the literature, it is apparent that we are on the verge of expanding our roles as health care providers into low income, underserved, isolated populations. In this, we can connect with patients on an individual basis where we can teach, provide ongoing care, and receive feedback as never before