Table 2.

Unanticipated participant perceptions of the text message-based diabetes program.

Self-awareness and control [62 quotations]	Participant: [During] this study I ate less candy. Interviewer: Okay. Participant: And drink less soda Interviewer: Why do you think that? Participant: Because I’m more aware of my diabetes. Interviewer: By having this reminder it made you more aware? Participant: Yes and I didn’t want the numbers to go up. They actually went down
	What did I like about it, what did I like about the texting… What I liked about the texting was that it made me more responsible….
	Well I think that question of how many times. Cause see a lot of times I get down on myself and maybe take one pill. But this is before the study. And I would take one pill instead of two to see how I would do. And I think while I was on the study I was mindful of that, I should do what my doctor told me to do. The number of times I take the medicine. And so I think it helped me be honest.
Reinforcement and feedback [36 quotations]	But I feel much better. And it’s not good having those low sugar reactions. And so I think that these 4 weeks have helped me to see the benefits of being on a regular schedule.
	I wanted to be able to answer [the text query about adherence] in the affirmative that, ‘Yes, I had already done that.’ So I think it helped me.
Seriousness of diabetes and acceptance [13 quotations]	Yes, I believe that it has truly helped me. Prior to the beginning of the study, I was very forgetful about taking my medication; I wasn’t taking it in a timely manner. By actually being in the study it made me become more aware of how important it was for me to take my medication at the same time everyday on a regular basis at a specific time.
	Interviewer: Now that it’s over, is there any part that you feel going to miss? Or is there any part that you’re glad that you’re done with? How about anything that you’re going to miss? Participant: I think one of the things I might miss is the reminder about checking my feet. Interviewer: Okay and why is that? Participant: Because I wasn’t aware of the importance of that before the study. Interviewer: Okay. So you feel that it’s important now? Participant: Yes. If it’s just once a week it made me more aware. Interviewer: And why is it important? What did you learn why it’s important? Participant: Well, I always knew people with high level of diabetes are prone to amputations…. Interviewer: Umm, hmm. Participant: And that’s something very serious and I wouldn’t want that to happen to me. And I just never realized that it was so closely related.
Caring and support [16 quotations]	Well I could ignore [my diabetes before the study]. You know I didn’t have any reminders. And I just figured if I felt okay then it’s okay to eat like cake whenever I wanted to or whatever. And then I would take my blood sugar and see it was high, then I would say, “oh I have to stop eating this cake”. But since I had someone else monitoring me, it wasn’t just me I felt obligated to take better care of myself.
	Interviewer: Okay. To having a real live person. So you were very aware that these were just coming with no person behind there. Participant: Yes I was. Interviewer: Okay. So in other words it would up your anti in a sense of liking it if there was some feed back? Participant: I totally would like it if it was feedback. Interviewer: Okay. Participant: I would considerably like it, if there was a feeling that somebody is there.
Role of text administrator [58 quotations]	Interviewer: Is it the personal contact that you look forward too? Participant: It’s both, it’s both…without the personal someone to really talk to see how I feel, and the feed back from it, then why even text when you’re not concerned really about the person? You’re just concerned about the answers, “yes” or “no”. “Did you check your”, “no”. But then like when you called you asked me, “what kind of feed back did I have”?
	Now I’m not much of a person on something coming through machines… So I have to have something in mind that makes me think it’s a person… And if it’s not, that message is not convincing or I can’t put a face to it or a voice to it to just a message, that I’m even going to call. I think I would over months time kind of ignore it or push it to the side.
	Participant: If I didn’t have the phone calls [weekly contact with liaison]?. It’s like anything else. Some things are just a crutch. Interviewer: What do you mean by that? Participant: I can lean on a crutch. It’s like, if I have a broken leg; I have to have a crutch up under me to help me get around….
Role of the physician [25 quotations]	Participant: Actually I am going to be honest, I liked the fact that each week after each week you called just to see how everything was going and I think that, that is something you don’t get a lot with your physician, sometimes you are just told that you have diabetes and not given any teaching or concern.
Role of family and friends [8 quotations]	Participant: [My husband] is a reminder just like [the text messages] are. He reminds me – did you take your medicine? Interviewer: So did he feel bad that you had another reminder in the house? Participant: No he wasn’t mad at all. Besides that was a little something off of him…He wouldn’t come off and say it, but I can read between the lines.