ArticleLiterature Review

Behavior Change Interventions Delivered by Mobile Telephone Short-Message Service

March 2009
American Journal of Preventive Medicine 36(2):165-73

March 2009
36(2):165-73

DOI:10.1016/j.amepre.2008.09.040

Source
PubMed

Authors:

Brianna S Fjeldsoe

The University of Queensland

Alison L Marshall

Queensland University of Technology

Yvette D Miller

Queensland University of Technology

The expansion and adoption of new methods of communication provide new opportunities for delivering health behavior change interventions. This paper reviews the current research examining mobile telephone short-message service (SMS) for delivering health behavior change interventions via text messages. This service has wide population reach, can be individually tailored, and allows instant delivery with asynchronous receipt, suggesting potential as a delivery channel for health behavior interventions. An electronic database search was conducted for studies published between January 1990 and March 2008. Studies were included in the review if they (1) evaluated an intervention delivered primarily via SMS, (2) assessed change in health behavior using pre-post assessment, and (3) were published in English in a peer-reviewed scientific journal. Of 33 studies identified, 14 met the inclusion criteria. Four of the 14 studies reviewed targeted preventive health behaviors (e.g., smoking cessation), and ten focused on clinical care (e.g., diabetes self-management). Positive behavior change outcomes were observed in 13 of the 14 reviewed studies. Intervention initiation (researcher or participant), SMS dialogue initiation, tailoring of SMS content, and interactivity were found to be important features of SMS-delivered interventions. Methodologic issues with current SMS research were also identified. This review suggests that SMS-delivered interventions have positive short-term behavioral outcomes. Further research is required to evaluate interventions for preventive health behaviors that incorporate features found to affect behavioral outcomes and participant acceptance. The quality of studies in this emerging field of research needs to improve to allow the full potential of this medium to be explored.

Technology-Based Interventions to Reduce Sugar-Sweetened Beverages among Adolescents: A Scoping Review

Article

Full-text available

Nov 2023
Int J Environ Res Publ Health

This scoping review investigates the effectiveness of technology-based interventions in reducing sugar-sweetened beverage (SSB) consumption among adolescents. The rise in SSB consumption among young individuals has become a global public health concern due to its association with obesity, diabetes, and various other health problems. The purpose of this scoping review is to map out and examine the various technology-based interventions used in reducing sugar-sweetened beverages among children and adolescents. A systematic search of three databases using the PRISMA guideline was followed, and 474 articles were retrieved. Seven articles met the inclusion criteria and the critical appraisal using the critical appraisal skill program (CASP). The seven articles underwent both descriptive and thematic analysis. Four technology-based interventions were identified from the selected articles, which include smartphone apps, online or web-based tools, text messages, and social marketing strategies. Our findings suggest that these interventions hold promise in improving adolescents’ eating patterns and health outcomes associated with SSB intake, highlighting their potential as useful strategies in resolving this urgent public health concern.

Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model

Article

Mar 2024

Background IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS. Objective This study aimed to assess HEWs’ intentions to use the eCHIS for health data management and service provision. Methods A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs’ intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95% CI with a corresponding P value of <.05. Results A total of 456 HEWs participated in the study, with a response rate of 99%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3%; 95% CI 34.7%-43.9%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy (β=0.256; P=.007), self-expectancy (β=0.096; P=.04), social influence (β=0.203; P=.02), and hedonic motivation (β=0.217; P=.03) were significantly associated with HEWs’ intention to use the eCHIS. Conclusions HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management.

How the healthcare-seeking sociocultural context shapes maternal health clients' mHealth utilization

Thesis

Full-text available

Sep 2021

Karen Sowon

The main objective of the study was to explain how mHealth utilization behavior emerges within the healthcare-seeking socio-cultural context. To achieve the objective, the study identified the socio-cultural characteristics of the maternal healthcare-seeking context and analyzed the user-technology interaction within this context. The study drew upon Activity Theory as a lens to understand the maternal mHealth utilization phenomenon. Hence, we theorized healthcare-seeking as an activity whose cultural aspects were further understood using Hofstede typology of culture. We employed semi-structured interviews, focus group discussions, observations, informal discussions and document review to gather data. The sample was purposively selected and comprised various maternal health stakeholders: maternal health clients, their partners, project implementers and healthcare professionals. The results of the study show that the healthcare-seeking socio-cultural context which is characterised by socio-cultural attributes such as high-power distance, high uncertainty avoidance, gendered relations, and collectivism shapes mHealth utilisation behaviour in a dialectical process. This process takes place as maternal health clients shape and are shaped by mHealth within their healthcare-seeking socio-cultural context through a process of internalisation and externalisation. From an internalisation perspective, uncertainties and risks in the maternal healthcare-seeking context resulted in hesitated adoption. Contextual perceptions of usefulness of the intervention resulted in the use of mHealth to substitute other healthcare structures while having different perceptions of the role of mHealth created dissonance among the maternal health clients. With regards to externalisation, maternal health clients adopted legitimisation strategies to reduce uncertainties and to develop trust required for initial and continued use of the intervention. They legitimised both the intervention artifact, and the information. Since the mHealth intervention presented appropriate social cues, being accompanied by the expected health provider's persona, maternal health clients readily humanised the intervention. The contextual social norms around pregnancy also presented a need for the maternal health clients to make their mHealth use an ‘appropriate behaviour’ by negotiating use with relevant stakeholders in the context. Finally, in response to mHealth technology paradoxes that challenged the very motive of healthcare-seeking, maternal health clients coped by abandoning mHealth, or otherwise accommodating it.

Mobile Web App Intervention to Promote Breast Cancer Screening among American Indian Women in the Northern Plains: A Feasibility and Efficacy Study (Preprint)

Article

Full-text available

Apr 2023

Background: Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. Objective: This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. Methods: Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants' satisfaction with and acceptance of the intervention. Results: A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=-5.22; P<.001), increase in knowledge (t120=-4.75; P<.001), and satisfaction with the intervention (t120=-3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. Conclusions: This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. Trial registration: ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603.

Feasibility and Response to the San Diego County, California, Supplemental Nutrition Assistance Program (SNAP) Agency Sending Food and Nutrition Text Messages to All Participants: Quasi-Experimental Web-Based Survey Pilot Study

Article

Full-text available

Apr 2023
J MED INTERNET RES

Background The Supplemental Nutrition Assistance Program (SNAP) provides over 40 million Americans with money for food without typically providing participants with food or nutrition information. Educational SMS text messages can reach large numbers of people, and studies suggest SNAP participants appreciate nutrition education and have access to mobile phones. Objective Using a pre-post intervention design, we assessed the feasibility of, and program satisfaction and outcomes resulting from, the San Diego County, California SNAP agency sending monthly food and nutrition education SMS text messages to all SNAP participants to increase fruit and vegetable purchasing and consumption. Methods We developed and sent 5 behavioral science–informed SMS text messages with links to a project website in English and Spanish with information about selecting, storing, and preparing seasonal fruits and vegetables. The San Diego County SNAP agency sent monthly texts to ~170,000 SNAP households from October 2020 to February 2021. SNAP participants completed web-based surveys in response to a text invitation from the SNAP agency in September 2020 (baseline, n=12,036) and April 2021 (follow-up, n=4927). Descriptive frequencies were generated, and adjusted multiple linear mixed models were run on a matched data set of participants that completed both baseline and follow-up surveys (n=875) assessing pre- or postattitudes, behaviors, knowledge, and self-efficacy. We used adjusted logistic regression models to assess differences between the matched (n=875) and nonmatched (n=4052) participants related to experiences with the intervention (questions asked only at follow-up). ResultsAfter the intervention, matched participants reported significant increase in knowing where to get information about selecting, storing, and preparing fruits and vegetables (3.76 vs 4.02 on a 5-point Likert scale with 5=strongly agree, P

Brazilian Immigrant Parents’ Preferences for Content and Intervention Modalities for the Design of a Family-Based Intervention to Promote Their Preschool-Age Children’s Healthful Energy Balance-Related Behaviors

Article

Full-text available

Mar 2023
Int J Environ Res Publ Health

Brazilians are a rapidly growing ethnic immigrant population in the United States (U.S.), and there is a lack of childhood obesity prevention interventions addressing the needs of Brazilian preschool-age children. Using the family ecological model (FEM) as a guide, this developmental cross-sectional study assessed the preferences (content, intervention modality, and language) of 52 individual Brazilian immigrant parents (27 mothers, 25 fathers) for a family-based intervention to promote healthful energy balance-related behaviors (EBRB). Overall, 85% or more of parents reported being interested or very interested in content related to five of the seven assessed EBRBs (increasing fruits and vegetables, reducing unhealthy foods and sugar-sweetened beverages, increasing physical activity, and reducing screen time). Parent-preferred intervention modalities were group sessions delivered by community health workers (CHWs, 86.5%), email (84.6%), and messaging (78.8%), with most parents (71.2%) indicating a preference for content in Portuguese. Interventions integrating multiple components, such as group sessions offered by CHWs and text messaging using SMS and WhatsApp, should be considered. Future steps for intervention development should include investigating different communication channels and their integration into a culturally and linguistically tailored family-based intervention designed to promote healthful EBRBs of preschool-age children in Brazilian families living in the U.S.

Effect of Mobile phone communication messages on participation in agriculture among university unemployed graduates

Article

Full-text available

May 2019

Verlumun Celestine Gever

The article analyzes an influence of 412 SMS from Mtn Nigeria agro info Services Added Value that were sent by graduates of universities with agricultural specialties during 2018. The author examined the content of those messages and their effectiveness in decision making by young specialists about their employment in Nigerian agricultural enterprises. For this purpose the author divided all messages into four categories (“evidentiary”, “local”, “descriptive”, “striking”). Of them, “evidentiary” messages were the most effective in communication by encouraging unemployed to make constructive decisions about their employment. Generally, the results of the research demonstrates that the messages sent to mobile phones are effective means in attraction of the qualified specialists to the work in agriculture sector of the county. Apart from historical, sociological component of this research is also important, because unemployment of graduates of universities makes them vulnerable and may influence negatively on the society. It is also important that the research may result in positive changes in certain behavior patterns, because now mobile phone is an effective means of not only communication, but also forming of certain tastes and values. Finally, the results of this research may influence on substantive content for mobile phone users, because they reflect a rather significant multiaspectual effectiveness of the named categories of SMS. Therefore, the most important innovation of the article is an evidence of the influence of mobile communication on important behavior reflexes; given facts and conclusions may be useful and instructive for telecommunication service providers and communications experts, as well as for managers of agricultural enterprises, social workers and researchers on this issue. The most important result of this research is the demonstration that due to the receiving agro-informational hints by unemployed graduates of universities a large part of them found employment, at the same time, those who did not regard this information remained unemployed.

The Role of Salience and Memory in Fertility Decisions: Experimental Evidence

Article

Full-text available

Jun 2024
POPUL RES POLICY REV

Public policies use communication campaigns to affect individual behavior. We analyze how providing women with information on the beneficial effects of using formal childcare may affect their realized fertility. We argue that cues in the messages are particularly salient for mothers and women with fertility intensions, since they activate these women’s past memories. Hence, cues induce these women to create mental representations of future actions, such as realized fertility. We exploit a randomized survey experiment run in 2011, which provides information on the positive effects that attending daycare may have on the children’ future cognitive development. Using a follow-up survey run six-year later we show that the treatment increases realized fertility among mothers and women with declared fertility intentions, for whom the communication was more salient. Yet, the treatment did not affect the individual knowledge nor recall of the information provided in the message. Our results carry important policy implications: persuading individuals is difficult, but communication can be effective if salient.

An analysis of factors influencing the popularity and user satisfaction of hypertension self-management applications: a cross-sectional study in China

Article

Mar 2019

Background: As the largest developing country in the world, China lacks data on the content and popularity of smartphone self-management apps for HTN. The major functional characteristics and consumer interaction metrics of smartphone apps are unknown. This is the first study to provide an evaluation of Chinese smartphone-based self-management apps for hypertension in user angle. We analyzed the Chinese Android and iPhone markets using the search terms ‘‘hypertension’’ and “high blood pressure’’ in July 2018. All search items were screened according to inclusion and exclusion criteri Fifty-six of the apps included (47.9%) were designed for the Apple iPhone, and 61 (52.1%) were designed for Android devices. Moreover, 93.2% were used for blood pressure (BP) self-monitoring, 17.1% were used for diet self-monitoring, and 48.7% were used for physical activity self-monitoring. Similarly, 58.1% were capable of tracking other health data, and 49.6% had the ability to enhance medication adherence. Only 3.4% could transform the smartphone into a medical device for the measurement of BP. There were no differences in app features between the two smartphone platforms. Android apps, which were capable of both physical activity self-monitoring (odds ratio, 6.31; P <. 001) and diet self-monitoring (odds ratio, 3.18; P <. 001), had high popularity. There was no significant correlation between the major functional characteristics of all apps with high user satisfaction. Future work will propose a new methodology for evaluating the quality and reliability of smartphone apps for HTN self-management from the perspective of healthcare professionals (HCPs).

The effect of cognitive behavioral therapy text messages on mood: A micro-randomized trial

Article

Full-text available

Feb 2024

The StayWell at Home intervention, a 60-day text-messaging program based on Cognitive Behavioral Therapy (CBT) principles, was developed to help adults cope with the adverse effects of the global pandemic. Participants in StayWell at Home were found to show reduced depressive and anxiety symptoms after participation. However, it remains unclear whether the intervention improved mood and which intervention components were most effective at improving user mood during the pandemic. Thus, utilizing a micro-randomized trial (MRT) design, we examined two intervention components to inform the mechanisms of action that improve mood: 1) text messages delivering CBT-informed coping strategies (i.e., behavioral activation, other coping skills, or social support); 2) time at which messages were sent. Data from two independent trials of StayWell are included in this paper. The first trial included 303 adults aged 18 or older, and the second included 266 adults aged 18 or older. Participants were recruited via online platforms (e.g., Facebook ads) and partnerships with community-based agencies aiming to reach diverse populations, including low-income individuals and people of color. The results of this paper indicate that participating in the program improved and sustained self-reported mood ratings among participants. We did not find significant differences between the type of message delivered and mood ratings. On the other hand, the results from Phase 1 indicated that delivering any type of message in the 3 pm-6 pm time window improved mood significantly over sending a message in the 9 am-12 pm time window. The StayWell at Home program increases in mood ratings appeared more pronounced during the first two to three weeks of the intervention and were maintained for the remainder of the study period. The current paper provides evidence that low-burden text-message interventions may effectively address behavioral health concerns among diverse communities.

BMC Cardiovascular Disorders The effect of personalized mobile health (mHealth) in cardiac rehabilitation for discharged elderly patients after acute myocardial infarction on their inner strength and resilience

Article

Full-text available

Feb 2024
BMC Cardiovasc Disord

Introduction Given the importance of promoting self-care and quality of life for discharged elderly patients after acute Myocardial Infarction(MI), It is necessitated we conduct interventions to promote these items. This study was conducted to determine the effect of mHealth-Cardiac rehabilitation (CR) on the inner Strength and resilience of elderly patients with MI after discharge from the hospital. Methods The present study was a randomized controlled trial that was conducted on 56 Elderly patients with myocardial infarction were discharged from the heart departments. In the intervention group after the patient’s discharge, the patients were contacted twice a week for one month and the necessary training and support were given online. To gather data, the Mini-Mental State Examination (MMSE), the demographic and clinical characteristics questionnaire, the inner strength scale (ISS), and the Connor-Davidson Resilience Scale (CD-RISC) were completed pre- and post-intervention. The data analysis was done by SPSS16. Results This study showed the mean resilience and inner strength scores before and after the intervention in the control group had no statistically significant difference(P˃0.05). There was a significant increase in the mean resilience and inner strength scores in the intervention group after the intervention (P ≤ 0.001). Conclusion The results of this study showed that mHealth as a kind of telenursing nursing has a significant effect on both variables of inner strength and resilience of post-discharge elderly patients after acute myocardial infarction. This means that using mHealth for these patients could increase the inner strength and resilience of the elderly discharged after myocardial infarction. Therefore, through using this method, elderly patients’ self-care ability and quality of life could be increased.

Teledentistry for improving access to, and quality of oral health care: A protocol for an overview of systematic reviews and meta-analyses

Article

Full-text available

Jan 2024
PLOS ONE

Digital technologies are becoming essential to address and optimize the suboptimal performance of healthcare systems. Teledentistry involves the use of information and communication technology to improve access to oral health care and the quality of oral health care delivery. Several systematic reviews (SRs) have been conducted to synthesize evidence on the effectiveness of teledentistry but with conflicting results. The aim of this review is to comprehensively summarize available SRs and provide evidence on the impact of teledentistry on access to oral care, patients’ and oral healthcare providers’ outcomes, quality of oral health care and costs. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42022373964). Six electronic databases including MEDLINE (Ovid), Embase ( Embase.com ), CINAHL (EBSCO), Web of Science, Cochrane Library and Epistemonikos will be searched for SRs of quantitative, qualitative, and mixed reviews evaluating teledentistry modalities involving both patients and/or oral health care providers (OHCPs). We will include studies published in English or French. The outcomes will include patients’ outcomes (e.g., access to oral health care, patient-reported outcomes, and patient-reported experiences); patient indicators (e.g., clinical outcomes, adherence to treatment, adverse outcomes and costs); and OHCP indicators (e.g., diagnostic accuracy, barriers and enablers costs and equity). Two independent reviewers will perform data screening, data extraction and will assess the quality of included studies using AMSTAR 2 and ROBIS tools. Data will be synthesized narratively and presented by tables and graphs. We will report any overlap of primary studies in the SRs. A statement on the strength of evidence for each outcome will be provided if possible. This review will inform decision-makers, patients, OHCPs, and researchers on the potential effectiveness, benefits, and challenges of teledentistry and support them in making recommendations for its use. Results will be disseminated through peer-reviewed publications, presentations at conferences, and on social media.

Validation of Mobile Messages for an mHealth Intervention for Smokeless Tobacco Cessation in India

Article

Full-text available

Dec 2023

Background: With the growth in use of mobile messages for behaviour change, the need to incorporate personal needs and cultural characteristics of target users has been promoted. The study aimed to describe the findings of content validation of mobile messages designed to promote smokeless tobacco cessation in primary care. Methods: This study used a concurrent mixed-method approach with 13 patients who were tobacco users at urban primary care clinics. The clarity and appeal of 32 messages were rated on a Likert scale from 1 to 10. A mean clarity and appeal score per message was generated. A 5-item discussion guide was used for in-depth interviews and data was analysed using framework analysis. Results: Participants found the content of the messages useful, and preferred shorter and audio formatted messages. The clarity scores for the messages ranged from 7.9 to 9.4 with an average score of 8.7 (SD 0.5). The appeal scores ranged from 7.3 to 9.2, with an average score of 8.5 (SD 0.6). Conclusions: Twenty-six from a total of 32 messages were found appropriate and finalised for use. This methodology can be used when developing contextually relevant mobile message interventions in other low resource settings.

Modelling the Predictors of Mobile Health (mHealth) Adoption among Healthcare Professionals in Low-Resource Environments

Article

Full-text available

Nov 2023
Int J Environ Res Publ Health

This study was conducted with objectives to measure and validate the unified theory of the acceptance and use of technology (UTAUT) model as well as to identify the predictors of mobile health (mHealth) technology adoption among healthcare professionals in limited-resource settings. A cross-sectional survey was conducted at the six public and private hospitals in the two districts (Lodhran and Multan) of Punjab, Pakistan. The participants of the study comprised healthcare professionals (registered doctors and nurses) working in the participating hospitals. The findings of the seven-factor measurement model showed that behavioral intention (BI) to mHealth adoption is significantly influenced by performance expectancy (β = 0.504, CR = 5.064, p < 0.05) and self-concept (β = 0.860, CR = 5.968, p < 0.05) about mHealth technologies. The findings of the structural equation model (SEM) showed that the model is acceptable (χ 2 (df = 259) = 3.207; p = 0.000; CFI = 0.891, IFI = 0.892, TLI = 0.874, RMSEA = 0.084). This study suggests that the adoption of mHealth can significantly help in improving people's access to quality healthcare resources and services as well as help in reducing costs and improving healthcare services. This study is significant in terms of identifying the predictors that play a determining role in the adoption of mHealth among healthcare professionals. This study presents an evidence-based model that provides an insight to policymakers, health organizations, governments, and political leaders in terms of facilitating, promoting, and implementing mHealth adoption plans in low-resource settings, which can significantly reduce health disparities and have a direct impact on health promotion.

The FINDING-Food Intervention: A Mixed-Methods Feasibility Study Addressing Food Insecurity

Article

Full-text available

Oct 2023

Food insecurity is an economic and social condition involving limited or uncertain access to food. The problem of food insecurity in communities is influenced by economic conditions, food deserts, and barriers to accessing healthy food. Individuals experiencing food insecurity often endure concurrent problems of financial instability, hunger, and poor mental and physical health. Public and non-profit services in the U.S., such as the federally supported Supplemental Nutrition Assistance Program (SNAP) and community food banks, provide food-related assistance to individuals who are at a high risk of experiencing food insecurity. Unfortunately, many individuals who qualify for these services still experience food insecurity due to barriers preventing them from accessing food. Effective approaches for removing barriers that prevent individuals from accessing food are needed to mitigate the increased risk of chronic disease among vulnerable populations. This study tested a novel food insecurity intervention called FINDING-Food, which stands for Frequent Informational Nudges Directing Individuals to Needed Goods. Informational nudges were used to promote food security through the removal of information barriers to accessing food. The intervention used in this mixed-methods feasibility study consisted of informational nudges in the form of weekly text messages that were sent to food pantry clients experiencing food insecurity (n = 24). The study aims were to test the efficacy and acceptability of the intervention by examining whether the informational nudges could enhance food pantry utilization, increase SNAP registration, and promote food security. Quantitative study results showed a lower prevalence of food insecurity in the intervention group than the control group at the end of the study. Qualitative findings revealed how intervention group participants who completed the study (n = 9) found the text messages to be helpful and informative. These study findings can enhance future food insecurity interventions aiming to eliminate barriers that prevent individuals who are food insecure from accessing healthy food.

The FINDING-Food Intervention: A Feasibility Study Addressing Food Insecurity

Preprint

Full-text available

Oct 2023

Food insecurity is an economic and social condition involving limited or uncertain access to food. The problem of food insecurity in communities is influenced by economic conditions, food deserts, and barriers to accessing healthy food. Individuals experiencing food insecurity often endure concurrent problems of financial instability, hunger, and poor mental and physical health. Public and non-profit services in the U.S., such as the federally supported Supplemental Nutrition Assistance Program (SNAP) and community food banks, provide food-related assistance to individuals who are at a high risk of experiencing food insecurity. Unfortunately, many individuals who qualify for these services still experience food insecurity due to barriers preventing them from accessing food. Effective approaches for removing barriers that prevent individuals from accessing food are needed to mitigate the increased risk of chronic disease among vulnerable populations. This study tested a novel food insecurity intervention called FINDING-Food, which stands for Frequent Informational Nudges Directing Individuals to Needed Goods. Informational nudges in the intervention promoted food security through the elimination of information barriers to accessing food. The intervention used in this mixed-methods feasibility study consisted of informational nudges in the form of weekly text messages that were sent to food pantry clients experiencing food insecurity. The study aims were to test the efficacy and acceptability of the intervention by examining whether the informational nudges could enhance food pantry utilization, increase SNAP registration, and promote food security. Quantitative study results showed a lower prevalence of food insecurity in the intervention group than the control group at the end of the study. Qualitative findings revealed how the intervention group found the text messages to be helpful and informative. These study findings can enhance future food insecurity interventions aiming to eliminate barriers that prevent individuals who are food insecure from accessing healthy food.

The Design and Testing of a Text Message for Use as an Informational Nudge in a Novel Food Insecurity Intervention

Article

Full-text available

Oct 2023

Food insecurity is an ongoing problem in the U.S. with implications for health problems and social disadvantages. Past food insecurity intervention studies have targeted barriers to accessing healthy food. However, information barriers have not been adequately addressed by food insecurity interventions. This research included the first phase of a two-phase feasibility study that involved testing a text message as an informational nudge through interviews among a small, preliminary sample of adults in the southwest U.S. (n = 10). Interview questions focused on the message content, persuasiveness, relevancy, clarity, and details that participants liked and disliked. A qualitative content analysis of interview responses then highlighted any necessary modifications to the text message. Interview responses highlighted that the message conveyed details about how to access food assistance resources. The message was perceived as informative, clear, and friendly. Participants highlighted the need for better spacing in the message layout, more details about the Supplemental Nutrition Assistance Program (SNAP), and a better explanation for why SNAP is relevant. Text message readability, relevancy, and informativeness were common concerns raised during interviews. Participant-informed modifications to the text message were applied in preparation for using the message in a food insecurity intervention. This research is a novel contribution to the extant literature on nudges, as no known intervention study has used informational nudges to exclusively promote food security. Future food insecurity research efforts should similarly test novel interventions to ensure the intervention is acceptable and relevant for the target population.

The Design and Testing of a Text Message for use as an Informational Nudge in a Novel Food Insecurity Intervention

Preprint

Full-text available

Aug 2023

Background: Food insecurity is an ongoing problem in the U.S. with implications for health problems and social disadvantages. Past food insecurity intervention studies have targeted barriers to accessing healthy food. Although, information barriers have not been adequately addressed by food insecurity interventions. Methods: This qualitative study involved testing a text message as an informational nudge through interviews among adults in the southwest U.S. (n = 10). Interview questions focused on the message content, persuasiveness, relevancy, clarity, and details that participants liked and disliked. A qualitative content analysis of interview responses then highlighted any necessary modifications to the text message. Results: Interview responses highlighted that the message conveyed details about how to access food assistance resources. The message was perceived as informative, clear, and friendly. Participants highlighted the need for better spacing in the message layout, more details about the Supplemental Nutrition Assistance Program (SNAP), and why SNAP is relevant. Conclusion: Text message readability and informativeness were common concerns raised during interviews. Participant-informed modifications to the text message were applied in preparation for using the message in a food insecurity intervention. Future food insecurity research efforts should similarly test novel interventions to ensure the intervention is acceptable for the target population.

Keeping Active with Texting after Stroke (KATS): development of a text message intervention to promote physical activity and exercise after stroke

Article

Full-text available

Jun 2023

Background Post-stroke physical activity reduces disability and risk of further stroke. When stroke rehabilitation ends, some people feel abandoned by services and struggle to undertake physical activities that support recovery and health. The aim of this study was to codesign a novel text message intervention to promote physical activity among people with stroke and provide support when formal rehabilitation ends. This manuscript describes the intervention development processes that will inform future pilot and feasibility studies. Methods The planned intervention was a series of text messages to be sent in a predetermined sequence to people with stroke at the end of rehabilitation. The intervention, underpinned by behaviour change theory and using salient behaviour change techniques, would provide daily messages offering encouragement and support for the uptake and maintenance of physical activity following stroke. The intervention was codesigned by a Collaborative Working Group, comprised of people with stroke, rehabilitation therapists, representatives from stroke charities and academics. A four-step framework was used to design the intervention: formative research on physical activity post-stroke, creation of the behaviour change text message intervention, pre-testing and refinement. Formative research included a review of the scientific evidence and interviews with community-dwelling people with stroke. Data generated were used by the Collaborative Working Group to identify topics to be addressed in the intervention. These were mapped to constructs of the Health Action Process Approach, and salient behaviour change techniques to deliver the intervention were identified. The intervention was rendered into a series of text messages to be delivered over 12 weeks. The draft intervention was revised and refined through an iterative process including review by people with stroke, their spouses, rehabilitation therapists and experts in the field of stroke. The messages encourage regular physical activity but do not prescribe exercise or provide reminders to exercise at specific times. They use conversational language to encourage engagement, and some are personalised for participants. Quotes from people with stroke provide encouragement and support and model key behaviour change techniques such as goal setting and coping planning. Discussion Co-design processes were critical in systematically developing this theory and evidence-based intervention. People with stroke and rehabilitation therapists provided insights into perceived barriers post-rehabilitation and identified strategies to overcome them. The structured multistep approach highlighted areas for improvement through successive rounds of review. The intervention will be tested for acceptability, feasibility and effectiveness in future studies. This co-design approach could be used for interventions for other heath behaviours and with different populations.

Individual and contextual level enablers and barriers determining electronic community health information system implementation in northwest Ethiopia

Article

Full-text available

Jun 2023
BMC HEALTH SERV RES

Background The government of Ethiopia has envisioned digitalizing primary healthcare units through the electronic community health information system (eCHIS) program as a re-engineering strategy aiming to improve healthcare data quality, use, and service provision. The eCHIS is intended as a community-wide initiative to integrate lower health structure with higher administrative health and service delivery unit with the ultimate goal of improving community health. However, the success or failure of the program depends on the level of identifying enablers and barriers of the implementation. Therefore, this study aimed to explore individual and contextual-level enablers and barriers determining eCHIS implementation. Method We conducted an exploratory study to determine the enablers and barriers to successfully implementing eCHIS in rural Wogera district, northwest Ethiopia. In-depth interviews and key informant interviews were applied at participants from multiple sites. A thematic content analysis was conducted based on the key themes reported. We applied the five components of consolidated framework for implementation research to interpret the findings. Results First, based on the intervention's characteristics, implementers valued the eCHIS program. However, its implementation was impacted by the heavy workload, limited or absent network and electricity. Outer-setting challenges were staff turnover, presence of competing projects, and lack of incentive mechanisms. In terms of the inner setting, lack of institutionalization and ownership were mentioned as barriers to the implementation. Resource allocation, community mobilization, leaders’ engagement, and availability of help desk need emphasis for a better achievement. With regard to characteristics of the individuals, limited digital literacy, older age, lack of peer-to-peer support, and limited self-expectancy posed challenges to the implementation. Finally, the importance of mentoring and engaging community and religious leaders, volunteers, having defined plan and regular meetings were identified elements of the implementation process and need emphasis. Conclusion The findings underlined the potential enablers and barriers of eCHIS program for quality health data generation, use, and service provision and highlighted areas that require emphasis for further scale-up. The success and sustainability of the eCHIS require ongoing government commitment, sufficient resource allocation, institutionalization, capacity building, communication, planning, monitoring, and evaluation.

Parents' Perceptions of Children’s and Adolescents' Use of Electronic Devices to Promote Physical Activity: A Systematic Review of Qualitative Evidence (Preprint)

Article

Full-text available

Dec 2022

Background The use of physical activity (PA) electronic devices offers a unique opportunity to engage children and adolescents in PA. For this age group (2-17 years), parents play a key role in promoting healthy lifestyles and regulating the use of electronic devices. Therefore, parents’ perceptions of the use of electronic devices for PA in children and adolescents are critical for efficient intervention. Objective The aim of this qualitative systematic review was to improve the understanding of parents’ perceptions of the use of electronic devices for PA in children and adolescents. Methods A systematic search of electronic databases (Medline/PubMed, SPORTDiscus, Web of Science, Scopus, OpenGrey, and Deep Blue) was conducted. Studies from inception (2010) to May 2022 were identified. Qualitative studies on the perceptions of healthy children’s and adolescents’ (aged 2-17 years) parents regarding PA interventions performed on electronic devices were included according to the Cochrane Qualitative and Implementation Methods Group Guidance Series and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used for methodological validity. Results In total, 18 studies with 410 parents, mostly mothers, were included. Parents’ perceptions were grouped into 4 categories: usefulness, advantages, general perceptions (electronic devices for health promotion, preferences for real-life PA, and concerns), and acceptability (barriers and facilitators) of electronic devices for PA. Parents perceived electronic devices as useful for increasing PA, learning new skills, and increasing motivation for PA and valued those devices that promoted socialization and family and peer bonding. In terms of general perceptions, parents had positive attitudes toward PA electronic devices; however, they preferred outdoor and real-life PA, especially for preschoolers and children. Concerns, such as physical and psychological harm, addiction, conflicts, and compliance difficulties, were found. Facilitators were identified as ease of use, appropriate feedback, promotion of socialization, and motivational strategies, such as rewards, challenges, and attractiveness. Barriers, such as discomfort, price, and difficulties in using or understanding electronic devices, were also identified. For older children and adolescents, parents were more concerned about high levels of screen time and setting limits on electronic devices and therefore preferred PA electronic devices rather than traditional ones. Conclusions Overall, the participants had positive attitudes toward electronic devices for PA and perceived them as an effective way to promote PA in children and adolescents. They also perceived several benefits of using electronic devices, such as health promotion, increased awareness and motivation, and socialization, as well as barriers, facilitators, and age differences. The results of this study could provide researchers with insights into designing more effective, age-appropriate PA electronic devices for children and adolescents and improving adherence to their use. Trial Registration PROSPERO CRD42021292340; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=292340

Impact of a Mobile Health Intervention to Support Exclusive Breastfeeding: A Scoping Review

Article

Mar 2013

Nowadays, mobile health (mHealth) intervention has become a popular and convenient strategy to support exclusive breastfeeding (EBF). However, the effectiveness of the mHealth intervention on this topic is still ambiguous. Thus, a scoping review was done to map the available evidence and identify the impact of mHealth interventions to support EBF. A scoping review of English academic journals was conducted using four electronic databases (Scopus, EBSCOHost, Google Scholar, and Science Direct) from 2016 to 2021. Only 23 articles were eligible. The sample size ranged from 50 to 1,568 participants, aged 18 and above. About 60% of the reviewed articles showed that mHealth interventions had a significant impact on EBF. The intervention group that received the mHealth tools had longer and higher EBF rates and duration compared to the control group. Other articles did not find a significant mHealth intervention impact towards EBF; however, it increased breastfeeding efficacy, mother’s knowledge and the child’s body weight.

The Impact of Behavioral Economics-Based Counseling and Mobile Phone Text Educational and Reminder Messages on the Use of Modern Family Planning in Jordan: A Cluster Randomized Controlled Trial

Article

Full-text available

May 2023

Background: Favorable attitudes toward modern family planning methods (MFPMs) among Jordanian and Syrian women do not always translate into behavioral changes, and the availability and cost of MFPMs do not appear to be related to either prior stalls in fertility rates in Jordan or to the current and likely temporary decline in fertility rates. This study aimed to determine whether behavioral economics (BE)-based family planning interventions influence the use of any family planning method, MFPMs use, continuation of MFPMs use, and pregnancy rates among women in Jordan. The BE-based family planning interventions included personalized text messaging and augmented counseling based on framing and identity-priming BE principles, with their effects tested over a 9-month period in the postpartum period following the birth of a child. Methods: A parallel-group cluster randomized controlled trial was conducted to compare two interventions, augmented counseling based on framing and identity-priming BE principles and personalized mobile phone text messages reminders, aiming to improve the utilization of MFPMs among postpartum women over status quo family planning services in comprehensive health centers in the north of Jordan. Results: In total, 1032 participated in the study: 295 women in the control group; 326 women in Intervention Group 1, which received only augmented counseling; and 411 women in intervention Group 2, which received augmented counseling and monthly text messages. The rates of using MFPMs in the counseling group and the counseling and messages group 3 months (54.7% and 57.1%, respectively), 6 months (50.0% and 51.7%, respectively), and 9 months (49.5% and 52.0%, respectively) were significantly higher than the rates among women in the control group (40.6% at 3 months, 37.6% at 6 months, and 34.3% at 9 months). Overall, 26.8% of women in the control group, 42.1% of women in the counseling-only group, and 45.2% of women in the counseling and messages group used MFPMs continuously for all 9 months. At 9 months, the pregnancy rate was significantly much higher in the control group (13.7%) compared to women in the counseling-only group (7.0%) and to women in the counseling and messages group (7.4%). Conclusions: Simple BE-based interventions can be effective methods for enhancing the use of MFPMs and maintaining the anticipated decline in Jordan's total fertility rate.

Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review

Article

Full-text available

Mar 2023

Unlabelled: This systematic review aimed to investigate the impact of different psychological models, strategies, and methods to improve plaque control and/or gingival inflammation in patients with periodontal diseases. Methods: The PubMed/MEDLINE, Cochrane Library, and Embase online databases were explored to identify relevant studies published before October 2022. Articles investigating the effects of different psychological approaches and intervention strategies on periodontitis patients' oral hygiene (OH) behavioral change were screened. Results: 5460 articles were identified, and 21 fulfilled the inclusion criteria. In total, 2 studies tested audio-visual modalities, and the remaining 19 publications involved six psychological models of health-related behavioral interventions, including Social Cognitive Theory, the Theory of Planned Behavior, the Health Action Process Approach, Leventhal's self-regulatory theory, Motivational Interviewing, and Cognitive Behavioral Therapy. A meta-analysis of the results was not carried out due to the high heterogeneity among the interventions. Conclusions: Considering the limitations of the available studies, psychological interventions based on social cognitive models that combine some of the techniques of this model (goal setting, planning, self-monitoring, and feedback) may improve OH in periodontitis patients, having a positive impact on periodontal clinical outcomes. Delivering cognitive behavioral therapy in combination with motivational interviewing may result in an improvement in OH as evaluated by decreasing plaque and bleeding scores.

Digital Interventions for Social Participation in Adults with Long-term Physical Conditions: A Systematic Review

Article

Full-text available

Feb 2023
J MED SYST

This review aims to identify and evaluate digital interventions for social participation in the growing population of adults with long-term physical conditions. Articles were sourced from MEDLINE, EMBASE, CINAHL and PsycINFO databases using subject headings and keywords related to “social participation” and “digital technology”. Studies that adopted digital technology interventions to improve social participation in adults with long-term physical conditions were included. Data on study methodology, participant and digital intervention characteristics, and findings related to social participation were extracted. The search yielded a total of 4646 articles and 14 articles met criteria for final review with five randomized controlled trials, two non-randomized clinical trials and seven one-group pretest–posttest clinical trials. Studies were organized based on the digital intervention strategy implemented to improve social participation: group support (n = 4), individual skill training or counseling (n = 6), education and support (n = 3), and mixed intervention (n = 1). The group support interventions developed a social network among participants through videoconference, app, or virtual reality platform. Three studies reported positive improvements in different aspects of social participation. Individual skill training or counseling mainly utilized phone calls to help participants cope with activity participation and interpersonal relationship issues. Only two studies demonstrated benefits for social participation. The education and support intervention, which used messages and website information to increase participants’ knowledge and provide support, showed positive findings in three studies. This review suggests digital interventions for improving social participation in adults with long-term physical conditions are feasible and the effectiveness of different strategies may vary. Registration: This review was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO) (registry number: CRD42021254105).

Feasibility, Acceptability, and Initial Efficacy of a Digital Intervention to Improve Consumption of Foods Received within a National Nutrition Assistance Program

Article

Full-text available

Jan 2023

Many mothers are vulnerable to poor diet quality, particularly those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrient-rich foods through its benefits packages, but many WIC participants are not redeeming them. We assessed the feasibility and acceptability of a digital intervention to support redemption and consumption of WIC-approved foods to ultimately improve diet quality. We enrolled 54 maternal–child dyads receiving WIC benefits to receive three to four weekly text messages for 12 weeks focused on behavioral goals to improve consumption of WIC-approved foods. We assessed engagement with weekly tracking messages and satisfaction and collected 24 h dietary recalls to assess preliminary efficacy on dietary intake. Participants were mostly non-Hispanic white (63%) and working (63%), and responded to 7.4 (standard deviation: 4.6) of the 12 weekly messages. Half (n = 27) were high engagers (responded to 80% or more of weekly messages), with 28% (n = 15) responding to all messages. Most felt the feedback (94%) and tips (87%) were helpful and would recommend the program (91%). More were consuming leafy green vegetables compared to baseline (p = 0.01). Mothers of children enrolled in WIC found a text messaging intervention focused on consumption of WIC-approved foods enjoyable and helpful.

Design issues in personalized nutrition advice systems (Preprint)

Article

Full-text available

Mar 2022
J MED INTERNET RES

The current health status of the general public can substantially benefit from a healthy diet. Using a personalized approach to initiate healthy dietary behavior seems to be a promising strategy, as individuals differ in terms of health status, subsequent dietary needs, and their desired behavior change support. However, providing personalized advice to a wide audience over a long period is very labor-intensive. This bottleneck can possibly be overcome by digitalizing the process of creating and providing personalized advice. An increasing number of personalized advice systems for different purposes is becoming available in the market, ranging from systems providing advice about just a single parameter to very complex systems that include many variables characterizing each individual situation. Scientific background is often lacking in these systems. In designing a personalized nutrition advice system, many design questions need to be answered, ranging from the required input parameters and accurate measurement methods (sense), type of modeling techniques to be used (reason), and modality in which the personalized advice is provided (act). We have addressed these topics in this viewpoint paper, and we have demonstrated the feasibility of setting up an infrastructure for providing personalized dietary advice based on the experience of 2 practical applications in a real-life setting.

Developing Culturally Tailored Mobile Web App Education to Promote Breast Cancer Screening: Knowledge, Barriers, and Needs Among American Indian Women

Article

Full-text available

Jan 2023

American Indian (AI) women face disproportionate rates of breast cancer mortality and cancer disparities. This study conducted qualitative research to assess perspectives of AI women towards breast cancer screening, knowledge, barriers, and needs about mobile web app–based education to promote breast cancer screening. This study, in collaboration with the Yankton Sioux Tribe (YST), followed a community-based participatory research approach and conducted two focus groups with a total of 22 YST women aged 40–70 years living on reservation in rural South Dakota. Each group consisted of 11 local professionals working in healthcare and social services and community members. A grounded theory was used for the qualitative analysis. A large portion of participants reported having prior knowledge about breast cancer and screening methods, yet lacked awareness of the detailed procedure and recommended guidelines. Competing priorities and cost of mammograms were noted as major barriers to screening. Participants wanted to learn—in a convenient and easy-to-understand manner—more about breast cancer and prevention from a credible source. Both groups were favorable toward novel educational tools, such as the mobile web app education, and cited potential health benefits, particularly for women aged 40s to 60s. Our findings highlighted the importance of creating effective, culturally tailored educational interventions built into programs specific to AIs to increase understanding about breast cancer screening and promote screening behaviors among AI women. Particular attention to how AIs’ culture, beliefs, and barriers are implicated in screening behaviors could help with developing culturally tailored health education tools for this population.

Participants’ and Health Care Providers’ Insights Regarding a Web-Based and Mobile-Delivered Healthy Eating Program for Disadvantaged People With Type 2 Diabetes: Descriptive Qualitative Study

Article

Full-text available

Jan 2023

Background Healthy eating is a key element of type 2 diabetes (T2D) self-management. Digital interventions offer new avenues to reach broad audiences to promote healthy eating behaviors. However, acceptance of these interventions by socioeconomically disadvantaged people (eg, those with lower levels of education and income or from ethnic minority groups) has not yet been fully evaluated. Objective This study aimed to investigate the acceptability and usability of EatSmart, a 12-week web-based and mobile-delivered healthy eating behavior change support program, from the perspective of intervention participants living with T2D and health care providers (HCPs) involved in diabetes care. Methods This study used a qualitative descriptive design. Overall, 60 disadvantaged adults with T2D, as determined by receipt of either a HealthCare Card or a pension or benefit as the main source of income, were recruited. Data from participants regarding their experiences with and perceptions of the program and longer-term maintenance of any behavior or attitudinal changes were collected through a web-based self-report survey with open-ended questions administered 12 weeks after baseline (54/60, 90%) and semistructured telephone interviews administered 36 weeks after baseline (16/60, 27%). Supplementary semistructured interviews with 6 HCPs involved in diabetes care (endocrinologists, accredited practicing dietitians, and diabetes nurse educators) were also conducted 36 weeks after baseline. These interviews aimed to understand HCPs’ views on successful and unsuccessful elements of EatSmart as a technology-delivered intervention; any concerns or barriers regarding the use of these types of interventions; and feedback from their interactions with patients on the intervention’s content, impact, or observed benefits. All data from the surveys and interviews were pooled and thematically analyzed. Results In total, 5 key themes emerged from the data: program impact on food-related behaviors and routines, satisfaction with the program, reasons for low engagement and suggestions for future programs, benefits and challenges of digital interventions, and cultural considerations. Results showed that EatSmart was acceptable to participants and contributed positively to improving food-related behaviors. Most participants (27/43, 63%) mentioned that they enjoyed their experience with EatSmart and expressed high satisfaction with its content and delivery. The educational and motivational content was considered the most useful part of the program. Benefits discussed by intervention participants included gaining health knowledge and skills, positive changes in their food purchasing and cooking, and eating greater quantities and varieties of fruits and vegetables. HCPs also described the intervention as beneficial and persuasive for the target audience and had specific suggestions for future tailoring of such programs. Conclusions The findings suggested that this digitally delivered intervention with supportive educational modules and SMS text messages was generally appealing for both participants and HCPs. This intervention medium shows promise and could feasibly be rolled out on a broader scale to augment usual diabetes care. International Registered Report Identifier (IRRID) RR2-10.2196/19488

Parents' Perceptions of Children’s and Adolescents' Use of Electronic Devices to Promote Physical Activity: A Systematic Review of Qualitative Evidence (Preprint)

Preprint

Dec 2022

BACKGROUND The use of electronic devices to promote physical activity (PA) offers a unique opportunity to engage parents and children in healthy lifestyles. OBJECTIVE The purpose of this qualitative systematic review is to increase the understanding of parents’ perceptions about electronic device-based PA interventions with children and adolescents. METHODS A systematic search in electronic databases (Medline/PubMed, SPORTDiscus, Web of Science, Scopus, OpenGrey, and Deep Blue) was conducted from the period of 2010 to May 2022 for qualitative studies about healthy children and adolescents, aged 2-17 years old, about their parents’ perceptions of PA interventions performed on electronic devices, according to the Cochrane Qualitative and Implementation Methods Group Guidance Series and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). The JBI Qualitative Assessment and Review Instrument (JBI-QARI) was used for methodological validity. RESULTS Eighteen studies, 410 parents, were included. Parents’ perceptions were grouped into five categories: usefulness, advantages, acceptability, general perceptions, and important features. Parents perceived electronic devices as useful for increasing PA and the learning of skills, to increase motivation, and family or peer bonding. Concerns such as physical and psychological damage, addiction, conflicts, difficulties in compliance were found. CONCLUSIONS Overall, parents perceived that PA electronic devices could be an effective way to promote PA and preferred physically active games over passive ones. Important features were the ease of use, appropriate feedback, promotion of socialization, and motivating strategies such as rewards, challenges, and appealing appearance. CLINICALTRIAL Prospero Registration: CRD42021292340.

Texting: Its Uses, Misuses, and Effects

Chapter

Jan 2015

Paola Pascual-Ferrá

Texting has become the preferred form of communication for many people around the world, especially teenagers and young adults. While texting allows individuals to communicate anywhere at any time, its accessibility also makes people prone to misuse the technology. This article attempts to synthesize the body of research on texting accumulated during the last decade, with a particular emphasis on the areas that have sparked the greatest debates regarding its use—education and learning, health, language and literacy, privacy and security, social relationships, text-bullying, and traffic safety. Other controversial mobile phone uses associated with texting, such as sexting, have been excluded from this article because of their increasing dependence on multi-media messaging services (MMS) and applications focused on sharing images, videos, and audio files beyond simple text. The article concludes with an assessment of the place of short message service (SMS) in the current mobile communication landscape and directions for future research.

My Voice as a Daily Reminder: Self-Voice Alarm for Daily Goal Achievement

Conference Paper

May 2024

A behaviour-based look at money matters Insights from experience & from science

Book

Full-text available

Apr 2024

The Consumer Choice Action Plan: background and context Financial decisions play a crucial role in our daily lives. In our modern world, it is essential to understand how consumers behave when faced with an important financial choice. Consumers must confront important financial choices even though they may not have the time, knowledge or motivation to make the right decision, and people are often influenced by unconscious and irrational factors. In practice, for example, when consumers are presented with several options they will often choose the middle one, regardless of the price and features of the other alternatives. They put off creating a savings buffer until the refrigerator and washing machine both break down at once, and they wait till the end of their current mortgage period before looking up information on interest-only mortgage options. Left to themselves, consumers do not always make the most rational decisions in their own interest. Many people see financial matters as a means, rather than an end in itself: they don’t want a mortgage – they want a house. They don’t want insurance – they just want to enjoy their skiing holiday. The financial side is a tool, a necessary evil, something they just have to do so they can get what they want. This is not a new insight; as the 2019 report by the Netherlands Scientific Council for Government Policy (WRR) put it, “Knowing what to do is not enough”. The partners in the Consumer Choices Action Plan have always aimed to support consumers to make better financial decisions. We want to publicise these insights and practices throughout the financial sector so that all stakeholders can take advantage of them, and so we can achieve our ultimate goal of promoting healthy financial decisions through behavioural insights. This publication arose from the Consumer Choices Action Plan, a collaboration involving more than 50 partners and individuals from diverse backgrounds in the financial sector. The initiatives in the Consumer Choices Action Plan are divided into five key themes, each dealing with challenges for promoting good consumer choices: 1 Financial literacy: Consumers need to be able to take action when their financial situation calls for it. How can we encourage consumers to be proactive and seek help as soon as they need it? 2 Investing: Investing has evolved. Instead of involving a physical visit to the bank, now people mostly invest online, and often without the help of advisers. Do consumers really understand the risks? 3 Saving: Ideally, consumers should have a savings buffer to deal with unexpected financial setbacks. How can we encourage consumers to set aside money for a buffer when they have the means to do so? 4 Borrowing and leasing: Another area of finance that’s largely moved online is the world of loans and lease agreements, and again it’s less common for a financial advisor to be involved. When it comes to long-term, important financial commitments, consumers need to make the best choices for their financial situation. How can behavioural insights help them do that? 5 Financial sustainability: Although consumers are keen to use sustainable financial products and energy-saving measures, factors such as inertia, habit and a short-term focus still get in the way. What behavioural interventions will help people actually take the plunge? The structure of this publication As you read further into this publication, the information becomes more in-depth. That said, each chapter can also be read on its own, so you can feel free to flip through and read only the parts that are relevant to you. Chapters 2 and 3 focus on practical results from the Consumer Choice Action Plan. In Chapter 2, we take the specific results from the Action Plan’s partner organisations and make them easily accessible to other stakeholders. Chapter 3 combines findings from Action Plan studies and experiments with the very latest knowledge and insights from financial behavioural science. Chapter 4 offers background information on various psychological mechanisms and some associated behavioural models. We want to inform and inspire people who work in the financial industry with an overview of a wide range of psychological mechanisms that impact financial behaviour. Psychological mechanisms have a big effect on the way people make financial decisions. The literature uses various different terms to discuss these mechanisms, from ‘interventions’, ‘techniques’ and ‘heuristics’ to ‘biases’, ‘illusions’, ‘nudges’ and ‘boosts’. This chapter explains specific mechanisms and models based on these terms and gives real-world examples. Chapter 5 provides an overview of some of the theoretical ideas and scientific traditions behind the various ways of influencing people’s behaviour. We use this overview to go into more detail on what we now know about behavioural change. In this chapter, we dive into the ocean of scientific theories on behavioural change and identify different types of behavioural models. We take you on a journey from Aristotle’s virtue theory to Seligman’s positive psychology; from Smith’s ‘invisible hand’ to Thaler’s nudges; and from Kant’s deontology to Cialdini’s theory of influence. As well as exploring these three main schools of thought, in this chapter we also identify procedural and mixed models. This publication was produced in association with experts from finance, government and science. Insights gained from the literature reinforce and enhance the results of the Consumer Choices Action Plan. We believe this blend of practical knowledge and scientific expertise represents a valuable contribution to the work of encouraging the people of the Netherlands to make good financial choices.

Comment on ‘text messaging interventions for breastfeeding outcomes: A systematic review and meta-analysis’

Article

Mar 2024
INT J NURS STUD

The feasibility, acceptability and potential efficacy of a parental text message and social media program on children's vegetable consumption and movement behaviours: A pilot randomised controlled trial

Article

Jan 2024

Issue Addressed Australian children fall short of meeting the dietary, physical activity and sedentary behaviour guidelines. This study aimed to test the feasibility, acceptability and potential efficacy of a parental text message and social media program on, primarily, their school‐aged children's vegetable consumption and movement behaviours, and, secondarily, their own. Methods Between August and November 2022, we conducted a two‐armed randomised controlled trial with 242 parents/caregivers of primary school‐aged children in New South Wales. The ‘Adventure & Veg’ intervention ran for 8 weeks, promoting vegetable eating behaviours, local outdoor physical activity opportunities and ideas for reducing screen time. Feasibility and acceptability were assessed via recruitment and retention data, intervention metrics and self‐reported participant data. Vegetable intake and movement behaviour data were collected via online‐surveys and effect sizes were examined. Results Most participants reported that they enjoyed receiving the text messages (88%) and the delivery frequency was acceptable (94%). Limitations to Facebook as a delivery platform were reported. The majority of participants used the text messages to influence the vegetable eating (65%) and movement (77%) behaviours of their child. Significant effects were observed among intervention child participants compared with control for mean daily vegetable consumption (0.45 serves, CI: .19; .71, p = .001, d = .5); weekly vegetable variety (1.85, CI: .25; 3.45, p < .001, d = .6); and weekly physical activity variety (.64 CI: .09; 1.19, p = .022, d = .3). Parents in the intervention group increased their daily vegetable intake by .44 serves (CI: .11; .78, p = .01, d = .4). Conclusions A parental text message and social media program has potential to support children's vegetable intake and movement behaviours. Further research is required to explore different online delivery methods to promote local outdoor activity options. So What? The Adventure & Veg program holds promise as a stand‐alone health promotion intervention or as a useful adjunct to current family or school‐based healthy lifestyle programs.

Preventive healthcare behavior: A hybrid systematic literature review (1998–2023)

Article

Full-text available

Dec 2023
Int J Consum Stud

Preventive healthcare behavior (PHB) refers to actions taken by consumers to avert possible incidences of lifestyle diseases. Over the years, diverse approaches have been used to comprehend the complex nature of PHB. This paper follows a three‐step process to examine work done in the PHB domain. At the outset, past literature was examined. This review included PHB models and frameworks, followed by a root‐cause analysis to identify factors that impacted PHB adoption. A systematic literature review (SLR) using a domain‐based hybrid review approach was the study's third and most crucial part. The SPAR‐4‐SLR (scientific procedures and rationales for systematic literature reviews) protocol was used to conduct the hybrid review, involving two separate review studies. In the first study, a bibliometric analysis was carried out, wherein a trend analysis was conducted on an initial pool of 1011 primary peer‐reviewed publications (1998–2023). The trend analysis was followed by a co‐citation network analysis of 39,608 secondary articles, which validated the importance of primary articles as indicated by the co‐citations in these secondary articles. Further, a purification process based on reliability, validity, and replicability criteria resulted in a final pool of 190 relevant articles. These articles were subjected to a thematic analysis. Next, a framework‐based review based on the theories, contexts, characteristics, and methods (TCCM) framework was conducted on the 190 articles. This step validated the primary study findings. Additionally, it examined and reported the underlying theories, context (country level), characteristics, and methods adopted by previous PHB studies. This analysis helps in indicating the future research agenda regarding PHB. Furthermore, the inferences drawn from the two studies were used to propose a conceptual framework for understanding consumers' PHB decisions based on the antecedents, decisions, and outcomes (ADO) framework. The framework posits that specific personal, demographic, cultural, social and socioeconomic factors are precursors to PHB adoption. This PHB adoption, in turn, has positive outcomes such as enhanced quality of life, consumer wellbeing, health promotion, health behavior change, and planning. The comprehensive review and proposed framework will significantly help advance knowledge about PHB. Apart from contributing to the academic literature, learnings from this study hold value for practitioners at the global level for designing actionable strategies for preventive healthcare products and services.

Food literacy in adults with type 2 diabetes in Kenya: designing mobile phone text messages using the Behaviour Change Wheel framework. (Preprint)

Article

Full-text available

Apr 2023

Background The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care. Objective This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya. Methods The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention. Results In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs. Conclusions This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D. International Registered Report Identifier (IRRID) RR1-10.2196/48271

Developing a text message intervention for fathers with partners experiencing perinatal depression or anxiety

Article

Sep 2023

Telemedicine and Tele-echocardiography in India

Article

Jan 2017

India is a vast nation with almost 75% of their population living in rural and remote regions. The obvious challenge is in the health-care delivery mechanism because of the disparity in the availability of services and specialists across the region. Therefore, the technology that facilitates the delivery of this essential health care to these remote areas is the need of the hour today. Telemedicine which essentially encompasses exchange of clinical information through a communication media has provided a platform for the delivery of quality health care. Advances in Information and Communication Technology in the area of video-to-video communication have led to the growth of extending the reach of specialist services for diagnostic investigations to areas wherein specialists are unavailable. For a country of over one billion, the number of cardiologists available for even screening patients is abysmally low. Echocardiography is often used to diagnose and exclude important cardiac diagnoses in adults and children. The use of telemedicine in echocardiography is one way to alleviate this problem, wherein a diagnosis can be made through the transmitted images and an appropriate management plan suggested based on the findings before there is patient movement. With the right diagnosis, some of them do not need medical intervention in terms of a procedure or surgery, and they can just be managed by medicines. The convergence of science and technology in our dynamic digital era has resulted in the development of innovative digital health devices that allow easy and accurate characterization in health and disease. Internet of Things (IoT)-assisted medical devices have found immense potential in addressing some of the long-standing issues related to diagnostic tests such as electrocardiogram and echocardiography. These technological advancements and the miniaturization of diagnostic instruments have led to decreasing health-care costs and improving outcomes.

Cognitive Behavioral and eHealth Approaches to Promote Engagement in Treatment

Chapter

Jan 2020

Chatbot-assisted therapy for patients with methamphetamine use disorder: a preliminary randomized controlled trial

Article

Full-text available

Jul 2023

Background Methamphetamine (MA) use disorder is associated with a large public health burden. Despite the therapeutic effects of psychosocial interventions based on current evidence, finding an approach to retain patients in treatment remains a real-world challenge. The rapid development of mobile health (mHealth) systems suggests the potential to provide real-time personalized care at any time and from any location, minimize barriers to treatment, maximize use, and promote the dissemination of accessible therapeutic tools in at-risk populations. Our study aimed to investigate the feasibility and effectiveness of chatbots for the treatment of MA use disorder. Method The inclusion criteria were (a) a diagnosis of MA use disorder as defined by the DSM-5, (b) age between 18 and 65 years, (c) no acute exacerbation of severe mental illness during the initial assessment, such as schizophrenia or bipolar I disorder, (d) willingness to participate in standard outpatient treatment for ≥ 6 months, and (e) an Android phone. Participants were randomly allocated to either a chatbot-assisted therapy via smartphone (CAT) group or a control group following simple randomization procedures (computerized random numbers) without blinding. All participants were followed up for 6 months. Treatment retention and monthly urine test results were analyzed as outcome measures. Participants' satisfaction with CAT was also assessed. Results In total, 50 and 49 participants were allocated to the CAT and control groups, respectively. There were no significant differences in retention time between the two treatment groups (df = 1, p = 0.099). The CAT group had fewer MA-positive urine samples than the control group (19.5% vs. 29.6%, F = 9.116, p = 0.003). The proportion of MA-positive urine samples was positively correlated with the frequency of MA use (r = 0.323, p = 0.001), severity of MA use disorder (r = 0.364, p < 0.001), and polysubstance use (r = 0.212, p = 0.035), and negatively correlated with readiness to change (r = −0.330, p = 0.001). Totally 55 participants completed the study at the 6-month follow-up and 60% reported relative satisfaction. Conclusion Participants in this study had favorable acceptance and generally positive outcomes, which indicates that chatbot is feasible for treating people who use MA.

Teledentistry for improving access to, and quality of oral health care: A protocol for an overview of systematic reviews and meta-analyses

Preprint

Full-text available

Jul 2023

Digital technologies are becoming essential to address and optimize the suboptimal performance of healthcare systems. Teledentistry involves the use of information and communication technology to improve access to oral health care and the quality of oral health care delivery. Several systematic reviews (SRs) have been conducted to synthesize evidence on the effectiveness of teledentistry but with conflicting results. The aim of this review is to comprehensively summarize available SRs and provide evidence on the impact of teledentistry on access to oral care, patients’ and oral healthcare providers’ outcomes, quality of oral health care and costs. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42022373964). Six electronic databases including MEDLINE (Ovid), Embase (Embase.com), CINAHL (EBSCO), Web of Science, Cochrane Library and Epistemonikos will be searched for SRs of quantitative, qualitative, and mixed reviews evaluating teledentistry modalities involving both patients and/or oral health care providers (OHCPs). We will include only studies published in English or French. The primary outcomes will be considered from the patients’ perspective (e.g., access to oral health care, patient-reported outcomes, and experiences). The secondary outcomes will include outcomes from patients and OHCPs (e.g., clinical outcomes, safety, behaviors, and costs). Two independent reviewers will perform data screening, data extraction and will assess the quality of included studies using the AMSTAR 2 and ROBIS tools. Data will be synthesized narratively and presented by tables and graphs. We will report any overlap of primary studies in the SRs. A statement on the strength of evidence for each outcome will be provided if possible. This review will inform decision-makers, patients, OHCPs, and researchers on the potential effectiveness, benefits, and challenges of teledentistry and support them in making recommendations for its use. Results will be disseminated through peer-reviewed publications, presentations at conferences, and on social media.

Use of Mobile Phone Applications and Software for Effective Public Health Management

Chapter

Jun 2023

The purpose of this chapter is to highlight the opportunities for digitizing important processes in the healthcare system to improve the efficiency of population health management. The introduction of these digital processes will increase patient satisfaction with the healthcare system, as well as provide a holistic outlook of patient health through access to data and give patients more control over their own health. Healthcare managers will also be using the developed internet applications to conduct clinical audits and monitor health problems in the administrative district. It is proposed to develop and use free internet applications and computer programs, namely 1) drug compatibility test online application, which is designed primarily for students; 2) electronic individual antenatal drug passport for a promising way to predict, prevent, and reduce the risk of allergic reactions; and 3) medical intelligence app using the artificial intelligence technologies to develop an individual educational trajectory for doctors and pharmacists.

Virtual Support for Real-World Movement: Using Chatbots to Overcome Barriers to Physical Activity

Chapter

Full-text available

Jun 2023

Conversational agents (CAs, aka chatbots) for behavioral interventions have great potential to improve patient engagement and provide solutions that can benefit human health. In this study, we examined the potential efficacy of chatbots in assisting with the resolution of specific barriers that people frequently encounter when doing behavioral interventions for the purpose of increasing physical activity (PA). To do this, six common barriers (i.e., things that stand in the way of increasing PA) were targeted (e.g., stress and fatigue), we adopted domain knowledge (i.e., psychological theories and behavioral change techniques) to design six interventions aimed at tackling each of these six barriers. These interventions were then incorporated into consultative conversations, which were subsequently integrated into a chatbot. A user study was conducted on non-clinical samples (n=77) where all participants were presented with three randomly but equally distributed chatbot interventions and a control condition. Each intervention conversation addressed a specific barrier to PA, while the control conversation did not address any barrier. The outcome variables were beliefs in PA engagement, attitudes toward the effectiveness of each intervention to resolve the barrier, and the overall chatbot experience. The results showed a significant increase in beliefs of PA engagement in most intervention groups compared to the control group, and positive attitudes toward the effectiveness of the interventions in reducing their respective barriers to PA, and positive chatbot experience. The results demonstrate that theory-grounded interventions delivered by chatbots can effectively help people overcome specific barriers to PA, thereby increasing their beliefs in PA engagement. These promising findings indicate that chatbot interventions can be an accessible and widely applicable solution for a larger population to promote PA.

Telemedicine - Application in Cardiology

Article

Jun 2023

Communication Inputs in the Performances of Nigeria Erosion and Watershed Management Project (NEWMAP) in Akwa Ibom State, Nigeria

Article

Full-text available

Apr 2023

Automated Text-Based Psychological Support to Improve Work-Life Balance and Sleep Quality: A pilot study report of work-from-home workers in Indonesia

Article

Full-text available

Apr 2023

Background: Work-at-home jobs may raise the risk of mental health concerns as they blur the boundaries between one’s job and personal responsibility. This study aimed to develop and test the feasibility of an online psychological intervention using the WhatsAppÓmessaging application. Materials and Method: During the 14-day intervention period, two messages were sent twice a day consisting of positive psychological affirmation aimed at assisting participants (N= 48; 13 males and 35 females) to achieve work-life balance and better sleep quality. The Indonesian-adapted Fisher’s work-life balance scale and the sleep disturbance scale were used to measure both constructs. These measures were administered at the beginning and end of the intervention. In addition, we provided participants with brief open-ended questions to check the program’s feasibility and acceptance of the intervention. Results: A paired t-test analysis revealed that although there was an increase in work-life balance scores in the post-test compared to the pre-test, the difference was not significant (t (47) = -1.75, p >.05). Nevertheless, individuals' sleep quality scores improved significantly after the intervention (t (47) = − 2.85, p <.05). Discussion: The findings of this study are expected to provide a preliminary argument to further pursue the development of behavioral interventions using online strategies in Indonesia during the pandemic.

Chronic Kidney Disease Management in Developing Countries

Chapter

Apr 2023

Danielle A Badro

The Effect of Tailored Short Message Service (SMS) on Physical Activity: Results from a Three-Component Randomized Controlled Lifestyle Intervention in Women with PCOS

Article

Full-text available

Mar 2023

This analysis of secondary outcome measures of a randomized controlled trial was conducted to study the effect of a one-year three-component (cognitive behavioural therapy, diet, exercise) lifestyle intervention (LSI), with or without additional Short Message Service (SMS) support, on physical activity and aerobic capacity in overweight or obese women with polycystic ovary syndrome (PCOS). Women diagnosed with PCOS and a BMI > 25 kg/m2 were randomly assigned to LSI with SMS support (SMS+, n = 60), LSI without SMS support (SMS−, n = 63) or care as usual (CAU, n = 60) in order to lose weight. Based on results from the International Physical Activity Questionnaire (IPAQ), we found a significant within-group increase after one year for SMS+ in the high physical activity category (+31%, p < 0.01) and sitting behaviour decreased (Δ −871 min/week, p < 0.01). Moreover, the peak cycle ergometer workload increased within SMS+ (Δ +10 watts, p < 0.01). The SMS+ group also demonstrated a significantly different increase in walking metabolic equivalent of task minutes (METmin)/week compared with CAU after one year (Δ 1106 METmin/week, p < 0.05). Apart from this increase in walking activity, no other between-group differences were found in this trial. Overall, based on within-group results, SMS support seemed to help with improving physical activity and aerobic capacity and decreasing sedentary behaviour.

Assessing the quality of digital patient-therapist communication: the development and validation of a text-based facilitative interpersonal skills task

Article

Dec 2022

Objective Text-based communication is becoming an increasingly salient feature of the psychotherapeutic landscape. Yet little is known about the factors distinguishing high- and low-quality therapeutic conversations taking place over this modality. Prior research on therapist effects has outlined several common factors associated with better clinical outcomes. But these common factors can only be researched in the context of text-based communication if they can be measured. Accordingly, we developed and validated a new behavioral task and coding system: the Facilitative Interpersonal Skills Performance Task for Text (FIS-T) to measure therapists’ messaging quality across eight dimensions of facilitative interpersonal skill. Methods 1150 survey-takers rated the interpersonal dynamics and response difficulty of the FIS-T Task’s text-based stimuli. The FIS-T was then administered to 64 therapists. Results The FIS-T stimuli displayed similar interpersonal dynamics to those elicited by the original FIS task, demonstrated a similar range of difficulties to those of the video-based stimuli of the original FIS Task, and showed high inter-rater reliability. Conclusions The text-based FIS-T Task demonstrates high reliability and convergent validity with the original FIS Task, making it appropriate for use in assessing the common factors in text-based therapy. Future directions in the quality assessment of internet-delivered psychotherapies are discussed.

Strengths and Weaknesses of Health Behavior Change Programs on the Internet

Article

Full-text available

Oct 2003

Full reviews were conducted on 37 public websites on health behavior change for disease prevention and management. All had at least four of five of the `5A's for effective health behavior change treatment on the Internet' (advise, assess, assist, anticipatory guidance and arrange follow-up) that are assumed to be minimum criteria for a program to have the potential for producing behavior change. The strength of these 37 programs included: rationales provided for assessments; privacy and confidentiality protections; some form of feedback provided; and some form of interactivity. The weaknesses included: few were theory driven; few had individualized tailoring; few had empirically based tailoring; and few were evidence based or reported subsequent plans for evaluation.

Rethinking Communication in the E-Health Era

Article

Full-text available

Jan 2003

There is substantial epidemiological evidence that widespread adoption of specific behavior changes can significantly improve population health. Yet, health communication efforts, while well intentioned, have often failed to engage people to change behavior within the complex contexts of their lives. `E-health communication', health promotion efforts that are mediated by computers and other digital technologies, may have great potential to promote desired behavior changes through unique features such as mass customization, interactivity and convenience. There is growing initial evidence that e-health communication can improve behavioral outcomes. However, we have much to learn about whether the technical promise of e-health communication will be effective within the social reality of how diverse people communicate and change in the modern world. This article examines current evidence concerning e-health communication and evaluates opportunities for e-health applications.

The HealthPia GlucoPack ™ Diabetes Phone: A Usability Study

Article

Full-text available

Apr 2007

Type I diabetes is a common chronic disease of childhood. Both the growing influence of peers and the shifting away from parental influence have been implicated as prime elements contributing to poor glycemic outcomes in adolescents. Mobile technology that can be directed towards providing self-management support and modifying potentially negative child parent interaction holds promise to improve control in adolescents with diabetes. HealthPia, Inc. (Palisades Park, NJ) has developed a prototype system, the HealthPia GlucoPack Diabetes Monitoring System, which integrates a small blood glucose monitoring device into the battery pack of a cell phone. A pilot study used mixed quantitative and qualitative methods to evaluate user satisfaction with the integrated system, including the potential of the device to transmit self-monitoring data to a website for review and analysis by clinicians, parents, and patients. Adolescents in our study liked the integration of the two technologies and agreed that the glucometer was easy to use and that the tool was useful in the management of their diabetes. Future work will focus on the utilization of the diabetes phone as a component of a care delivery system for adolescents with diabetes, including involvement of the health care team and enhancement of the web services that support the use of the phone.

Improving the Quality of Reports of Meta-Analyses of Randomised Controlled Trials: The QUOROM Statement

Article

Full-text available

Dec 1999

The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with "trial flow", study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.

Review of Computer-generated Outpatient Health Behavior Interventions: Clinical Encounters "in Absentia"

Article

Full-text available

Jan 2001

To evaluate evidence of the effectiveness of computer-generated health behavior interventions-clinical encounters "in absentia"-as extensions of face-to-face patient care in an ambulatory setting. Systematic electronic database and manual searches of multiple sources (1996-1999) plus search for gray literature were conducted to identify clinical trials using computer-generated health behavior interventions to motivate individuals to adopt treatment regimens, focusing on patient-interactive interventions and use of health behavior models. Eligibility criteria included randomized controlled studies with some evidence of instrument reliability and validity; use of at least one patient-interactive targeted or tailored feedback, reminder, or educational intervention intended to influence or improve a stated health behavior; and an association between one intervention variable and a health behavior. Studies were described by delivery device (print, automated telephone, computer, and mobile communication) and intervention type (personalized, targeted, and tailored). We employed qualitative methods to analyze the retrieval set and explore the issue of patient interactive computer-generated behavioral intervention systems. Studies varied widely in methodology, quality, subject number, and characteristics, measurement of effects and health behavior focus. Of 37 eligible trials, 34 (91.9 percent) reported either statistically significant or improved outcomes. Fourteen studies used targeted interventions; 23 used tailored. Of the 14 targeted intervention studies, 13 (92.9 percent) reported improved outcomes. Of the 23 tailored intervention studies, 21 (91.3 percent) reported improved outcomes. The literature indicates that computer-generated health behavior interventions are effective. While there is evidence that tailored interventions can more positively affect health behavior change than can targeted, personalized or generic interventions, there is little research comparing different tailoring protocols with one another. Only those studies using print and telephone devices reported a theoretic basis for their methodology. Future studies need to identify which models are best suited to which health behavior, whether certain delivery devices are more appropriate for different health behaviors, and how ambulatory care can benefit from patients' use of portable devices.

The Promise and Challenge of eHealth Interventions

Article

Full-text available

Nov 2002

To discuss how health behavior researchers can use the Internet to study and intervene on health behavior. Describe how the Internet is increasingly able to offer a viable medium for health behavior intervention and the challenges and opportunities inherent in conducting online interventions and research. The challenges of eHealth include coping with the additional demands of development, finding ways to reach "hard-to-reach" audiences, and maintaining privacy and security while monitoring participant use. Health behavior researchers and interventionists need to learn to apply eHealth tools to extend their ability to study and influence health behavior.

Mobile phone text messaging in the management of diabetes

Article

Full-text available

Feb 2004

We conducted a trial of mobile phone text messaging (short message service; SMS) for diabetes management. In an eight-month period, 23 diabetic patients used the service. Patients used SMS to transmit data such as blood glucose levels and body weight to a server. The server automatically answered with an SMS acknowledgement message. A monthly calculated glycosylated haemoglobin result was also automatically sent to the patient by SMS. During the trial the patients sent an average of 33 messages per month. Although users showed good acceptance of the SMS diabetes system, they expressed various concerns, such as the inability to enter data from previous days. Nonetheless, the trial results suggest that SMS may provide a simple, fast and efficient adjunct to the management of diabetes. It was particularly useful for elderly persons and teenagers, age groups that are known to have difficulty in controlling their diabetes.

College Smoking-Cessation Using Cell Phone Text Messaging

Article

Full-text available

Sep 2004

Although rates of smoking among college-aged students continue to rise, few interventions that focus on college smokers' unique motivations and episodic smoking patterns exist. The authors developed and evaluated a prototype program targeting college students that integrates Web and cell phone technologies to deliver a smoking-cessation intervention. To guide the user through the creation and initialization of an individualized quitting program delivered by means of cell phone text messaging, the program uses assessment tools delivered with the program Web site. Forty-six regular smokers were recruited from local colleges and provided access to the program. At 6-week follow-up, 43% had made at least one 24-hour attempt to quit, and 22% were quit--based on a 7-day prevalence criterion. The findings provide support for using wireless text messages to deliver potentially effective smoking-cessation behavioral interventions to college students.

Management of Patients with Diabetes Through Information Technology: Tools for Monitoring and Control of the Patients' Metabolic Behavior

Article

Full-text available

Nov 2004

The junction of telemedicine home monitoring with multifaceted disease management programs seems nowadays a promising direction to combine the need for an intensive approach to deal with diabetes and the pressure to contain the costs of the interventions. Several projects in the European Union and the United States are implementing information technology-based services for diabetes management using a comprehensive approach. Within these systems, the role of tools for data analysis and automatic reminder generation seems crucial to deal with the information overload that may result from large home monitoring programs. The objective of this study was to describe the automatic reminder generation system and the summary indicators used in a clinical center within the telemedicine project M2DM, funded by the European Commission, and to show their usage during a 7-month on-field testing period. M2DM is a multi-access service for management of patients with diabetes. The basic functionality of the technical service includes a Web-based electronic medical record and messaging system, a computer telephony integration service, a smart-modem located at home, and a set of specialized software modules for automated data analysis. The information flow is regulated by a software scheduler, called the Organizer, that, on the basis of the knowledge on the health care organization, is able to automatically send e-mails and alerts notifications as well as to commit activities to software agents, such as data analysis. Thanks to this system, it was possible to define an automatic reminder system, which relies on a data analysis tool and on a number of technologies for communication. Within the M2DM system, we have also defined and implemented a number of indexes able to summarize the patients' day-by-day metabolic control. In particular, we have defined the global risk index (GRI) of developing microangiopathic complications. The system for generating automatic alarms and reminders coupled with the indexes for evaluating the patients' metabolic control has been used for 7 months at the Fondazione Salvatore Maugeri (FSM) in Pavia, Italy. Twenty-two patients (43 +/- 16 years old, 12 men and 10 women) have been involved; six dropped out from the study. The average number of monthly automatic messages was 29.44 +/- 9.83, i.e., about 1.8 messages per patient per month. The number of monthly alarm reminders generated by the system was 16.44 +/- 4.39, so that the number of alarms per patient was about 1. The number of messages sent by patients and physicians during the project was about 13 per month. The GRI analysis shows, during the last trimester, a slight improvement of the performance of the FSM clinic, with a decrease in the percentage of badly controlled values from 33% to 27%. Finally, we found the presence of a linear increasing correlation between the mean GRI values and the number of alarms generated by the system. A telemedicine system may incorporate features that make it a suitable technological backbone for implementing a disease management program. The availability of data analysis tools, automated messaging system, and summary indicators of the effectiveness of the health care program may help in defining efficient clinical interventions.

Improving Asthma Control Through Telemedicine: A Study of Short-Message Service

Article

Full-text available

Feb 2005

Home peak expiratory flow (PEF) measurement is recommended by asthma guidelines. In a 16-week randomized controlled study on 16 subjects with asthma (24.6 6.5 years old, asthma duration small ze, Cyrillic 6 months), we examined Global System for Mobile Communications (GSM) mobile telephone short-message service (SMS) as a novel means of telemedicine in PEF monitoring. All subjects received asthma education, self-management plan, and standard treatment. All measured PEF three times daily and kept a symptom diary. In the study group, therapy was adjusted weekly by an asthma specialist according to PEF values received daily from the patients. There was no significant difference between the groups in absolute PEF, but PEF variability was significantly smaller in the study group (16.12 +/- 6.93% vs. 27.24 +/- 10.01%, p = 0.049). forced expiratory flow in 1 second (FEV1; % predicted) in the study group was slightly but significantly increased (81.25 +/- 17.31 vs. 77.63 +/- 14.80, p = 0.014) and in the control group, unchanged (78.25 +/- 21.09 vs. 78.88 +/- 22.02, p = 0.497). Mean FEV1 was similar in the two groups both before and after the study. Controls had significantly higher scores for cough (1.85 +/- 0.43 vs. 1.42 +/- 0.28, p < 0.05) and night symptoms (1.22 +/- 0.23 vs. 0.85 +/- 0.32, p < 0.05). There was no significant difference between the groups in daily consumption of inhaled medicine, forced vital capacity, or compliance. Per patient, per week, the additional cost of follow-up by SMS was Euros 1.67 (equivalent to approximately $1.30 per 1 Euro), and SMS transmission required 11.5 minutes. Although a study group of 40 patients is needed for the follow-up study to achieve the power of 80% within the 95% confidence interval, we conclude that SMS is a convenient, reliable, affordable, and secure means of telemedicine that may improve asthma control when added to a written action plan and standard follow-up.

Do U smoke after TXT? Results of a randomised trial of smoking cessation using mobile phone text messaging

Article

Full-text available

Aug 2005
TOB CONTROL

To determine the effectiveness of a mobile phone text messaging smoking cessation programme. Randomised controlled trial New Zealand 1705 smokers from throughout New Zealand who wanted to quit, were aged over 15 years, and owned a mobile phone were randomised to an intervention group that received regular, personalised text messages providing smoking cessation advice, support, and distraction, or to a control group. All participants received a free month of text messaging; starting for the intervention group on their quit day to assist with quitting, and starting for the control group at six months to encourage follow up. Follow up data were available for 1624 (95%) at six weeks and 1265 (74%) at six months. The main trial outcome was current non-smoking (that is, not smoking in the past week) six weeks after randomisation. Secondary outcomes included current non-smoking at 12 and 26 weeks. More participants had quit at six weeks in the intervention compared to the control group: 239 (28%) v 109 (13%), relative risk 2.20 (95% confidence interval 1.79 to 2.70), p < 0.0001. This treatment effect was consistent across subgroups defined by age, sex, income level, or geographic location (p homogeneity > 0.2). The relative risk estimates were similar in sensitivity analyses adjusting for missing data and salivary cotinine verification tests. Reported quit rates remained high at six months, but there was some uncertainty about between group differences because of incomplete follow up. This programme offers potential for a new way to help young smokers to quit, being affordable, personalised, age appropriate, and not location dependent. Future research should test these findings in different settings, and provide further assessment of long term quit rates.

Texting Decreases the Time to Treatment for Genital Chlamydia Trachomatis Infection

Article

Full-text available

Feb 2006

To assess the effectiveness of a text message result service within an inner London sexual health clinic. Demographic data, diagnoses, and time to diagnosis and treatment were collected over a 6 month period for patients receiving text messages and a matched standard recall group. Data on messages sent, staff time, and cost in relation to result provision were collected. Over a 6 month period 952 text messages were sent. In the final month of analysis, 33.9% of all clinic results were provided by text, resulting in a saving of 46 hours of staff time per month. 49 messages requested that the patient return for treatment, 28 of these patients had untreated genital Chlamydia trachomatis (CT) infection. The mean number of days (SD) to diagnosis was significantly shorter in the text message group (TG) v the standard recall group (SG) (7.9 (3.6) v 11.2 (4.7), p <0.001). The median time to treatment was 8.5 days (range 4-27 days) for the TG group v 15.0 (range 7-35) for SG, p = 0.005. Patients with genital CT infection are diagnosed and receive treatment sooner since the introduction of a text message result service. The introduction of this service has resulted in a significant saving in staff time.

Do Machines Become Us?: The Social Context of Personal Communication Technology

Chapter

Jul 2017

James Katz

Mobile World: Past, Present and Future

Book

Jan 2005

Why have mobile phones so quickly become part of our everyday lives? This book brings together the perspectives of key researchers in the area to explore lessons on social shaping, examining what can be learnt from the adoption of mobile devices that can be applied to other, newer, digital technologies. Forecasting the impact of new technology is always difficult. Occasionally demand is underestimated, but more often it is overestimated, and at great cost. Digital technology is unlike anything that has gone before, making it particularly difficult to understand its implications for businesses, public services and society in general. By looking at what has happened in the past and what is happening now, and offering methods of using this knowledge to look forward, this book will contribute to reducing expensive forecasting errors in the future. Key reading for all those involved with the future of mobile communications, this book is a valuable resource, particularly for advanced undergraduate and postgraduate students on Mobile Technology courses, practitioners, and researchers working in mobile communications, CSCW and HCI. This volume is a sequel to Brown et al: Wireless World: Social and Interactional Aspects of the Mobile Age, also in the CSCW series. "This book presents a rich insight into how and why the mobile has become so important in today’s society. It explores the strong emotional attachment that people have to these devices, and argues that it is people and not the technology that developers must put at the heart of future mobile offerings. A valuable book for industry and academics alike." Dr Phil Gosset, Vodafone Group R&D

Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses

Article

Nov 1999

Background: The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). Methods: The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. Findings: The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with "trial flow", study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. Interpretation: We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.

Cell Phone Culture: Mobile Technology in Everyday Life

Article

Jan 2012

Gerard Goggin

Providing the first comprehensive, accessible, and international introduction to cell phone culture and theory, this book is and clear and sophisticated overview of mobile telecommunications, putting the technology in historical and technical context.

Study on the background contents of Sb in soils

Article

Jan 1991

Use of SMS Text Messaging to Improve Outpatient Attendance

Article

Oct 2005

Objective: To evaluate the effect of appointment reminders sent as short message service (SMS) text messages to patients' mobile telephones on attendance at outpatient clinics. Design: Cohort study with historical control. Setting: Royal Children's Hospital, Melbourne, Victoria. Patients: Patients who gave a mobile telephone contact number and were scheduled to attend any of five outpatient clinics (dermatology, gastroenterology, general medicine, paediatric dentistry and plastic surgery) in September (trial group) or August (control group), 2004. Main outcome measures: Failure to attend (FTA) rate compared between the group sent a reminder and those who were not. Results: 2151 patients were scheduled to attend a clinic in September; 1382 of these (64.2%) gave a mobile telephone contact number and were sent an SMS reminder (trial group). Corresponding numbers in the control group were 2276 scheduled to attend and 1482 (65.1%) who gave a mobile telephone number. The FTA rate for individual clinics was 12%-16% for the trial group, and 19%-39% for the control group. Overall FTA rate was significantly lower in the trial group than in the control group (14.2% v 23.4%; P < 0.001). Conclusions: The observed reduction in failure to attend rate was in line with that found using traditional reminder methods. The ease with which large numbers of messages can be customised and sent by SMS text messaging, along with its availability and comparatively low cost, suggest it may be a suitable means of improving patient attendance.

Book Review: Machines That Become Us: The Social Context of Personal Communication Technology

Article

Feb 2006
NEW MEDIA SOC

Naomi Baron

Eficacia de una intervención informativa a hipertensos mediante mensajes de alerta en el teléfono móvil (HTA-ALERT)

Article

Dec 2004

Objective To analyze the effect of an intervention to provide information with mobile phone text messages to patients with hypertension on compliance with therapy for hypertension. Design Comparative, controlled, multicenter, randomized cluster study. Setting. 26 primary care health centers in Spain. Participants 26 researchers were randomized to a control group or an intervention group (52 patients each, for a total of 104 patients). All patients were receiving monotherapy for uncontrolled hypertension. Intervention Patients in the control group received their physician’s usual interventions. Patients in the intervention group received messages and reminders sent to their mobile phones 2 days per week during 4 months. Main outcome measures Tablets were counted and blood pressure was measured at the start of the study and 1, 3, and 6 months later. The percentage of compliers, mean percentage of compliance and degree of control of hypertension were compared. The reduction in absolute and relative risk was calculated, as was the number of individuals needed to treat to avoid noncompliance. Results The results were evaluated for a total of 67 individuals (34 in the intervention group and 33 in the control group). The rate of compliance was 85.1% (CI, 74.9%-95.3%) overall, 85.7% (CI, 70.5%-100.9%) in the control group and 84.4% in the intervention group (CI, 70.7%-95.3%) (P=NS). Mean percentage compliance was 90.2%±16.3% overall, 88.1%±20.8% in the control group and 91.9%±11.6% in the intervention group (P=NS). The percentage of patients whose hypertension was controlled at the end of the study was 51.5% (CI, 34.4%-68.6%) in the control group and 64.7% (CI, 48.6%-80.8%) in the intervention group (P=NS). Conclusions The telephone messaging intervention with alerts and reminders sent to mobile phones did not improve compliance with therapy in patients with hypertension.

The Mobile Connection: The Cell Phone''s Impact on Society

Article

May 2004

Rich Ling

Has the cell phone forever changed the way people communicate? The mobile phone is used for â?real timeâ coordination while on the run, adolescents use it to manage their freedom, and teens â?textâ to each other day and night. The mobile phone is more than a simple technical innovation or social fad, more than just an intrusion on polite society. This book, based on world-wide research involving tens of thousands of interviews and contextual observations, looks into the impact of the phone on our daily lives. The mobile phone has fundamentally affected our accessibility, safety and security, coordination of social and business activities, and use of public places. Based on research conducted in dozens of countries, this insightful and entertaining book examines the once unexpected interaction between humans and cell phones, and between humans, period. The compelling discussion and projections about the future of the telephone should give designers everywhere a more informed practice and process, and provide researchers with new ideas to last years.

Finland: a mobile culture

Article

Jan 2002

Jukka-Pekka Puro

Cell Phone Culture: Mobile Technology in Everyday Life (review)

Article

Jul 2009

Jon Agar

Gerard Goggin explores the ways in which mobile telecommunications, and the cell phone in particular, are implicated in changing cultural patterns. His book is global in scope—as studies in mobile phone cultures must be—comparative in style, and rich in observation and insight. Under the sign of “culture” Goggin takes in everything from novel ways of communication (text or SMS) and disruptive behaviors (“happy slapping”) and resulting cultural reactions (“moral panics” about youth and health) to celebrity scandals (David Beckham, cricketer Shane Warne, and sundry royals), TV show voting (Australian Idol), and digital photography as a new way of seeing. His methodological model is Stuart Hall’s venerable “circuits of culture” approach—a breakdown of cultural practices into representation, identity, production, consumption, and regulation—that will be familiar to British students of technology and culture through the 1997 textbook by Paul du Gay and his collaborators for the Open University’s Culture, Media and Identities course, Doing Cultural Studies: The Story of the Sony Walkman. After a perfectly competent, but familiar, chapter on the history of the cell phone, stretching from the first portable radiotelephones of the 1930s through the early years of the cellular mobile phone as an expensive status symbol to the ubiquitous object of the 1990s and 2000s, Cell Phone Culture begins to grab the reader’s attention in a chapter on producers and identities. Nokia and Vodafone are taken as case studies of handset manufacturers and service providers, respectively. Goggin proves more than willing to pick away at corporate mythology. So, for example, Nokia’s prowess at design is not denied; rather, the question becomes why has design become such an important aspect of Nokia’s face to the world. Goggin also points out that Nokia has been a voracious reader of social studies of technology, in particular the user-centered theories and studies of recent years. Goggin wonders whether there is something superficial about such user engagement. When our studies now routinely discover the importance of users, we might also wonder whether we are not merely recording third-hand corporate strategy. The chapter on text-messaging cultures is particularly fine. We knew already (indeed the generalization has become a cliché of our field) that the designers of text messaging did not anticipate its extraordinary popularity. Goggin cites an industry analyst’s retrospective view: “Trying to imagine the same situation today, it is not hard to imagine the average modern executive immediately tearing the SMS concept . . . into pieces” (p. 71). Even now, I do not think we understand the SMS boom of the late 1990s—one billion messages sent between five million Finns certainly needs more explanation than the noting of a landmark agreement between national mobile operators to pass texts between networks. Goggin is an astute collator of secondary sources—drawing, for example, on Eija-Liisa Kasesniemi’s studies this past decade of Finnish text culture, and Raul Pertierra’s and Bella Ellwood-Clayton’s nuanced analyses of the role of text messaging in the downfall of Filipino politician Joseph Estrada. Finally, to provide a very useful corrective case study, Goggin highlights the relative failure of text messaging in Hong Kong. The chapter on how two different disabled groups—the deaf and the blind—have developed mobile cultures is excellent in the way that it combines scholarship (critical disability studies and social and cultural studies of technology) and insight. For the deaf community, text messaging is a way to communicate by telephone without the intervention of a TTY (tele-typewriter) operator. Usage is high and has led to redesigns in the interests of deaf users. In contrast, Goggin writes that mobile technology “has not been imagined or designed with Blind users in mind” (p. 98). It is a thought-provoking comparison. “This is an important research agenda,” writes Goggin, “not only as a matter of human rights and justice but also because these narratives unsettle our taken for granted theories of technology” (p. 102). He is right. Cell Phone Culture does have a few weaknesses. Goggin is guilty of fence-sitting on more than one occasion. He is frustratingly reluctant to pin down the causal relations between cell-phone use and the racist riots...

Understanding the potential role of mobile phone-based monitoring on asthma self-management: qualitative study

Article

Mar 2007

National and international healthcare policy increasingly seeks technological solutions to the challenge of providing care for people with long-term conditions. Novel technologies, however, have the potential to change the dynamics of disease monitoring and self-management. We aimed to explore the opinions and concerns of people with asthma and primary care clinicians on the potential role of mobile phone monitoring technology (transmitting symptoms and peak flows, with immediate feedback of control and reminder of appropriate actions) in supporting asthma self-management. This qualitative study recruited 48 participants (34 adults and teenagers with asthma, 14 asthma nurses and doctors) from primary care in Lothian (Central Scotland) and Kent (South East England). Thirty-nine participated in six focus groups, which included a demonstration of the technology; nine gave in-depth interviews before and after a 4-week trial of the technology. Participants considered that mobile phone-based monitoring systems can facilitate guided self-management although, paradoxically, may engender dependence on professional/technological support. In the early phases, as patients are learning to accept, understand and control their asthma, this support was seen as providing much-needed confidence. During the maintenance phase, when self-management predominates, patient and professionals were concerned that increased dependence may be unhelpful, although they appreciated that maintaining an on-going record could facilitate consultations. Mobile phone-based monitoring systems have the potential to support guided self-management by aiding transition from clinician-supported early phases to effective self-management during the maintenance phase. Continuing development, adoption and formal evaluation of these systems should take account of the insights provided by our data.

Use of text messaging in the aftercare of patients with bulimia nervosa

Article

May 2003
EUR EAT DISORD REV

The development of a text messaging (SMS) based intervention for the aftercare treatment of bulimia nervosa is reported. The programme is offered to bulimic patients for 6 months following discharge from inpatient psychotherapy in a German hospital for psychosomatic medicine. The intervention consists of weekly messages from the patients on their bulimic symptomatology and a corresponding weekly feedback that is a mixture of pre-programmed parts and individually tailored information. An ongoing pilot study is described, designed to investigate the acceptance, the practicability, and the effectiveness of the intervention. Preliminary results indicate that the programme is well-accepted and gives support to bulimic patients after finishing inpatient treatment. Advantages and limitations of the use of the SMS intervention programme in the treatment of bulimia nervosa are discussed. Copyright © 2003 John Wiley & Sons, Ltd and Eating Disorders Association.

Cellular phone transferred self blood glucose monitoring: Prerequisites for positive outcome

Article

Jun 2004
Practical Diabetes Int

The aim of this one-year study was to assess transmission of glucose values by cellular phone in the treatment of type 1 diabetic patients. In total, 100 consecutive patients visiting a diabetes outpatient clinic were given a cellular phone containing a special menu for transmitting blood glucose values to a database. The doctors checked the results once a week and sent a text message to the patients giving instructions. The controls (100 consecutive diabetic patients) received standard treatment. All patients had a routine clinical visit every three months. The phone system worked well technically and none of the patients had any difficulties in transmitting their glucose values. The phone system was not associated with overall improvement in HbA1c, probably due to the patients' low measurement activity. Seven patients who were most active in measuring and transferring glucose values had a better outcome than the rest of the group. Sophisticated electronic systems are not beneficial to all patients, but should be restricted to those having high motivation to use them. Copyright

Comparing Internet and Mobile Phone Usage: Digital Divides of Usage, Adoption, and Dropouts

Article

Sep 2003
TELECOMMUN POLICY

Results from a national representative telephone survey of Americans in 2000 show that Internet and mobile phone usage was very similar, and that several digital divides exist with respect to both Internet and mobile phone usage. The study identifies and analyzes three kinds of digital divides for both the Internet and mobile phones—users/nonuser, veteran/recent, and continuing/dropout—and similarities and differences among those digital divides based on demographic variables. The gap between Internet users and nonusers is associated with income and age, but no longer with gender and race, once other variables are controlled. The gap between mobile phone users and nonusers is associated with income, work status, and marital status. The veteran/recent Internet gap is predicted by income, age, education, phone user, membership in community religious organizations, having children, and gender; for mobile phones, age, work status and marital status are predictors. The gap between continuing and dropout users is predicted by education for Internet usage and income for mobile phone usage. Finally, cross-categorization of Internet and mobile phone usage/nonusage is distinguished (significantly though weakly) primarily by income and education. Thus, there are several digital divides, each predicted by somewhat different variables; and while Internet and mobile phone usage levels in 2000 were about the same, their users overlap but do not constitute completely equivalent populations.

When fingers do the talking: A study of text messaging

Article

Mar 2005

SMS or text messaging is an area of growth in the communications field. The studies described below consisted of a questionnaire and a diary study. The questionnaire was designed to examine texting activities in 565 users of the mobile phone. The diary study was carried out by 24 subjects over a period of 2 weeks. The findings suggest that text messaging is being used by a wide range of people for all kinds of activities and that for some people it is the preferred means of communication. These studies should prove interesting for those examining the use and impact of SMS.

Statistical power ANALYSIS for the Behavioral sciences

Article

Jan 1988
J AM STAT ASSOC

Jacob Cohen

Incluye bibliografía e índice

The doctor will text you now: Is there a role for the mobile telephone in health care?

Article

Mar 2003

Badal Pal

The development of computer-generated tailored interventions

Article

Mar 1999
PATIENT EDUC COUNS

Tailoring information to individual characteristics of a person is a promising line of development of self-help interventions. This article presents a three-phase methodology for developing computer-generated tailored interventions. The first phase of the development concerns the formulation of intervention objectives on the basis of analyses of the cognitive determinants of behavior. The second phase concerns the core of the development of a tailored intervention. For each objective, a so-called tailoring matrix is developed which specifies the individual characteristics to which the message will be adapted to. The tailoring matrices are the basis of the tailored messages and the tailoring questionnaire which will assess the individual characteristics. In the third phase, all the separately written messages must be integrated to one coherent intervention text and the lay-out is designed. This methodology may result in largely different tailored interventions depending on the theoretical framework used, the adaptation of the messages and the inclusion of feedback.

Information technology and the future of preventive medicine - Potential, pitfalls, and policy

Article

Sep 2000
AM J PREV MED

Kevin Patrick

Interactive communication strategies - Implications for population-based physical-activity promotion

Article

Sep 2000
AM J PREV MED

Physical inactivity is a recognized independent risk factor for the development of cardiovascular disease. However, a large proportion of the U.S. population does not participate in regular physical activity, and research has shown that without intervention, most people remain sedentary. Thus, an urgent need exists for developing effective interventions to promote physical-activity adoption and maintenance. Additionally, it is important that these interventions can be disseminated to the large population of sedentary individuals. To be disseminable, physical-activity interventions must move beyond reliance on strictly face-to-face modes and begin to more fully use newer technologies, such as the Internet. This article summarizes the progress made in promoting physical activity with interactive communications. We also delineate areas for future research.

Improving the Quality of Reports of Meta-Analyses of Randomised Controlled Trials: The QUOROM Statement

Article

Mar 2000
REV ESP SALUD PUBLIC

The Quality of Reporting of Meta-analyses (QUOROM) Conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). The QUOROM group consists of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. it is organized into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with 'trial flow', study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.

Understanding the Effects of Printed Health Education Materials: Which Features Lead to Which Outcomes?

Article

Jul 2001

Printed health education materials (HEMs) are widely used to increase awareness and knowledge, change attitudes and beliefs, and help individuals adopt and maintain healthy lifestyle behaviors. While much of the contemporary research and development of persuasive communication is based on McGuire's input/output model, to date few studies have compared the impact of a large set of inputs across a comprehensive set of the 12 outputs. We examined the effects of printed HEMs on weight loss on the cognitive, affective, and behavioral responses of 198 overweight adults. Participants were recruited via a newspaper advertisement and were randomly assigned to review one of three HEMs. Participants were interviewed and asked to complete a series of questionnaires both before and after viewing the HEMs. Regression analyses were conducted to identify the input characteristics associated with success at each of the output steps. The results revealed attractiveness, encouragement, level of information, and application to one's life were significantly associated with early steps (attention, liking, and understanding) as well as some of the mediating steps (recalling, keeping, and rereading HEMs). Later steps, such as intention to change behavior and show others, were associated with readiness to change, self-efficacy, and perceived application to one's life. Behavior change was more likely for those who received tailored materials and those who had higher self-efficacy. These results provide useful direction for the use of computers in tailoring the content of HEMs and the development of effective communication of health information on weight loss.

Mobile phone text messaging can help young people manage asthma [11]

Article

Oct 2002
Br Med J

EDITOR—The main reason why asthma is suboptimally controlled in many young people is that the medicine (inhaled drugs) and the message (education) do not reach their intended target—the lung and the brain. Doctors try to make young people comply with treatment while young people try to make the disease comply with their lifestyle. 1 2 We set up a mobile phone text message service consisting of daily reminders to use an inhaler, health education tips, …

The Efficacy of Tailored Interventions

Article

Dec 2002

To evaluate the efficacy of Tailored Informational Interventions (TIs) compared to Standard Informational Interventions (SIs) and to determine whether efficacy varies by type of behavior, use of feedback, type of delivery channel, dose of the intervention, or time. Cooper's method of literature integration (Cooper, 1989; Cooper & Hedges, 1994) was used. Eighty-five articles were located that contained the word tailoring in the title or abstract; 20 met criteria for inclusion. Participants preferred TIs to SIs, perceived that the TIs were personal, and read and remembered more of the TI information. TIs were more effective than were SIs in 50% of studies. The effects of tailored and standard interventions were equivocal in the remaining 50% of studies. TIs had small increases in effect sizes compared to SIs. The efficacy of TIs differed by type of behavior. TIs had greater efficacy when ipsative feedback (comparing current to past behavior) was included as part of the intervention than when the intervention did not include such feedback. Repeated versus single administration of TIs did not affect health behaviors. The efficacy of TIs changed over time in some studies, but the pattern of change was not consistent. Tailored interventions could be improved by (a) identifying the most salient characteristics to be tailored, (b) further delineating essential components of TIs, (c) determining the efficacy of different delivery channels, (d) determining factors that moderate effects of TIs, and (e) clarifying whether the efficacy of TIs changes over time.

Short Message Service (SMS): A useful communication tool for surgeons

Article

Jun 2002

Extract: Over recent years, mobile phones have gradually become part of our daily life – an essential tool of personal communication. Besides voice calls, mobile phones can be used to send and receive text messages to and from other mobile users. These are known as SMS or short message service. So far, email has served us well in delivering fast communications, but besides being plagued by virus attacks such as the Code Red computer worm (which in July 2001 disrupted 359 000 computers in 14 h1), it also imposes restrictions that SMS is not subjected to. © Copyright Eugene Sherry, Beatrice Colloridi & Patrick H. Warnke, 2002. Journal compilation © Copyright Royal Australasian College of Surgeons, 2002

"Sweet Talk": Text Messaging Support for Intensive Insulin Therapy for Young People with Diabetes

Article

Feb 2003

Optimal diabetes management involves considerable behavioural modification, while nonadherence contributes significantly to poor glycaemia. Extensive research on psychological interventions aiming to improve glycaemia suggests that current strategies are costly and time-consuming and in our experience do not appeal to young people with Type 1 diabetes. Text messaging has rapidly become a socially popular form of communication. It is personal, highly transportable, and widely used, particularly in the adolescent population. However, text messaging coupled with specific behavioural health strategies has yet to be utilised effectively. We have developed a novel support network ("Sweet Talk"), based on a unique text-messaging system designed to deliver individually targeted messages and general diabetes information. Individualised motivation strategies--based on social cognition theory, the health belief model, and goal setting--form the theoretical basis of the message content. Intensifying insulin therapy and increasing contact with the diabetes team can improve control, but are difficult to provide within existing resources. Our support system offers a means of contact and support between clinic visits and aims to increase adherence with intensive insulin regimens and to improve clinical outcome.

Effectiveness of an intervention to provide information to patients with hypertension as short text messages of reminders sent to their mobile phone (HTA-Alert)

Article

Dec 2004

To analyze the effect of an intervention to provide information with mobile phone text messages to patients with hypertension on compliance with therapy for hypertension. Comparative, controlled, multicenter, randomized cluster study. 26 primary care health centers in Spain. 26 researchers were randomized to a control group or an intervention group (52 patients each, for a total of 104 patients). All patients were receiving monotherapy for uncontrolled hypertension. Patients in the control group received their physician's usual interventions. Patients in the intervention group received messages and reminders sent to their mobile phones 2 days per week during 4 months. Tablets were counted and blood pressure was measured at the start of the study and 1, 3, and 6 months later. The percentage of compliers, mean percentage of compliance and degree of control of hypertension were compared. The reduction in absolute and relative risk was calculated, as was the number of individuals needed to treat to avoid noncompliance. The results were evaluated for a total of 67 individuals (34 in the intervention group and 33 in the control group). The rate of compliance was 85.1% (CI, 74.9%-95.3%) overall, 85.7% (CI, 70.5%-100.9%) in the control group and 84.4% in the intervention group (CI, 70.7%-95.3%) (P=NS). Mean percentage compliance was 90.2%+/-16.3% overall, 88.1%+/-20.8% in the control group and 91.9%+/-11.6% in the intervention group (P=NS). The percentage of patients whose hypertension was controlled at the end of the study was 51.5% (CI, 34.4%-68.6%) in the control group and 64.7% (CI, 48.6%-80.8%) in the intervention group (P=NS). The telephone messaging intervention with alerts and reminders sent to mobile phones did not improve compliance with therapy in patients with hypertension.

Development of web-based diabetic patient management system using short message service (SMS)

Article

Jan 2005
DIABETES RES CLIN PR

We developed a blood glucose management system using the Internet and short message service (SMS) which can lessen the social economic burden and materialize an individualized diabetes mellitus management. A total of 185 diabetic patients participated in this study and their mean age was 42.4 years old (8-79 year-old). Participants sent their self-measured blood glucose levels, medication and its dosages, amount of meal, and degree of exercise to their health providers in this specialized web-based diabetes management system for 3 months. The health providers consisting of endocrinology specialists, dietitians, and nurses sent recommendations for individualized diabetes management according to the data on the web. Laboratory tests including lipid profiles and glycated hemoglobin (HbA1c), and a survey of satisfaction about this system were performed before and after the study period. The mean HbA1c improved from 7.5 +/- 1.5 to 7.0 +/- 1.1% after using the management program (P = 0.003). The mean serum triglyceride and HDL-cholesterol levels turned for the better also. HbA1c improved from 8.4 +/- 1.2 to 7.5 +/- 1.0% after applying this program to patients with the HbA1c of 7% or higher at baseline (P = 0.010). We propose this web-based diabetic patient management system as a new tool for communication between health care providers and patients.

Development and effects of a health promotion program utilizing the mail function of mobile phones

Article

Oct 2004
Nippon Koshu Eisei Zasshi Jpn J Publ Health

The purpose of the study was to develop a health education program, named "i-exerM," utilizing the mail function of the mobile phone and affect its effects setting body weight reduction as the achievement target. The i-exerM was developed with 136 adults (28 males and 108 females) living or working in Shizuoka Prefecture, and subscribing to the i-mode of NTT DoCoMo orJ-sky of JPHONE (currently Vodafone), who indicated an interest in participating in a body weight reduction twelve week (between July 15th and October 9th, 2003) program. As-one of the special characteristics of the i-exerM, the subjects were informed once every day via mailing to the mobile phone some new items regarding body weight reduction knowledge and practice. By use of a self-monitoring method, the subjects were asked to register the body weight via internet from time to time. Information for each individual at the start and the end of the i-exerM monitoring session was collected with a questionnaire covering physical conditions, lifestyle and program evaluation, without an meeting with the participants during the program. From this trial result, the enforcement potential of healthy education utilizing the mail function of mobile phones was examined. 1) Those who submitted a questionnaire before the i-exerM start and after the end were 14 adult (50%) males and 69 adult (64%) females. 2) A tendency for reduced body weight was found in 63 (46%) of 136 adults who participated in the i-exerM. Furthermore, average body weights were significantly reduced (P < 0.001) from 73.2 kg to 71.1 kg (males), and from 58.8 kg to 57.6 kg (females). 3) The i-exerM program was evaluated positively, 44 adults (32%) indicating that it was "greatly effective" for "stimulating consideration of body reduction and starting concrete efforts." The success of the current i-exerM program suggests its possible application for chronic disease states such as hypertension and hyperlipidemia.

Feasibility of Collecting Diary Data From Asthma Patients Through Mobile Phones and SMS (Short Message Service): Response Rate Analysis and Focus Group Evaluation From a Pilot Study

Article

Jan 2005
J MED INTERNET RES

Self-management of asthma may improve asthma outcomes. The Internet has been suggested as a tool for the monitoring and self-management of asthma. However, in a recent study we found that a Web interface had some disadvantages and that users stopped using the application after a short while. The primary objective of this study was to evaluate, from a user perspective, the feasibility of using short message service (SMS) for asthma diary data collection through mobile phones. The secondary objective was to investigate patient compliance with an SMS diary, as measured by response rates over time. The study included quantitative response rate data, based on SMS collection, and qualitative data from a traditional focus group setting. In a period of 2 months, the participants received 4 SMS messages each day, including a medication reminder, a request to enter peak flow, data on sleep loss, and medication dosage. Participants were asked to reply to a minimum of 3 of the messages per day. Diary inputs were collected in a database and the response rate per patient was expressed as the number of diary inputs (SMS replies) divided by diary requests (product of number of days in the study and the number of diary questions per day) for each participant. After the study period, the participants were invited to a focus group interview addressing the participants' attitudes to their disease, their experience with the SMS asthma diary, and their future expectations from the SMS asthma diary. Twelve patients with asthma (6 males, 6 females) participated in the data collection study. The median age was 38.5 (range: 13-57) years. The median response rate per patient was 0.69 (range: 0.03-0.98), ie, half the participants reported more than about two thirds of the requested diary data. Furthermore, response rates were relatively steady during the study period with no signs of decreasing usage over time. From the subsequent focus group interview with 9 users we learned that, in general, the participants were enthusiastic about the SMS diary--it became an integrated part of their everyday life. However, the participants wished for a simpler diary with only one SMS message to respond to and a system with a Web interface for system customization and graphical display of diary data history. This study suggests that SMS collection of asthma diary data is feasible, and that SMS may be a tool for supporting the self-management of asthma (and possibly other chronic diseases) in motivated and self-efficacious patients because mobile phones are a part of people's everyday lives and enable active requests for data wherever the patient is. The combination of SMS data collection and a traditional Web page for data display and system customization may be a better and more usable tool for patients than the use of Web-based asthma diaries which suffer from high attrition rates.

Intensity of Mobile Phone Use and Health Com-promising Behaviors—How Is Information and Communication Technology Connected to Health-Related Lifestyle in Adolescence?

Article

Mar 2005

The association of mobile phone use with health compromising behaviours (smoking, snuffing, alcohol) was studied in a survey comprising a representative sample of 14-16-year-olds (N=3485) in 2001. Mobile phone was used by 89% of respondents and by 13% for at least 1h daily. The intensity of use was positively associated with health compromising behaviours. The associations remained, although somewhat reduced, after including weekly spending money in the models. This study concludes that, at least in the present developmental level of communication technologies, intensive mobile phone use seems to be part of the same health-related lifestyle as health compromising behaviours.

New technology and partner notification - Why aren't we using them?

Article

Feb 2005

Partner notification is crucial to the effective control of sexually transmissible infections (STIs) and has not changed substantially over recent years. New technology for communication has been rapidly adopted in our communities but little work has been carried out about its role in contact tracing. Text messaging, emails and the Internet could be useful tools for both provider and patient referral but considerable ethical considerations are involved. Technology is available to help protect the basic tenets of confidentiality and privacy but more thorough exploration of these methods is required to establish efficacy and appropriateness in contact tracing. This research is important if we are to procure an evidence base for future contact tracing strategies rather than allowing these methods to become commonplace at the initiation of our clients.

Failed Appointments in an Orthodontic Clinic

Article

Apr 2005
AM J ORTHOD DENTOFAC

The aim of this study was to retest the hypotheses of Reekie and Devlin (1998) by conducting a similar randomized controlled trial in an orthodontic clinic in the Netherlands. It was hypothesized that a reminder would reduce the failed attendance rate and that the form of the reminder would be irrelevant. All patients with appointments in the orthodontic clinic at the Academic Centre of Dentistry Amsterdam during a 3-week period were divided into 4 groups. Three groups received a reminder 1 day before the appointment, either by telephone, mail, or short message service (SMS, a service used to send and receive short text messages to and from cell phones). A control group did not receive a reminder. In a follow-up study, random subsamples in each group were interviewed by telephone. Subjects were asked how they felt about receiving a reminder and which reminder they preferred. The hypothesis that a reminder would reduce the failed attendance rate was not confirmed. Also, no differences were found between the 4 conditions, indicating that the form of the reminder is irrelevant. However, most of the interviewed participants felt positive or very positive about receiving a reminder. There was a significant preference for a reminder by mail (56.3%), followed by a telephone reminder (26.0%) and a reminder by SMS (17.7%). No less than 20% of the interviewed participants felt negative or very negative about the reminders and considered them to be a waste of time and money. The hypothesis that reminders are useful in the prevention of failed appointments was not confirmed. This study underlines the importance of replication studies. It demonstrates that every research result, whether it is generated by evidence-based or tradition-based research, should be interpreted with care and should be replicated in other studies before the results can be generalized.

Parent-Child Interaction Using a Mobile and Wireless System for Blood Glucose Monitoring

Article

Feb 2005
J MED INTERNET RES

Children with type 1 diabetes and their parents face rigorous procedures for blood glucose monitoring and regulation. Mobile telecommunication systems show potential as an aid for families' self-management of diabetes. A prototype designed to automatically transfer readings from a child's blood glucose monitor to their parent's mobile phone was tested. In this formative stage of development, we sought insights into the appropriateness of the concept, feasibility of use, and ideas for further development and research. During four months, a self-selected sample of 15 children (aged 9 to 15 years) with type 1 diabetes and their parents (n = 30) used the prototype approximately three times daily. Parent and child experiences were collected through questionnaires and through interviews with 9 of the parents. System use was easily integrated into everyday life, and parents valued the sense of reassurance offered by the system. Parents' ongoing struggle to balance control of their children with allowing independence was evident. For children who measured regularly, use appeared to reduce parental intrusions. For those who measured irregularly, however, parental reminders (eg, "nagging") appeared to increase. Although increased reminders could be considered a positive outcome, they can potentially increase parent-child conflict and thus also undermine proper metabolic control. Parents felt that system appropriateness tapered off with the onset of adolescence, partly due to a potential sense of surveillance from the child's perspective that could fuel oppositional behavior. Parental suggestions for further developments included similar alerts of irregular insulin dosages and automatically generated dietary and insulin dosage advice. User enthusiasm suggests that such systems might find a consumer market regardless of whether or not they ultimately improve health outcomes. Thus, more rigorous studies are warranted to inform guidelines for appropriate use. Potentially fruitful approaches include integrating such systems with theory-based parenting interventions and approaches that can aid in interpreting and responding to experiences of surveillance, virtual presence, and balances of power in e-mediated relationships.

Systematic review on communicating with patients about evidence

Article

Mar 2006

To conduct a systematic search for (1) the effectiveness of evidence-based communication tools to increase patient understanding of evidence, (2) effective formats for representing probabilistic information and (3) effective strategies for eliciting patient preferences about evidence. A case scenario is used to illustrate some of the difficulties of putting these results into practice. Systematic search of The Cochrane Library, Medline, Psychinfo, Embase and Cancerlit. Systematic reviews of randomized controlled trials (RCTs) and high quality RCTs were included. Studies were excluded if they did not address the question, were focused on behavioural outcomes without attempting to increase understanding, were concerned with counselling as a therapeutic intervention, or were specific to communication regarding clinical trial participation. We found 10 systematic reviews of RCTs and 30 additional RCTs addressing our questions. Communication tools in most formats (verbal, written, video, provider-delivered, computer-based) will increase patients' understanding but are more likely to do so if structured, tailored and/or interactive. Probabilistic information is best represented as event rates (natural frequencies) in relevant groups of people, rather than words, probabilities or summarized as effect measures such as relative risk reduction. Illustrations such as cartoons, or graphs (vertical bar charts) appear to aid understanding. Values clarification exercises may be better than standard utility techniques for eliciting preferences in individual decision making. Looking for effective evidence-based communication tools for prostatic specific antigen testing highlighted the challenges for clinicians and consumers in accessing tools that are evidence-based in design as well as content. There is an increasing body of evidence supporting the design of effective evidence-based communication tools but variable access to such tools in practice.

A randomized trial of a proactive cellular telephone intervention for smokers living with HIV/AIDS

Article

Feb 2006

To assess the efficacy of an innovative smoking cessation intervention targeted to a multiethnic, economically disadvantaged HIV-positive population. A two-group randomized clinical trial compared a smoking cessation intervention delivered by cellular telephone with usual care approach. Current smokers from a large, inner city HIV/AIDS care center were recruited and randomized to receive either usual care or a cellular telephone intervention. The usual care group received brief physician advice to quit smoking, targeted self-help written materials and nicotine replacement therapy. The cellular telephone intervention received eight counseling sessions delivered via cellular telephone in addition to the usual care components. Smoking-related outcomes were assessed at a 3-month follow-up. The trial had 95 participants and 77 (81.0%) completed the 3-month follow-up assessment. Analyses indicated biochemically verified point prevalence smoking abstinence rates of 10.3% for the usual care group and 36.8% for the cellular telephone group; participants who received the cellular telephone intervention were 3.6 times (95% confidence interval, 1.3-9.9) more likely to quit smoking compared with participants who received usual care (P = 0.0059). These results suggest that individuals living with HIV/AIDS are receptive to, and can be helped by, smoking cessation treatment. In addition, smoking cessation treatment tailored to the special needs of individuals living with HIV/AIDS, such as counseling delivered by cellular telephone, can significantly increase smoking abstinence rates over that achieved by usual care.

A 10-Year Retrospective of Research in New Technologies for Health Communication

Article

Feb 2006

L. Suzanne Suggs

The use of new technologies is growing in virtually all areas of health communication, including consumer, patient, and provider education; decision and social support; health promotion; knowledge transfer; and the delivery of services. Many applications have the potential to make major contributions in meeting the needs of an unhealthy and aging population. Key questions confronting health communication research reflect long-standing concerns about effects of new technology on health knowledge, health behavior, health delivery, and health outcomes. A review of the literature provides useful insights about how technology has been used to communicate health messages and their associated outcomes. Focus is placed on effective health communication, lessons learned, and implications for the future. During the next 10 years, the application of new technologies in health communication will be enriched by a tradition that has evolved to reflect a more dynamic connection between health users and providers. Future applications have the potential to provide cost-effective communications tailored to large numbers of individuals and achieve positive health outcomes. Consequently, we should strive to answer research questions about tailoring communication content, the channel used to deliver the message, and evaluation models that are best suited for examining outcomes of multicomponent tailored, technology-based communication.

Behavior Change Interventions Delivered by Mobile Telephone Short-Message Service

Abstract

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