Text Messaging as a Tool for Behavior Change in Disease Prevention and Management

Abstract

Mobile phone text messaging is a potentially powerful tool for behavior change because it is widely available, inexpensive, and instant. This systematic review provides an overview of behavior change interventions for disease management and prevention delivered through text messaging. Evidence on behavior change and clinical outcomes was compiled from randomized or quasi-experimental controlled trials of text message interventions published in peer-reviewed journals by June 2009. Only those interventions using text message as the primary mode of communication were included. Study quality was assessed by using a standardized measure. Seventeen articles representing 12 studies (5 disease prevention and 7 disease management) were included. Intervention length ranged from 3 months to 12 months, none had long-term follow-up, and message frequency varied. Of 9 sufficiently powered studies, 8 found evidence to support text messaging as a tool for behavior change. Effects exist across age, minority status, and nationality. Nine countries are represented in this review, but it is problematic that only one is a developing country, given potential benefits of such a widely accessible, relatively inexpensive tool for health behavior change. Methodological issues and gaps in the literature are highlighted, and recommendations for future studies are provided.

Alcohol and disadvantaged men: A feasibility trial of an intervention delivered by mobile phone

“…This was achieved with disadvantaged men, who commonly have lower engagement in research 10 and are more likely to be lost to follow up 66, 67. Mobile phone‐delivered interventions that tackle adverse health behaviours typically have retention rates of 70–90% 26, 27, 29, so the present study ranks among the highest. This may have been because of the use of evidence‐based retention techniques, particularly the use of financial incentives 61, 68, 69.…”

“…A series of interactive text messages and images were designed (by DWF) using messaging theory 46, 47, 48, social cognition models 49, systematic reviews of interventions to tackle alcohol problems 7, 8, 9 and systematic reviews of text message intervention studies 26, 27, 29. The intervention adopted a motivational interviewing approach of helping individuals to decide for themselves that they wish to change, rather than advising them to change 50.…”

“…An emerging literature is beginning to provide a solid theoretical and empirical basis for intervention design 24. A variety of techniques have been used: tailoring of text messages to the target group, making texts interactive, information giving, individually tailored advice, self‐monitoring of the behaviour to be changed and goal setting 13, 25, 26, 27, 28. An important recommendation is to vary the number and timing of text messages to fit the target behaviour.…”

Mobile Health - An Effective Nutrition Communication Tool

“…Health promotion campaigns using mHealth technologies most frequently make use of text messaging technology to send information on pertinent health issues to target populations. [15] Health-related functions of text messaging interventions can include health behaviour reminders, prompts to schedule or confirm an appointment, notification of a laboratory result or health status report, requests for data, encouragement to engage in positive behaviours, or information and resources to improve self-efficacy. The goal of these interventions is to promote efficiencies in care management practices and, ultimately, improve individual and population health outcomes.…”

“…[6] A systematic review of the literature on disease management and prevention services delivered through text messages found evidence to support text messaging as a tool for behaviour change in eight of nine studies with sufficient sample sizes. [7] In this study, the information, education and communication (IEC) approaches were being used to reach the target groups where nutrition education platform has been produced in the form of text messages integrated with mobile communication. The idea was to provide an alternative choice of media which is already popular among college students to impart nutrition education instead of usual nutrition education practices.…”