Behavior Change Interventions Delivered by Mobile Telephone Short-Message Service

School of Psychology, The University of Queensland, Qld, Australia.
American journal of preventive medicine (Impact Factor: 4.53). 03/2009; 36(2):165-73. DOI: 10.1016/j.amepre.2008.09.040
Source: PubMed


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.

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Available from: Brianna S Fjeldsoe,
    • "The vast majority of teens presenting to the ED, however, use mobile phones [10] [11], and more than 95% of teen ED patients using mobile phones report that they use text messaging [11] [12]. Text message-based behavioral interventions have been shown to be acceptable, valid, and reliable with adolescents for a variety of sensitive topics [4] [13]. "
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    ABSTRACT: Mobile psychological interventions are of growing interest, particularly for populations with little access to traditional mental health services. Optimum structural components of these interventions are unknown. In this study, twenty-one adolescents (age 13-17) with past two week depressive symptoms were recruited from the emergency department to participate in a semi-structured interview, to inform development of a text-message-based depression prevention intervention. Teens expressed conflict about intervention structure. Although trust and reliability were essential to sustain engagement, teens disagreed about how to best maintain reliability, whether the program should be 'pushed' or 'pulled', and what the ideal degree of human interaction would be. These findings highlight the challenges in automating psychological interventions that are normally delivered face-to-face. Data indicate a broad desire for developing tailoring methods for system design (duration, frequency, and level of interactivity). The paper closes with thoughts about potential solutions to these structural issues for mobile psychological interventions.
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    • "Researchers have studied how best to deliver health messages and engage people in healthy behavior. Fjeldsoe et al. (2009) analyzed 33 studies that involve using mobile phone short-­message service (SMS) to deliver behavior change interventions. They found that SMS-­delivered interventions have positive short-­term behavioral outcomes, but the studies also did not control for the timing of intervention messages or the number of messages. "

    iConference, Newport Beach, CA; 03/2015
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    • "Although lifestyle interventions can reduce blood pressure in prehypertension and prevent progression to hypertension, current primary care systems in the region lack of effective health promotion programs. Mobile health strategies have been shown to improve patient provider communication , encourage behavior change, and assist in chronic disease management (Fjeldsoe et al. 2009; Cole-Lewis and Kershaw 2012). Additionally, it has been shown that positive results occur in chronic disease outcomes in low-and middleincome countries (LMICs) where NCDs constitute a major component of the disease burden (Beratarrechea et al. 2014; Krishna et al. 2009; Glassman et al. 2010). "
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    ABSTRACT: The present study describes the processes related to the implementation of mHealth interventions for lifestyle modification in a randomized controlled trial conducted with prehypertensive subjects in Argentina, Guatemala, and Peru from low-resource settings. In the intervention group, participants received, during the course of a year, a monthly counseling call from a trained caller and a one-way weekly tailored short message service (SMS) to promote lifestyle modification. We evaluated reach, fidelity, dose, and attrition to assess how the intervention was implemented. 637 prehypertensives were included in the study, 321 in the control and 316 in the intervention group. Fifty-three percent were women with a mean age of 43.4 ± 8.4 years. Ninety-eight percent of the participants assigned to the mHealth arm were reached. The mean number of calls that had to be made to conduct a counseling call in prehypertensive subjects was 3.29 ± 1.55 (3.15 ± 1.54 in Argentina, 2.58 ± 0.96 in Guatemala and 4.12 ± 1.65 in Peru). The overall median number of counseling calls was six (IQR 4–8) with no differences observed across the countries. With regard to SMS, 58.3 % of the participants reported that they received the SMS. Attrition rate was 13 % (24 % in Argentina, 10.5 % in Guatemala, and 4.7 % in Peru). The delivery of the intervention was challenging in the three countries with differences among them in process results. Process evaluation methods and metrics are useful to assess whether the intervention program was delivered as planned.
    Technologies for Development, What is essential?, Edited by S. Hostettler et al, 01/2015: chapter Challenges of Implementing mHealth Interventions for Lifestyle Modification in Prehy: pages 119'127; Springer International Publishing., ISBN: 978-3-319-16246-1
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