Review and special articleBehavior Change Interventions Delivered by Mobile Telephone Short-Message Service
Introduction
Recent reviews have focused on the effectiveness of health behavior change interventions delivered via telephone1, 2, 3, 4 and the Internet.5, 6, 7 Researchers have suggested exploring other interactive delivery channels, such as mobile telephone short-message service (SMS),8, 9, 10, 11, 12 but no systematic reviews have been reported to date. The aim of this paper is to review the preliminary evidence of health behavior change interventions delivered via SMS texting.
Mobile telephones and SMS are becoming integrated into virtually all aspects of society.13, 14, 15, 16 In the U.S. in 2007, approximately 7,000,000,000 SMS messages were sent every month.17 In developed countries, use of SMS pervades all age groups,9, 15, 18, 19 cultures,16 and socioeconomic backgrounds.9, 15 This service allows for instantaneous delivery of short messages (maximum 160 characters) directly to individuals at any time, place, or setting. These messages are asynchronous, meaning they can be accessed at a time that suits an individual. Customized SMS messages can be tailored to individuals, which is important given that personally tailored messages are more effective for health behavior change than untailored messages.20, 21, 22, 23, 24 This medium also allows for seamless (and quantifiable) interaction between the participant and the interventionist, so that participant engagement with the intervention can be monitored and compared to exposure. Communication with SMS may also be more cost effective than other telephone or print-based interventions.19, 25
The potential of SMS may be particularly significant among population groups most likely to use mobile telephones as their primary means of communication. The highest level of mobile telephone use is among adolescents, younger adults, socioeconomically disadvantaged populations, less educated young adults, and people who rent or frequently change addresses.26, 27, 28 Further, a high level of mobile telephone use is associated with lower levels of self-rated health,28 higher BMI,29 and engaging in health-compromising behaviors.30 Therefore, SMS presents a prime delivery channel for health behavior change interventions because it has high penetration in populations of lower sociodemographic position and populations with poorer health.
The application of SMS for behavioral intervention is new. However, there are established research agendas for using SMS to remind patients of scheduled medical appointments,31, 32, 33, 34, 35 coordinate medical staff,25 deliver medical test results,36, 37, 38 and monitor patient side effects following treatment.39 This review analyzes the application of SMS for delivering health behavior change interventions to establish what can be learned from research conducted to date and make recommendations for future research.
Section snippets
Evidence Acquisition
An electronic database search of MEDLINE, PubMed, ERIC, Web of Science, and PsycINFO was conducted for studies published between January 1990 and March 2008. The search terms included: mobile telephone or cell phone, SMS or text message, health, health intervention, and behavior. The search was limited to English. For inclusion in the review, studies had to evaluate an intervention delivered primarily via SMS to change a health behavior in any population group and have at least a pre–post
Study Designs
Six63, 65, 67, 69, 72, 73 of the 14 studies were RCTs (Table 1). One study was a clustered randomized comparative trial74; one was a randomized crossover trial70; and the other six64, 66, 68, 71, 75, 76 were single group, pre–post design studies. Intervention length ranged from 6 weeks64 to 1 year.67, 69 None of the 14 studies collected follow-up data beyond the end of the intervention period. Most studies used objective and validated measures to assess intervention outcomes. Three studies63, 64
Discussion
This review draws together the preliminary evidence of delivering health behavior change interventions via SMS. Most studies conducted to date have focused on clinical care interventions, using SMS as a reminder to increase adherence to treatment programs among sick individuals. Fewer studies have focused on promoting preventive health behaviors to healthy individuals through SMS. Of the 14 SMS reviewed interventions, 13 demonstrated positive behavior changes, although some studies were too
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