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Digital Interventions for Behaviour Change (Cole-Lewis & Kershaw…

- - - - Intervention length ranged from 3 months to 12 months, and, for all studies, follow-up was conducted at baseline and immediately after the intervention. Some studies included intermediate follow-up times, but none had long-term follow-up that extended beyond completion of the intervention. Frequency of text messaging varied greatly, ranging from once weekly to 5 times per day or more.
      - Other features used to tailor messages to individuals included using a participant’s nickname, allowing participants to write their own reminder messages, and incorporating information specific to personal goals, culture, gender, age, or current health status. One study was unique in that patients never received the same message twice (Raab et al. 2009)
      - Most studies had an interactive component that requested input via text messaging from the participant; only 2 were unidirectional
      - In all studies, text messaging was initiated by the researcher with the exception of one disease prevention
      - Text messaging was the only intervention component in 5 studies whereas others included supplementary components such as e-mail and the Internet. Only one of the disease prevention studies provided an additional tool for patient self-monitoring.
      - The majority of the studies (8) found evidence of a short-term effect regarding a behavioral or clinical outcome related to disease prevention and management. Of those that found no evidence of effect, only one had sufficient power to detect an effect in the primary outcome. Evidence for text messaging in disease prevention and management interventions was observed for weight loss, smoking cessation, and diabetes management. Effects appeared to exist among adolescents and adults, among minority and nonminority populations, and across nationalities.
        
        Supported by Fjeldsoe et al. 2009 : 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.
    - - Despite the strengths of text messaging highlighted in this review, some weaknesses should also be noted. A potential drawback to the use of text-message-based mHealth interventions is potential marginalization of certain populations, such as those that are illiterate or do not have access to a mobile phone for financial reasons. However, these limitations may be reduced as mobile technology advances.
      - Another potential limitation of mHealth is that delivery of interventions can be interrupted if the mobile phone is stolen or lost. However, the same limitations exist with many other forms of communication (e.g., postal mail may be delivered to the wrong address, e-mail boxes may be too full to receive messages).
- - - - interventions explicitly addressing forgetfulness,
        especially for preventative therapies such as oral
        contraception, are not only few and far between, but also
        tend to focus on reminders alerting people to take their
        medication at a specified time (Vervolet et al. 2012)
        
        This focus on timed
        alerts disregards the fact that time-based tasks are more
        difficult to remember than tasks related to routine actions
        [34] and many medication regimens are habitual tasks that
        could be easily incorporated into a daily routine, which in
        itself also supports remembering.