Cellular phone and Internet-based individual intervention on blood pressure and obesity in obese patients with hypertension

Making sense of personal health information: challenges for information visualization

This article presents a systematic review of the literature on information visualization for making sense of personal health information. Based on this review, five application themes were identified: treatment planning, examination of patients' medical records, representation of pedigrees and family history, communication and shared decision making, and life management and health monitoring. While there are recognized design challenges associated with each of these themes, such as how best to represent data visually and integrate qualitative and quantitative information, other challenges and opportunities have received little attention to date. In this article, we highlight, in particular, the opportunities for supporting people in better understanding their own illnesses and making sense of their health conditions in order to manage them more effectively.

Internet programs targeting multiple lifestyle interventions in primary and secondary care are not superior to usual care alone in improving cardiovascular risk profile: a systematic review

OBJECTIVE

To review the effects of Internet delivered multiple modifiable lifestyle interventions complementary to usual care on cardiovascular risk factors in the primary and secondary healthcare setting.

METHOD

PubMed, EMBASE.com, CINAHL, PsycINFO, and the Cochrane Library were searched up to June 2012 for English written studies that 1) addressed multiple lifestyle interventions, 2) used Internet intervention through websites or email, 3) included at least one usual care group not using Internet, 4) aimed to improve any of cardiovascular risk factors and 5) targeted patients aged 18 or older.

RESULTS

Our systematic search yielded 1857 citations of which 9 were selected for this review. Three studies reported significant differences in weight loss in favor of the intervention group and five studies reported non-significant differences between groups. From the 7 studies reporting on blood pressure (BP) measurements, two found significant improvement in favor of the intervention group, while the other studies found no significant differences. Only one study found a significant improvement of LDL-C in the intervention group compared to usual care. Another study found a significant improvement of HDL-C in the usual care group compared to the intervention group.

CONCLUSION

The addition of a multiple modifiable lifestyle Internet intervention in primary or secondary care is not superior to usual care with respect to prevention and treatment of cardiovascular risk factors. However, an Internet delivered program does have the potential of being successful in reducing the number of doctor's visits and may therefore be cost-effective when applied in large scale.

Web-based interventions in nursing

With recent advances in computer and Internet technologies and high funding priority on technological aspects of nursing research, researchers at the field level began to develop, use, and test various types of Web-based interventions. Despite high potential impacts of Web-based interventions, little is still known about Web-based interventions in nursing. In this article, to identify strengths and weaknesses of Web-based nursing interventions, a literature review was conducted using multiple databases with combined keywords of "online," "Internet" or "Web," "intervention," and "nursing." A total of 95 articles were retrieved through the databases and sorted by research topics. These articles were then analyzed to identify strengths and weaknesses of Web-based interventions in nursing. A strength of the Web-based interventions was their coverage of various content areas. In addition, many of them were theory-driven. They had advantages in their flexibility and comfort. They could provide consistency in interventions and require less cost in the intervention implementation. However, Web-based intervention studies had selected participants. They lacked controllability and had high dropouts. They required technical expertise and high development costs. Based on these findings, directions for future Web-based intervention research were provided.

A lifestyle intervention supported by mobile health technologies to improve the cardiometabolic risk profile of individuals at risk for cardiovascular disease and type 2 diabetes: study rationale and protocol

BACKGROUND

Metabolic syndrome is a cluster of cardiovascular risk factors that greatly increase the risk of developing cardiovascular disease and type 2 diabetes. Regular exercise improves the risk profile, but most people do not successfully change their exercise habits to beneficially reduce risk. Tailored exercise prescribed by a family physician has shown promise as a means to increase fitness and reduce cardiometabolic risk, but optimal implementation practices remain unknown. Mobile health technologies have proved to be a beneficial tool to achieve blood pressure and blood glucose control in patients with diabetes. These technologies may address the limited access to health interventions in rural and remote regions. However, the potential as a tool to support exercise-based prevention activities is not well understood. This study was undertaken to investigate the effects of a tailored exercise prescription alone or supported by mobile health technologies to improve metabolic syndrome and related cardiometabolic risk factors in rural community-dwelling adults at risk for cardiovascular disease and type 2 diabetes.

METHODS/DESIGN

Adults (n = 149) with at least two metabolic syndrome risk factors were recruited from rural communities and randomized to either: 1) an intervention group receiving an exercise prescription and devices for monitoring of risk factors with a smartphone data portal equipped with a mobile health application; or 2) an active control group receiving only an exercise prescription. All participants reported to the research centre at baseline, and at 12-, 24- and 52-week follow-up visits for measurement of anthropometrics and blood pressure and for a blood draw to test blood-borne markers of cardiometabolic health. Vascular and autonomic function were examined. Fitness was assessed and exercise prescribed according to the Step Test and Exercise Prescription protocol.

DISCUSSION

This study tested the effects of a prescriptive exercise intervention alone, versus one supported by mobile health technology on cardiometabolic risk factors. The intervention was designed to be translated into clinical or community-based programming. Results will contribute to the current literature by investigating the utility of mobile health technology support for exercise prescription interventions to improve cardiometabolic risk status and maintain improvements over time; particularly in rural communities.

TRIAL REGISTRATION

CLINICAL TRIALS REGISTRATION

NCT01944124.

Feasibility and effectiveness of an automated bilingual text message intervention for weight loss: pilot study

Background

Little is known about the feasibility and acceptability of tailored text message based weight loss programs for English and Spanish-language speakers.

Objective

This pilot study evaluated the feasibility, acceptability, and estimated impact of a tailored text message based weight loss program for English and Spanish-language speakers. The purpose of this pilot study was to inform the development of a full-scale randomized trial.

Methods

There were 20 overweight or obese participants (mean age 40.10, SD 8.05; 8/20, 40% male; 9/20, 45% Spanish-speakers) that were recruited in San Diego, California, from March to May 2011 and evaluated in a one-group pre/post clinical trial. For 8 weeks, participants received and responded to 3-5 text messages daily sent from a fully automated text messaging system. They also received printed weight loss materials and brief 10-15 minute weekly counseling calls. To estimate the impact of the program, the primary outcome was weight (kg) measured during face-to-face measurement visits by trained research staff. Pre and post differences in weight were analyzed with a one-way repeated measures analysis of variance. Differences by language preference at both time points were analyzed with t tests. Body mass index and weight management behaviors also were examined. Feasibility and acceptability were determined by recruitment success, adherence (ie, percentage of replies to interactive text messages and attrition), and participant satisfaction.

Results

Participants who completed the final assessment (N=18) decreased body weight by 1.85 kg (F_1,17=10.80, P=.004, CI_∆ 0.66-3.03, η²=0.39). At both time points, there were no differences in weight by language preference. Participants responded to 88.04% (986/1120) of interactive text messages, attrition rate was 10% (2/20), and 94% (19/20) of participants reported satisfaction with the program.

Conclusions

This fully automated text message based weight program was feasible with English and Spanish-speakers and may have promoted modest weight loss over an 8-week period.

Trial Registration

Clinicaltrials.gov NCT01171586; http://clinicaltrials.gov/ct2/show/NCT01171586 (Archived by WebCite at http://www.webcitation.org/6Ksr6dl7n).

User-centered development of a smart phone mobile application delivering personalized real-time advice on sun protection

Smart phones are changing health communication for Americans. User-centered production of a mobile application for sun protection is reported. Focus groups (n = 16 adults) provided input on the mobile application concept. Four rounds of usability testing were conducted with 22 adults to develop the interface. An iterative programming procedure moved from a specification document to the final mobile application, named Solar Cell. Adults desired a variety of sun protection advice, identified few barriers to use and were willing to input personal data. The Solar Cell prototype was improved from round 1 (seven of 12 tasks completed) to round 2 (11 of 12 task completed) of usability testing and was interoperable across handsets and networks. The fully produced version was revised during testing. Adults rated Solar Cell as highly user friendly (mean = 5.06). The user-centered process produced a mobile application that should help many adults manage sun safety.

Human-centred methods in the design of an e-health solution for patients undergoing weight loss treatment

BACKGROUND AND OBJECTIVE

Patients undergoing weight loss treatment require follow-up as part of the treatment process. E-health solutions may be used for this purpose. We have used an iterative design approach to develop a patient-centred e-health solution for patients undergoing weight loss treatment. Our objective is to describe and report on the design process and suggest implications for human-centred design of such systems.

METHODS

Human-centred design methods were assessed as part of the design process. The process involved a field study to gain domain knowledge, followed by needs assessment through a series of participatory design workshops, and system evaluation through a workshop and a number of usability tests before system implementation.

RESULTS

By using an iterative design approach and by involving patients and healthcare professionals throughout the process, letting them hold the roles as informants, design partners, testers and users, we could reveal important aspects throughout the design process that are crucial for system realization and user acceptance. We found that weight loss patients are vulnerable, requiring that designers take special care when involving them in the design process. Our findings imply that involving stakeholders separately during specific human-centred activities is important in order to capture subtle, but critical aspects of the users' requirements.

CONCLUSION

Applying human-centred methods in the design of e-health solutions requires that designers must take particular considerations when patients and healthcare professionals are involved in the design process.

Reducing blood pressure with Internet-based interventions: a meta-analysis

BACKGROUND

Elevated blood pressure is a leading risk factor for cardiovascular disease and mortality. Internet-based interventions (e-counselling) have the potential to deliver a wide range of preventive counselling services. The purpose of this review was to (1) assess the efficacy of e-counselling in reducing blood pressure and (2) identify key components of successful trials in order to highlight factors that may contribute significantly to blood pressure control.

METHODS

MEDLINE, PubMed, EMBASE, PsycINFO, and the Cochrane Library were searched up to June 2012 with the following key words: Web-based, Internet-based, e-counselling, mobile health, blood pressure, and hypertension. Trials were selected in which blood pressure was reported as a primary or secondary outcome and whose participants had baseline systolic and diastolic blood pressure within the prehypertensive (120-139/80-89 mm Hg) or hypertensive (≥ 140/90 mm Hg) range.

RESULTS

The search strategy identified 13 trials, and the mean reduction of systolic and diastolic blood pressure was -3.8 mm Hg (95% confidence interval [Cl], -5.63 to -2.06 mm Hg; P < 0.01) and -2.1 mm Hg (95% CI, -3.51 to -0.65 mm Hg; P < 0.05), respectively. The greatest magnitude of blood pressure reduction was found for interventions that lasted 6 months or longer, used 5 or more behavior change techniques, or delivered health messages proactively.

CONCLUSION

Research on preventive e-counselling for blood pressure reduction is at an early stage of development. This review provides preliminary evidence of blood pressure reduction with Internet-based interventions. Future studies need to evaluate the contribution of specific intervention components in order to establish a best practice e-counselling protocol that is efficacious in reducing blood pressure.

Short message service (SMS) text messaging as an intervention medium for weight loss: A literature review

Nearly 68% of American adults are obese or overweight. Mobile devices such as mobile phones have emerged as a mode of intervention delivery to help people improve their health, particularly in relation to weight loss. This literature review examines the relationship between the use of short message service (SMS) text messaging as an intervention medium and weight loss. Results from this literature review (n = 14) suggest that SMS as an intervention tool for weight loss is still in its infancy. Initial results are promising but continued investigation is needed. We offer several recommendations for future research.

Efficacy of a programme for workers with metabolic syndrome based on an e-health system in the workplace: a pilot study

We tested the efficacy of the Healthy Workplace programme for metabolic syndrome. A total of 226 workers with metabolic syndrome from 12 companies enrolled in the study and completed baseline and 6-month follow-up. The Healthy Workplace programme consisted of a 4-week structured education module, telephone counselling, mobile phone messages (SMS) and email messages in the ensuing 6 months. The main outcome measures of the pre-post study were waist circumference, high-density lipoprotein (HDL) cholesterol, triglycerides, blood pressure (BP) and glucose levels. At follow-up, waist circumference and diastolic BP were significantly reduced compared to baseline. Triglyceride and fasting glucose levels improved significantly 6 months after the study. At 6-month follow-up, manifest risk factors for metabolic syndrome had disappeared in 9% of the participants. The integrated Healthy Workplace programme encouraged workers to improve self-care behaviours.

Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people

BACKGROUND

The World Health Organization (WHO) estimates that the number of obese or overweight individuals worldwide will increase to 1.5 billion by 2015. Chronic diseases associated with overweight or obesity include diabetes, heart disease, hypertension and stroke.

OBJECTIVES

To assess the effects of interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people.

SEARCH METHODS

We searched several electronic databases, including CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO, through 25 May 2011. We also searched clinical trials registries to identify studies. We scanned reference lists of included studies and relevant systematic reviews.

SELECTION CRITERIA

Studies were included if they were randomized controlled trials or quasi-randomized controlled trials that evaluated interactive computer-based weight loss or weight maintenance programs in adults with overweight or obesity. We excluded trials if the duration of the intervention was less than four weeks or the loss to follow-up was greater than 20% overall.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted study data and assessed risk of bias. Where interventions, control conditions, outcomes and time frames were similar between studies, we combined study data using meta-analysis.

MAIN RESULTS

We included 14 weight loss studies with a total of 2537 participants, and four weight maintenance studies with a total of 1603 participants. Treatment duration was between four weeks and 30 months. At six months, computer-based interventions led to greater weight loss than minimal interventions (mean difference (MD) -1.5 kg; 95% confidence interval (CI) -2.1 to -0.9; two trials) but less weight loss than in-person treatment (MD 2.1 kg; 95% CI 0.8 to 3.4; one trial). At six months, computer-based interventions were superior to a minimal control intervention in limiting weight regain (MD -0.7 kg; 95% CI -1.2 to -0.2; two trials), but not superior to infrequent in-person treatment (MD 0.5 kg; 95% -0.5 to 1.6; two trials). We did not observe consistent differences in dietary or physical activity behaviors between intervention and control groups in either weight loss or weight maintenance trials. Three weight loss studies estimated the costs of computer-based interventions compared to usual care, however two of the studies were 11 and 28 years old, and recent advances in technology render these estimates unlikely to be applicable to current or future interventions, while the third study was conducted in active duty military personnel, and it is unclear whether the costs are relevant to other settings. One weight loss study reported the cost-effectiveness ratio for a weekly in-person weight loss intervention relative to a computer-based intervention as USD 7177 (EUR 5678) per life year gained (80% CI USD 3055 to USD 60,291 (EUR 2417 to EUR 47,702)). It is unclear whether this could be extrapolated to other studies. No data were identified on adverse events, morbidity, complications or health-related quality of life.

AUTHORS' CONCLUSIONS

Compared to no intervention or minimal interventions (pamphlets, usual care), interactive computer-based interventions are an effective intervention for weight loss and weight maintenance. Compared to in-person interventions, interactive computer-based interventions result in smaller weight losses and lower levels of weight maintenance. The amount of additional weight loss, however, is relatively small and of brief duration, making the clinical significance of these differences unclear.

Seizure diaries for clinical research and practice: limitations and future prospects

PURPOSE

An NINDS-sponsored conference in April of 2011 reviewed issues in epilepsy clinical trials. One goal was to clarify new electronic methods for recording seizure information and other data in clinical trials.

METHODS

This selective literature review and compilation of expert opinion considers advantages and limitations of traditional paper-based seizure diaries in comparison to electronic diaries.

KEY FINDINGS

Seizure diaries are a type of patient-reported outcome. All seizure diaries depend first on accurate recognition and recording of seizures, which is a problem since about half of seizures recorded during video-EEG monitoring are not known to the patient. Reliability of recording is another key issue. Diaries may not be at hand after a seizure, lost or not brought to clinic visits. On-line electronic diaries have several potential advantages over paper diaries. Smartphones are increasingly accessible as data entry gateways. Data are not easily lost and are accessible from clinic. Entries can be time-stamped and provide immediate feedback, validation or reminders. Data can also can be graphed and pasted into an EMR. Disadvantages include need for digital sophistication, higher cost, increased setup time, and requiring attention to potential privacy issues. The Epilepsy Diary by epilepsy.com and Irody, Inc. has over 13,000 registrants and SeizureTracker over 10,000, and both are used for clinical and research purposes. Some studies have documented patient preference and increased compliance for electronic versus paper diaries. Seizure diaries can be challenging in the pediatric population. Children often have multiple seizure types and limited reporting of subjective symptoms. Multiple caregivers during the day require more training to produce reliable and consistent data. Diary-based observational studies have the advantages of low cost, allowing locus-of-control by the patient and testing in a "real-world" environment. Diary-based studies can also be useful as descriptive "snapshots" of a population. However, the type of information available is very different from that obtained by prospective controlled studies. The act of self-recording observations may itself influence the observation, for example, by causing the subject to attend more vigilantly to seizures after changing medication. Pivotal anti-seizure drug or device trials still mostly rely on paper-based seizure diaries. Industry is aware of the potential advantages of electronic diaries, particularly, the promise of real-time transmission of data, time-stamping of entries, reminders to subjects, and potentially automatic interfaces to other devices. However, until diaries are validated as research tools and the regulatory environment becomes clearer, adoption of new types of diaries as markers for a primary study outcome will be cautious.

SIGNIFICANCE

Recommendations from the conference included: further studies of validity of epilepsy diaries and how they can be used to improve adherence; use and further development of core data sets, such as the one recently developed by NINDS; encouraging links of diaries to electronic sensors; development of diary privacy and legal policies; examination of special pediatric diary issues; development of principles for observational research from diaries; and work with the FDA to make electronic diaries more useful in industry-sponsored clinical trials.

Evaluation of mobile phone and Internet intervention on waist circumference and blood pressure in post-menopausal women with abdominal obesity

PURPOSE

The present study evaluated whether an intervention using a short message service (SMS) by personal cellular phone and Internet would reduce cardiovascular risk factors in post-menopausal women with abdominal obesity over 12 weeks.

METHODS

This is a quasi-experimental design with pre and post tests. Participants were recruited from the gynecology outpatient and family medicine departments of a tertiary care hospital located in an urban city of South Korea. Only 67 subjects completed the entire study, 34 in the intervention group and 33 controls. The goal of intervention was to reduce waist circumference (WC), body weight (BW) and blood pressure (BP) levels. Before the intervention, demographic variables, WC, BW, BP, fasting plasma glucose (FPG) and serum lipids were measured as pre-test data. The WC, BW, BP, FPG and serum lipids were measured again 12 weeks later. Patients in the intervention group were requested to record their WC, BW, BP, type and amount of diet and exercise in a weekly web-based diary through the Internet or by cellular phone. The researchers sent weekly recommendations on diet and exercise as an intervention to each patient, by both cellular phone and Internet. The intervention was applied for 12 weeks.

RESULTS

WC and BW significantly decreased by 3.0 cm and 2.0 kg, respectively, at 12 weeks compared with the baseline in the intervention group. However, the mean changes in the control group significantly increased by 0.9 cm and 0.7 kg. Systolic BP (SBP) and diastolic BP (DBP) significantly decreased by 6.5 and 4.6 mmHg in the intervention group, respectively. The mean changes in the control group were not significant in either SBP or DBP. A significant mean decrease in total cholesterol (TC) was observed for the intervention group by 12.9 mg/dl, while the control group showed a significant mean increase by 1.5mg/dl. Low-density lipoprotein-cholesterol (LDL-C) for the intervention group showed a significant mean decrease 11.3mg/dl. The mean change in the control group was, however, not significant.

CONCLUSION

Web-based individual intervention using both SMS and Internet improved WC, BW, BP, TC, and LDL-C during 12 weeks in post-menopausal women with abdominal obesity.

The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy

Team-based care is one of the key components of the patient-centered medical home. Studies have consistently demonstrated that teams involving pharmacists or nurses in patient management can significantly improve blood pressure control. These findings have been demonstrated in several meta-analyses and systematic reviews. These reviews have generally found that team-based care can reduce systolic blood pressure by 4-10 mm Hg over usual care. However, these reviews have also concluded that many of the studies had various limitations and that additional research should be conducted. The present state of the art review paper will highlight newer studies, many of which were funded by the National Institutes of Health. Newer strategies involve telephone and/or web-based management which is an evolving area to improve blood pressure control in large populations. Social media and other technology is currently being investigated to assist pharmacists or nurses in communicating with patients to improve hypertension management. Few cost-effectiveness analyses have been performed but generally have found favorable costs for team-based care when considering the potential to reduce morbidity and mortality. The authors will suggest additional research that needs to be conducted to help evaluate strategies to best implement team-based care to improve blood pressure management.

U-health service for managing chronic disease: a case study on managing metabolic syndrome in a health center in South Korea

OBJECTIVES

We were to analyze the effect of managing metabolic syndrome using a u-health service in a health center.

METHODS

We collected biometric data from 316 subjects living in a county (gun) in South Korea before and after the introduction of uhealth services in 2010. Analysis was done by contingency table using SPSS and latent growth model using AMOS.

RESULTS

We found that regional u-health services affected instance of metabolic syndrome. Further, biometrics and health behavior improved. After six months of u-health services, the number of subjects with three or more factors for metabolic syndrome decreased by 62.5%; 63.3% of regular drinkers stopped drinking; 83.3% of subjects who rarely exercised began to exercise twice a week or more; and 60.9% of smokers stopped smoking.

CONCLUSIONS

U-health services can change health behavior and biometrics to manage metabolic syndrome in rural areas. The usefulness of u-health services is discussed.

Healthcare in the pocket: mapping the space of mobile-phone health interventions

Mobile phones are becoming an increasingly important platform for the delivery of health interventions. In recent years, researchers have used mobile phones as tools for encouraging physical activity and healthy diets, for symptom monitoring in asthma and heart disease, for sending patients reminders about upcoming appointments, for supporting smoking cessation, and for a range of other health problems. This paper provides an overview of this rapidly growing body of work. We describe the features of mobile phones that make them a particularly promising platform for health interventions, and we identify five basic intervention strategies that have been used in mobile-phone health applications across different health conditions. Finally, we outline the directions for future research that could increase our understanding of functional and design requirements for the development of highly effective mobile-phone health interventions.

Impact of home blood pressure telemonitoring and blood pressure control: a meta-analysis of randomized controlled studies

BACKGROUND

Home blood pressure telemonitoring figures among the possible solutions that could help improve blood pressure control of hypertensive patients. To summarize the effectiveness of home blood pressure telemonitoring on blood pressure control from randomized, controlled studies.

METHODS

Electronic databases were searched for publications in English, reporting on randomized trials of home blood pressure telemonitoring vs. usual care. Outcome measures were office or ambulatory blood pressure changes, rate of blood pressure control, and number of antihypertensive drugs used by patients. A random effects model was applied.

RESULTS

Twelve studies met inclusion criteria. A high level of heterogeneity was found among studies for all the variables explored. Office blood pressure was reduced significantly more in patients randomized to home telemonitoring (systolic: 5.64 (95% confidence interval: 7.92, 3.36) mm Hg; diastolic: 2.78 (3.93, 1.62) mm Hg; 11 comparisons, n = 4,389). The effect on ambulatory blood pressure was smaller than on office blood pressure (systolic: 2.28 (4.32, 0.24); diastolic: 1.38 (3.55, +0.79) mm Hg; 3 comparisons, n = 655). The relative risk of blood pressure normalization (<140/90 mm Hg nondiabetics and <130/80 mm Hg diabetics) in the telemonitoring vs. the usual care group was 1.31 (1.06, 1.62) (5 comparisons, n = 2,432 subjects). Use of telemonitoring was associated with a significantly increased use of antihypertensive medications (+0.22 (+0.02, +0.43), 5 comparisons, n = 1,991).

CONCLUSIONS

Home blood pressure telemonitoring may represent a useful tool to improve blood pressure control. However, heterogeneity of published studies suggests that well designed, large-scale, randomized, controlled studies are still needed to demonstrate the clinical usefulness of this technique.

Increasing clinical presence of mobile communication technology: avoiding the pitfalls

Mobile communication technologies are employed in many diverse areas of healthcare delivery to provide improved quality and efficiency of communication and facilitate increased rapidity of data or information transfer. Mobile phones enable healthcare professionals to possess a portable platform from which to provide many healthcare-related applications and are a popular means to directly communicate with colleagues and patients. As involvement of mobile communication technology in healthcare delivery continues to rapidly expand, there are also important considerations of relevance to patient safety and security as a result. Here, we review the previous evidence of reported clinical risks associated with mobile communication technology, such as electromagnetic interference, confidentiality and data security, distraction/noise, infection control, and cross contamination. In conclusion, although mobile phones provide much putative potential improvement to healthcare delivery, further evaluation and research are required to both inform and protect health professionals and users of such technology in the healthcare environment and provide the evidence base to support the provision of clear and comprehensive guidelines.

Text messaging in health care: a systematic review of impact studies

BACKGROUND

Studies suggest text messaging is beneficial to health care; however, no one has synthesized the overall evidence on texting interventions. In response to this need, we conducted a systematic review of the impacts of text messaging in health care.

METHODS

PubMed database searches and subsequent reference list reviews sought English-language, peer-reviewed studies involving text messaging in health care. Commentaries, conference proceedings, and feasibilities studies were excluded. Data was extracted using an article coding sheet and input into a database for analysis.

RESULTS

Of the 61 papers reviewed, 50 articles (82%) found text messaging had a positive effect on the primary outcome. Average sample sizes in articles reporting positive findings (n=813) were significantly larger than those that did not find a positive impact (n=178) on outcomes (p = 0.032). Articles were categorized into focal groups as follows: 27 articles (44.3%) investigated the impact of texting on disease management, 24 articles (39.3%) focused texting's impact to public health related outcomes, and 10 articles (16.4%) examined texting and its influence on administrative processes. Articles in focal groups differed by the purpose of the study, direction of the communication, and where they were published, but not in likelihood of reporting a positive impact from texting.

CONCLUSIONS

Current evidence indicates that text messaging health care interventions are largely beneficial clinically, in public health related uses, and in terms of administrative processes. However, despite the promise of these findings, literature gaps exist, especially in primary care settings, across geographic regions and with vulnerable populations.