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Choi Y, Ibrahim S, Park LP, Bukusi EA, Huchko MJ. The impact of text message reminders on cryotherapy uptake among women testing positive for HPV in western Kenya: a prospective cohort study. BMC Womens Health 2024; 24:32. [PMID: 38218782 PMCID: PMC10787999 DOI: 10.1186/s12905-023-02842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/13/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) has become an increasingly popular strategy to improve healthcare delivery and health outcomes. Communicating results and health education via text may facilitate program planning and promote better engagement in care for women undergoing human papillomavirus (HPV) screening. We sought to develop and evaluate an mHealth strategy with enhanced text messaging to improve follow-up throughout the cervical cancer screening cascade. METHODS Women aged 25-65 participated in HPV testing in six community health campaigns (CHCs) in western Kenya as part of a single arm of a cluster-randomized trial. Women received their HPV results via text message, phone call, or home visit. Those who opted for text in the first four communities received "standard" texts. After completing the fourth CHC, we conducted two semi-structured focus group discussions with women to develop an "enhanced" text strategy, including modifying the content, number, and timing of texts, for the subsequent two communities. We compared the overall receipt of results and follow-up for treatment evaluation among women in standard and enhanced text groups. RESULTS Among 2368 women who were screened in the first four communities, 566 (23.9%) received results via text, 1170 (49.4%) via phone call, and 632 (26.7%) via home visit. In the communities where enhanced text notification was offered, 264 of the 935 screened women (28.2%) opted for text, 474 (51.2%) opted for phone call, and 192 (20.5%) for home visit. Among 555 women (16.8%) who tested HPV-positive, 257 (46.3%) accessed treatment, with no difference in treatment uptake between the standard text group (48/90, 53.3%) and the enhanced text group (22/41, 53.7%). More women in the enhanced text group had prior cervical cancer screening (25.8% vs. 18.4%; p < 0.05) and reported living with HIV (32.6% vs. 20.2%; p < 0.001) than those in the standard text group. CONCLUSIONS Modifying the content and number of texts as an enhanced text messaging strategy was not sufficient to increase follow-up in an HPV-based cervical cancer screening program in western Kenya. A one-size approach to mHealth delivery does not meet the needs of all women in this region. More comprehensive programs are needed to improve linkage to care to further reduce structural and logistical barriers to cervical cancer treatment.
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Affiliation(s)
- Yujung Choi
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | | | - Lawrence P Park
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Megan J Huchko
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
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2
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Choi Y, Ibrahim S, Park LP, Bukusi EA, Huchko MJ. The impact of text message reminders on uptake of cryotherapy among women testing positive for HPV in western Kenya. RESEARCH SQUARE 2023:rs.3.rs-2828978. [PMID: 37333183 PMCID: PMC10274960 DOI: 10.21203/rs.3.rs-2828978/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Mobile health (mHealth) has become an increasingly popular strategy to improve healthcare delivery and health outcomes. Communicating results and health education via text may facilitate program planning and promote better engagement in care for women undergoing human papillomavirus (HPV) screening. We sought to develop and evaluate an mHealth strategy with enhanced text messaging to improve follow-up throughout the cervical cancer screening cascade. Methods Women aged 25-65 participated in HPV testing in six community health campaigns (CHCs) in western Kenya. Women received their HPV results via text message, phone call, or home visit. Those who opted for text in the first four communities received "standard" texts. After completing the fourth CHC, we conducted two focus group discussions with women to develop an "enhanced" text strategy, including modifying the content, number, and timing of texts, for the subsequent two communities. We compared the overall receipt of results and follow-up for treatment evaluation among women in standard and enhanced text groups. Results Among 2,368 women who were screened in the first four communities, 566 (23.9%) received results via text, 1,170 (49.4%) via phone call, and 632 (26.7%) via home visit. In the communities where enhanced text notification was offered, 264 of the 935 screened women (28.2%) opted for text, 474 (51.2%) opted for phone call, and 192 (20.5%) for home visit. Among 555 women (16.8%) who tested HPV-positive, 257 (46.3%) accessed treatment, with no difference in treatment uptake between the standard text group (48/90, 53.3%) and the enhanced text group (22/41, 53.7%). More women in the enhanced text group had prior cervical cancer screening (25.8% vs. 18.4%; p < 0.05) and reported living with HIV (32.6% vs. 20.2%; p < 0.001) than those in the standard text group. Conclusions Modifying the content and number of texts as an enhanced text messaging strategy was not sufficient to increase follow-up in an HPV-based cervical cancer screening program in western Kenya. A one-size approach to mHealth delivery does not meet the needs of all women in this region. More comprehensive programs are needed to improve linkage to care to further reduce structural and logistical barriers to cervical cancer treatment.
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Pedrana AE, Pina J, Padmawati RS, Zuhrina R, Lazuardi L, Lim MSC, Hellard ME, Prabandari YS. A quasi-experimental text messaging trial to improve adolescent sexual and reproductive health and smoking knowledge in Indonesia. Sex Health 2021; 17:167-177. [PMID: 32017868 DOI: 10.1071/sh18199] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 09/09/2019] [Indexed: 11/23/2022]
Abstract
Background To evaluate the feasibility and acceptability of a text message intervention to improve young people's knowledge of sexual reproductive health (SRH) and harms related to smoking in Indonesia. METHODS A quasi-experimental short message service (SMS) trial of young people aged 16-24 years receiving twice weekly SMS over a 10-week intervention period. Pre- and post-online demographic and risk behaviour surveys were used to assess changes in knowledge. Among respondents who completed both surveys, we assessed changes in knowledge before and after SMS intervention using paired McNemar's test and differences in mean knowledge score using a paired t-test. RESULTS In total, 555 eligible young people were enrolled into the SMS intervention; 235 (42%) completed a follow-up survey, of which 198 (84%) were matched to a baseline survey. Median age of participants was 19 years and the majority were female (63%). The mean knowledge score significantly increased between baseline and follow-up surveys for SRH questions [2.7, (95% CI 2.47, 2.94) vs 3.4 (95% CI 2.99, 3.81) (P = <0.01)] and smoking-related questions [3.8 (95% CI 3.66, 3.99) vs 4.1 (95% CI 3.99, 4.28) (P = 0.03)]. A majority of participants reported that the SMS intervention increased their knowledge (95%) and were a useful reminder (95%). CONCLUSIONS An SMS intervention was feasible, acceptable and improved adolescents' SRH knowledge and smoking knowledge in a low- to middle-income setting. SMS interventions targeting young people need to be scaled up, with the potential to explore additional topics around healthy lifestyle, nutrition and physical activity.
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Affiliation(s)
- Alisa E Pedrana
- Disease Elimination, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia; and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia; and Corresponding Author.
| | - Jamie Pina
- Public Health Informatics Program, RTI International, Waltham, MA 02452, USA
| | - Retna S Padmawati
- Department of Health Behavior, Environment Health and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogjakarta 55281, Indonesia; and Center of Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Ririh Zuhrina
- Department of Health Behavior, Environment Health and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogjakarta 55281, Indonesia
| | - Lutfan Lazuardi
- SIMKES - Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogjakarta 55281, Indonesia
| | - Megan S C Lim
- Disease Elimination, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia; and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia; and Melbourne School of Population and Global Health, University of Melbourne, Vic. 3010, Australia
| | - Margaret E Hellard
- Disease Elimination, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia; and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia; and Melbourne School of Population and Global Health, University of Melbourne, Vic. 3010, Australia
| | - Yayi S Prabandari
- Department of Health Behavior, Environment Health and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogjakarta 55281, Indonesia; and Center of Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
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4
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Carrotte ER, Webb M, Flego A, Vincent B, Heath J, Blanchard M. Acceptability, Safety, and Resonance of the Pilot Digital Suicide Prevention Campaign "Better Off With You": Qualitative Study. JMIR Form Res 2021; 5:e23892. [PMID: 33656441 PMCID: PMC7970163 DOI: 10.2196/23892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/14/2020] [Accepted: 01/17/2021] [Indexed: 01/26/2023] Open
Abstract
Background The Interpersonal Theory of Suicide posits that there are three key elements of suicidal behavior: perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. The digital campaign Better Off With You was developed to directly challenge the idea of perceived burdensomeness among people who are contemplating suicide in 2 communities within Australia. Objective The aim of this study is to explore the needs and preferences of people with lived experience of suicidal thoughts and actions to inform the development of Better Off With You. Methods This study involved a series of focus groups that aimed to discuss campaign messaging, scope, and approach. People with lived experience of suicidal thoughts and actions attended the focus groups. After the completion of initial focus groups, the results informed the creation of campaign collateral by creative agencies. Early versions of the campaign collateral were then presented in the user testing sessions. Transcriptions were analyzed via thematic analysis. Results In total, 13 participants attended the focus groups and 14 attended the user testing sessions. The following three overarching themes were presented: acceptability, safety, and resonance. Participants believed that suicide is a serious and ongoing issue in their communities and welcomed a localized suicide prevention focus via peer-to-peer storytelling. The idea of perceived burdensomeness required clarification but was perceived as acceptable and relevant. Participants seemed drawn toward peer narratives that they perceived to be authentic, genuine, and believable as given by real people with lived experience. Campaign messaging needs to be clear and empathetic while directly talking about suicide. Participants did not anticipate any significant negative or harmful impact from any campaign videos and highlighted the importance of providing appropriate help-seeking information. Conclusions This iterative study provided important insights and knowledge about peer-to-peer storytelling in suicide prevention campaigns. Future campaigns should involve simple messaging, be validating and empathetic, and consider including a lived experience perspective.
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Affiliation(s)
| | - Marianne Webb
- Anne Deveson Research Centre, SANE Australia, South Melbourne, Australia
| | - Anna Flego
- Anne Deveson Research Centre, SANE Australia, South Melbourne, Australia
| | - Bonnie Vincent
- Anne Deveson Research Centre, SANE Australia, South Melbourne, Australia
| | - Jack Heath
- Anne Deveson Research Centre, SANE Australia, South Melbourne, Australia
| | - Michelle Blanchard
- Anne Deveson Research Centre, SANE Australia, South Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
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Howards PP, Mink PJ, Kim KH, Woodard JJ, Mertens AC. Comparison of Young Adult Female Cancer Survivors Recruited from a Population-Based Cancer Registry to Eligible Survivors. Cancer Epidemiol Biomarkers Prev 2021; 30:727-735. [PMID: 33531434 DOI: 10.1158/1055-9965.epi-20-1409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/18/2020] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Population-based cancer registries provide a resource to recruit young adult cancer survivors who may not be easily identified otherwise. METHODS We compared demographic and cancer-related characteristics of participants in a cohort of female young adult cancer survivors to those of eligible survivors in the Georgia Cancer Registry, a population-based registry in the United States. We examined associations between survivor characteristics and nonparticipation using logistic regression and associations between survivor characteristics and different types of nonparticipation (refusal, unable to contact, or unresolved vs. interviewed) using polytomous regression. RESULTS The Georgia Cancer Registry was able to contact 60% of eligible women (3,061/5,137). Of those, 78% agreed to study contact (n = 2,378), and of those, 56% were interviewed (n = 1,342). Participation was similar across age at contact and at diagnosis but varied across cancer type from 17% for cervical cancer to 32% for breast cancer. White women were slightly more likely to be interviewed (28%) than African American women (23%), which was mostly attributable to greater difficulty in contacting African American women (odds ratio 1.7, 95% confidence interval: 1.5-2.1). CONCLUSIONS The greatest challenge to recruiting women was contacting them, which differed across some but not all demographic and cancer-related characteristics. When successfully contacted, most survivors agreed to participate. IMPACT Population-based cancer registries can serve as an invaluable resource to recruit representative samples of young adult cancer survivors, who are otherwise difficult to identify.
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Affiliation(s)
- Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Pamela J Mink
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Health Economics Program, Minnesota Department of Health, Saint Paul, Minnesota
| | - Konny H Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jill J Woodard
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ann C Mertens
- Emory University, School of Medicine, Department of Pediatrics, Atlanta, Georgia
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Bogale B, Mørkrid K, O'Donnell B, Ghanem B, Abu Ward I, Abu Khader K, Isbeih M, Frost M, Baniode M, Hijaz T, Awwad T, Rabah Y, Frøen JF. Development of a targeted client communication intervention to women using an electronic maternal and child health registry: a qualitative study. BMC Med Inform Decis Mak 2020; 20:1. [PMID: 31906929 PMCID: PMC6945530 DOI: 10.1186/s12911-019-1002-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Targeted client communication (TCC) using text messages can inform, motivate and remind pregnant and postpartum women of timely utilization of care. The mixed results of the effectiveness of TCC interventions points to the importance of theory based interventions that are co-design with users. The aim of this paper is to describe the planning, development, and evaluation of a theory led TCC intervention, tailored to pregnant and postpartum women and automated from the Palestinian electronic maternal and child health registry. METHODS We used the Health Belief Model to develop interview guides to explore women's perceptions of antenatal care (ANC), with a focus on high-risk pregnancy conditions (anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, and fetal growth restriction), and untimely ANC attendance, issues predefined by a national expert panel as being of high interest. We performed 18 in-depth interviews with women, and eight with healthcare providers in public primary healthcare clinics in the West Bank and Gaza. Grounding on the results of the in-depth interviews, we used concepts from the Model of Actionable Feedback, social nudging and Enhanced Active Choice to compose the TCC content to be sent as text messages. We assessed the acceptability and understandability of the draft text messages through unstructured interviews with local health promotion experts, healthcare providers, and pregnant women. RESULTS We found low awareness of the importance of timely attendance to ANC, and the benefits of ANC for pregnancy outcomes. We identified knowledge gaps and beliefs in the domains of low awareness of susceptibility to, and severity of, anemia, hypertension, and diabetes complications in pregnancy. To increase the utilization of ANC and bridge the identified gaps, we iteratively composed actionable text messages with users, using recommended message framing models. We developed algorithms to trigger tailored text messages with higher intensity for women with a higher risk profile documented in the electronic health registry. CONCLUSIONS We developed an optimized TCC intervention underpinned by behavior change theory and concepts, and co-designed with users following an iterative process. The electronic maternal and child health registry can serve as a unique platform for TCC interventions using text messages.
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Affiliation(s)
- Binyam Bogale
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian O'Donnell
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Buthaina Ghanem
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Itimad Abu Ward
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Khadija Abu Khader
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Mervett Isbeih
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Michael Frost
- Health Information Systems Program, Department of Informatics, University of Oslo, Oslo, Norway
| | - Mohammad Baniode
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | | | - Tamara Awwad
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Yousef Rabah
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
- Center for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
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Ricci-Cabello I, Bobrow K, Islam SMS, Chow CK, Maddison R, Whittaker R, Farmer AJ. Examining Development Processes for Text Messaging Interventions to Prevent Cardiovascular Disease: Systematic Literature Review. JMIR Mhealth Uhealth 2019; 7:e12191. [PMID: 30924790 PMCID: PMC6460311 DOI: 10.2196/12191] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/27/2018] [Accepted: 01/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background Interventions delivered by mobile phones have the potential to prevent cardiovascular disease (CVD) by supporting behavior change toward healthier lifestyles and treatment adherence. To allow replication and adaptation of these interventions across settings, it is important to fully understand how they have been developed. However, the development processes of these interventions have not previously been systematically examined. Objective This study aimed to systematically describe and compare the development process of text messaging interventions identified in the Text2PreventCVD systematic review. Methods We extracted data about the development process of the 9 interventions identified in the Text2PreventCVD systematic review. Data extraction, which was guided by frameworks for the development of complex interventions, considered the following development stages: intervention planning, design, development, and pretesting. Following data extraction, we invited the developers of the interventions to contribute to our study by reviewing the accuracy of the extracted data and providing additional data not reported in the available publications. Results A comprehensive description of the development process was available for 5 interventions. Multiple methodologies were used for the development of each intervention. Intervention planning involved gathering information from stakeholder consultations, literature reviews, examination of relevant theory, and preliminary qualitative research. Intervention design involved the use of behavior change theories and behavior change techniques. Intervention development involved (1) generating message content based on clinical guidelines and expert opinions; (2) conducting literature reviews and primary qualitative research to inform decisions about message frequency, timing, and level of tailoring; and (3) gathering end-user feedback concerning message readability, intervention acceptability, and perceived utility. Intervention pretesting involved pilot studies with samples of 10 to 30 participants receiving messages for a period ranging from 1 to 4 weeks. Conclusions The development process of the text messaging interventions examined was complex and comprehensive, involving multiple studies to guide decisions about the scope, content, and structure of the interventions. Additional research is needed to establish whether effective messaging systems can be adapted from work already done or whether this level of development is needed for application in other conditions and settings.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Balearic Islands Health Research Institute, Palma de Mallorca, Spain.,Atención Primaria Mallorca, IB-Salut, Palma de Mallorca, Spain.,Ciber de Epidemiologia y Salud Publica, Madrid, Spain
| | - Kirsten Bobrow
- Chronic Disease Initiative for Africa, Cape Town, South Africa.,Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Radcliffe Observatory Quarter, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.,National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Andrew J Farmer
- Radcliffe Observatory Quarter, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Moodley J, Constant D, Botha MH, van der Merwe FH, Edwards A, Momberg M. Exploring the feasibility of using mobile phones to improve the management of clients with cervical cancer precursor lesions. BMC WOMENS HEALTH 2019; 19:2. [PMID: 30616579 PMCID: PMC6322222 DOI: 10.1186/s12905-018-0702-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/20/2018] [Indexed: 12/26/2022]
Abstract
Background Cancer screening programs hold much potential for reducing the cervical cancer disease burden in developing countries. The aim of this study was to determine the feasibility of mobile health (mHealth) phone technology to improve management and follow-up of clients with cervical cancer precursor lesions. Methods A sequential mixed methods design was employed for this study. Quantitative data was collected using a cross-sectional survey of 364 women eligible for a Pap smear at public sector health services in Cape Town, South Africa. Information was collected on socio-demographic status; cell phone ownership and patterns of use; knowledge of cervical cancer prevention; and interest in Pap smear results and appointment reminders via SMS-text messages. Descriptive statistics, crude bivariate comparisons and logistic regression models were employed to analyze survey results. Qualitative data was collected through 10 in-depth interviews with primary health care providers and managers involved in cervical cancer screening. Four focus group discussions with 27 women attending a tertiary level colposcopy clinic were also conducted. Themes related to loss of mobile phones, privacy and confidentiality, interest in receiving SMS-text messages, text language and clinic-based management of a SMS system are discussed. Thematic analyses of qualitative data complemented quantitative findings. Results Phone ownership amongst surveyed women was 98% with phones mostly used for calls and short message service (SMS) functions. Over half (58%) of women reported loss/theft of mobile phones. Overall, there was interest in SMS interventions for receiving Pap smear results and appointment reminders. Reasons for interest, articulated by both providers and clients, included convenience, cost and time-saving benefits and benefits of not taking time off work. However, concerns were expressed around confidentiality of SMS messages, loss/theft of mobile phones, receiving negative results via SMS and accessibility/clarity of language used to convey messages. Responsibility for the management of a clinic-based SMS system was also raised. Conclusions Results indicated interest and potential for mHealth interventions in improving follow-up and management of clients with abnormal Pap smears. Health system and privacy issues will need to be addressed for mHealth to achieve this potential. Next steps include piloting of specific SMS messages to test feasibility and acceptability in this setting.
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Affiliation(s)
- Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa. .,Women's Health Research Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Anzio Road. Observatory, Cape Town, 7925, South Africa. .,SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Anzio Road. Observatory, Cape Town, 7925, South Africa.
| | - Deborah Constant
- Women's Health Research Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Anzio Road. Observatory, Cape Town, 7925, South Africa
| | - Matthys H Botha
- Unit for Gynaecological Oncology, Tygerberg Academic Hospital and Stellenbosch University, Stellenbosch, South Africa
| | - Frederick H van der Merwe
- Unit for Gynaecological Oncology, Tygerberg Academic Hospital and Stellenbosch University, Stellenbosch, South Africa
| | - Amanda Edwards
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Mariette Momberg
- Women's Health Research Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Anzio Road. Observatory, Cape Town, 7925, South Africa
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Design and development of a complex narrative intervention delivered by text messages to reduce binge drinking among socially disadvantaged men. Pilot Feasibility Stud 2018; 4:105. [PMID: 29992038 PMCID: PMC5989343 DOI: 10.1186/s40814-018-0298-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/15/2018] [Indexed: 12/02/2022] Open
Abstract
Background Socially disadvantaged men are at high risk of suffering from alcohol-related harm. Disadvantaged groups are less likely to engage with health promotion. There is a need for interventions that reach large numbers at low cost and which promote high levels of engagement with the behaviour change process. The aim of this study was to design a theoretically and empirically based text message intervention to reduce binge drinking by socially disadvantaged men. Results Following MRC guidance, the intervention was developed in four stages. Stage 1 developed a detailed behaviour change strategy based on existing literature and theory from several areas. These included the psychological theory that would underpin the intervention, alcohol brief interventions, text message interventions, effective behaviour change techniques, narratives in behaviour change interventions and communication theory. In addition, formative research was carried out. A logic model was developed to depict the pathways between intervention inputs, processes and outcomes for behaviour change. Stage 2 created a narrative which illustrated and modelled key steps in the strategy. Stage 3 rendered the intervention into a series of text messages and ensured that appropriate behavioural change techniques were incorporated. Stage 4 revised the messages to ensure comprehensive coverage of the behaviour change strategy and coherence of the narrative. It also piloted the intervention and made final revisions to it. Conclusions The structured, systematic approach to design created a narrative intervention which had a strong theoretical and empirical basis. The use of a narrative helped make the intervention realistic and allowed key behaviour change techniques to be modelled by characters. The narrative was intended to promote engagement with the intervention. The intervention was rendered into a series of short text messages, and subsequent piloting showed they were acceptable in the target group. Delivery of an intervention by text message offers a low-cost, low-demand method that can reach large numbers of people. This approach provides a framework for the design of behaviour change interventions which could be used for interventions to tackle other health behaviours. Electronic supplementary material The online version of this article (10.1186/s40814-018-0298-0) contains supplementary material, which is available to authorized users.
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Adebamowo SN, Francis V, Tambo E, Diallo SH, Landouré G, Nembaware V, Dareng E, Muhamed B, Odutola M, Akeredolu T, Nerima B, Ozumba PJ, Mbhele S, Ghanash A, Wachinou AP, Ngomi N. Implementation of genomics research in Africa: challenges and recommendations. Glob Health Action 2018; 11:1419033. [PMID: 29336236 PMCID: PMC5769805 DOI: 10.1080/16549716.2017.1419033] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/08/2017] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There is exponential growth in the interest and implementation of genomics research in Africa. This growth has been facilitated by the Human Hereditary and Health in Africa (H3Africa) initiative, which aims to promote a contemporary research approach to the study of genomics and environmental determinants of common diseases in African populations. OBJECTIVE The purpose of this article is to describe important challenges affecting genomics research implementation in Africa. METHODS The observations, challenges and recommendations presented in this article were obtained through discussions by African scientists at teleconferences and face-to-face meetings, seminars at consortium conferences and in-depth individual discussions. RESULTS Challenges affecting genomics research implementation in Africa, which are related to limited resources include ill-equipped facilities, poor accessibility to research centers, lack of expertise and an enabling environment for research activities in local hospitals. Challenges related to the research study include delayed funding, extensive procedures and interventions requiring multiple visits, delays setting up research teams and insufficient staff training, language barriers and an underappreciation of cultural norms. While many African countries are struggling to initiate genomics projects, others have set up genomics research facilities that meet international standards. CONCLUSIONS The lessons learned in implementing successful genomics projects in Africa are recommended as strategies to overcome these challenges. These recommendations may guide the development and application of new research programs in low-resource settings.
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Affiliation(s)
- Sally N. Adebamowo
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for Bioethics and Research, Ibadan, Nigeria
| | - Veronica Francis
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ernest Tambo
- Sydney Brenner Institute of Molecular Bioscience, University of Witwatersrand, Johannesburg, South Africa
| | - Seybou H. Diallo
- Faculté de Médecine et d’Odonstomatologie, Université des Sciences, des Techniques, et des Technologies de Bamako, Bamako, Mali
| | - Guida Landouré
- Faculté de Médecine et d’Odonstomatologie, Université des Sciences, des Techniques, et des Technologies de Bamako, Bamako, Mali
| | - Victoria Nembaware
- Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Eileen Dareng
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Primary Care and Public Health, University of Cambridge, Cambridge, UK
| | - Babu Muhamed
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Cardiovascular Genetics, Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael Odutola
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Teniola Akeredolu
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Barbara Nerima
- National Livestock Resources Research Institute, Tororo, Uganda
| | - Petronilla J. Ozumba
- Clinical Lab Molecular Virology Unit, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Slee Mbhele
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Anita Ghanash
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ablo P. Wachinou
- National Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin Republic
| | - Nicholas Ngomi
- Health Challenges and Systems program, African Population and Health Research Center, Nairobi, Kenya
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11
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Hales S, Turner-McGrievy GM, Wilcox S, Davis RE, Fahim A, Huhns M, Valafar H. Trading pounds for points: Engagement and weight loss in a mobile health intervention. Digit Health 2017; 3:2055207617702252. [PMID: 29942590 PMCID: PMC6001249 DOI: 10.1177/2055207617702252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 02/20/2017] [Indexed: 12/14/2022] Open
Abstract
Objective The objective of this study was to describe participant engagement and examine predictors of weight loss and points earned through the point-based incentive system of the Social Pounds Off Digitally (POD) app. Materials and methods Overweight and obese adults with Android smartphones/tablets (body mass index 25-49.9 kg/m2; N = 24) were recruited for a 3-month weight loss intervention. Participants completed a survey assessing demographics and personality and had their weight measured. Participants received the content of the intervention via podcasts and used the Social POD app to self-monitor diet, physical activity, and weight. The Social POD app contained: tracking features; in-app notifications to track; pre-set goals for tracking; newsfeed for updates on others' goal attainment; ability to earn and track points for usage (exchanged for study-provided prizes); and a message screen. Analyses examined relationships between percent weight loss, personality characteristics, and total points earned. Results A total of 4843 points were earned (mean = 202 ± 105 points/participant). Most participants earned all three prizes (62.5%), followed by two prizes (21%), no prizes (12.5%), and one prize (4%). Total points earned significantly predicted percent weight loss (B = -0.02, p = .01), and higher conscientiousness significantly predicted greater total points earned (B = 10.27, p = .01), but other personality characteristics assessed did not. Conclusion A mobile app yielded moderately high participant engagement, as demonstrated by points earned. Earning points was significantly associated with percent weight loss, and conscientiousness was significantly associated with total points earned. Future research should examine whether point systems impact health behavior and weight loss when rewards are discontinued. Clinical trial registration number NCT02344836.
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Affiliation(s)
- Sarah Hales
- Health Promotion, Education, and Behavior, University of South Carolina, USA.,Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
| | | | - Sara Wilcox
- Exercise Science, University of South Carolina, USA.,Prevention Research Center, University of South Carolina, USA
| | - Rachel E Davis
- Health Promotion, Education, and Behavior, University of South Carolina, USA
| | - Arjang Fahim
- Computer Science and Engineering, University of South Carolina, USA
| | - Michael Huhns
- Computer Science and Engineering, University of South Carolina, USA
| | - Homayoun Valafar
- Computer Science and Engineering, University of South Carolina, USA
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12
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Mermelstein H, Guzman E, Rabinowitz T, Krupinski E, Hilty D. The Application of Technology to Health: The Evolution of Telephone to Telemedicine and Telepsychiatry: A Historical Review and Look at Human Factors. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s41347-017-0010-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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13
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Wright CJC, Leinberger K, Lim MSC. Challenges to translating new media interventions in community practice: a sexual health SMS program case study. Health Promot J Austr 2017; 27:70-73. [PMID: 26480819 DOI: 10.1071/he15057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 08/27/2015] [Indexed: 11/23/2022] Open
Abstract
Issue addressed Herein we discuss translational challenges for new media interventions, using the Sexual Health & Youth (SHY) short message service (SMS) project to illustrate particular challenges relating to recruitment and evaluation. Methods Following the delivery of an SMS sexual health program, available documents (progress reports, communications with project staff, ethics submissions and reporting) were analysed thematically to elucidate the barriers to recruitment, implementation and evaluation. Results Despite being framed by evidence-based research, the project had little impact on the intended population. Only 119 of an expected 5100 young people (2%) enrolled to receive SMS messages. Program documents highlighted the difficulty of recruiting participants for new media interventions. Key issues identified in recruitment included under-resourcing, delays waiting to receive ethics approval and challenges of school-based recruitment. Conclusion The minimal impact of the SHY program illustrates the need for improved research translation in the field of new media interventions. It is important that recruitment procedures align with the convenience and appeal of mobile phone-based interventions. So what? New media research is not always easily translated into community settings. Large-scale recruitment requires adequate resourcing and careful planning, even for low-cost mobile interventions. Stronger formative research, documentation and use of partnerships are essential for successful implementation. Researchers must also consider translation in planning and disseminating their work.
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Affiliation(s)
- Cassandra J C Wright
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Kaytlyn Leinberger
- headspace Central West Gippsland, 99 Buckley Street, Morwell, Vic. 3840, Australia
| | - Megan S C Lim
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
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14
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Thiha P, Pisani AR, Gurditta K, Cherry E, Peterson DR, Kautz H, Wyman PA. Efficacy of Web-Based Collection of Strength-Based Testimonials for Text Message Extension of Youth Suicide Prevention Program: Randomized Controlled Experiment. JMIR Public Health Surveill 2016; 2:e164. [PMID: 27829575 PMCID: PMC5121531 DOI: 10.2196/publichealth.6207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/20/2016] [Accepted: 10/12/2016] [Indexed: 12/31/2022] Open
Abstract
Background Equipping members of a target population to deliver effective public health messaging to peers is an established approach in health promotion. The Sources of Strength program has demonstrated the promise of this approach for “upstream” youth suicide prevention. Text messaging is a well-established medium for promoting behavior change and is the dominant communication medium for youth. In order for peer ‘opinion leader’ programs like Sources of Strength to use scalable, wide-reaching media such as text messaging to spread peer-to-peer messages, they need techniques for assisting peer opinion leaders in creating effective testimonials to engage peers and match program goals. We developed a Web interface, called Stories of Personal Resilience in Managing Emotions (StoryPRIME), which helps peer opinion leaders write effective, short-form messages that can be delivered to the target population in youth suicide prevention program like Sources of Strength. Objective To determine the efficacy of StoryPRIME, a Web-based interface for remotely eliciting high school peer leaders, and helping them produce high-quality, personal testimonials for use in a text messaging extension of an evidence-based, peer-led suicide prevention program. Methods In a double-blind randomized controlled experiment, 36 high school students wrote testimonials with or without eliciting from the StoryPRIME interface. The interface was created in the context of Sources of Strength–an evidence-based youth suicide prevention program–and 24 ninth graders rated these testimonials on relatability, usefulness/relevance, intrigue, and likability. Results Testimonials written with the StoryPRIME interface were rated as more relatable, useful/relevant, intriguing, and likable than testimonials written without StoryPRIME, P=.054. Conclusions StoryPRIME is a promising way to elicit high-quality, personal testimonials from youth for prevention programs that draw on members of a target population to spread public health messages.
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Affiliation(s)
- Phyo Thiha
- Department of Computer Science, University of Rochester, Rochester, NY, United States
| | - Anthony R Pisani
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States.,Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Kunali Gurditta
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Erin Cherry
- Northrop Grumman, Huntsville, AL, United States
| | - Derick R Peterson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Henry Kautz
- Department of Computer Science, University of Rochester, Rochester, NY, United States
| | - Peter A Wyman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
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15
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Huang ETY, Williams H, Hocking JS, Lim MS. Safe Sex Messages Within Dating and Entertainment Smartphone Apps: A Review. JMIR Mhealth Uhealth 2016; 4:e124. [PMID: 27826133 PMCID: PMC5120239 DOI: 10.2196/mhealth.5760] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 08/24/2016] [Accepted: 10/12/2016] [Indexed: 12/20/2022] Open
Abstract
Background Smartphone apps provide a new platform for entertainment, information distribution, and health promotion activities, as well as for dating and casual sexual encounters. Previous research has shown high acceptability of sexual health interventions via smartphone apps; however, sexual health promotion apps were infrequently downloaded and underused. Integrating sexual health promotion into established apps might be a more effective method. Objective The objective of our study was to critically review popular sex-related apps and dating apps, in order to ascertain whether they contain any sexual health content. Methods Part 1: In January 2015, we used the term “sexual” to search for free apps in the Apple iTunes store and Android Google Play store, and categorized the sexual health content of the 137 apps identified. Part 2: We used the term “dating” to search for free geosocial-networking apps in the Apple iTunes and Android Google Play stores. The apps were downloaded to test functionality and to determine whether they included sexual health content. Results Part 1: Of the 137 apps identified, 15 (11.0%) had sexual health content and 15 (11.0%) contained messages about sexual assault or violence. The majority of the apps did not contain any sexual health content. Part 2: We reviewed 60 dating apps: 44 (73%) targeting heterosexual users, 9 (15%) targeting men who have sex with men (MSM), 3 (5%) targeting lesbian women, and 4 (7%) for group dating. Only 9 dating apps contained sexual health content, of which 7 targeted MSM. Conclusions The majority of sex-related apps and dating apps contained no sexual health content that could educate users about and remind them of their sexual risks. Sexual health practitioners and public health departments will need to work with app developers to promote sexual health within existing popular apps. For those apps that already contain sexual health messages, further study to investigate the effectiveness of the content is needed.
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Affiliation(s)
- Evelyn Tzu-Yen Huang
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Austin Hospital, Austin Health, Heidelberg, Australia
| | - Henrietta Williams
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Megan Sc Lim
- Centre for Population Health, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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16
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Berrouiguet S, Baca-García E, Brandt S, Walter M, Courtet P. Fundamentals for Future Mobile-Health (mHealth): A Systematic Review of Mobile Phone and Web-Based Text Messaging in Mental Health. J Med Internet Res 2016; 18:e135. [PMID: 27287668 PMCID: PMC4920962 DOI: 10.2196/jmir.5066] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/30/2016] [Indexed: 01/02/2023] Open
Abstract
Background Mobile phone text messages (short message service, SMS) are used pervasively as a form of communication. Almost 100% of the population uses text messaging worldwide and this technology is being suggested as a promising tool in psychiatry. Text messages can be sent either from a classic mobile phone or a web-based application. Reviews are needed to better understand how text messaging can be used in mental health care and other fields of medicine. Objective The objective of the study was to review the literature regarding the use of mobile phone text messaging in mental health care. Methods We conducted a thorough literature review of studies involving text messaging in health care management. Searches included PubMed, PsycINFO, Cochrane, Scopus, Embase and Web of Science databases on May 25, 2015. Studies reporting the use of text messaging as a tool in managing patients with mental health disorders were included. Given the heterogeneity of studies, this review was summarized using a descriptive approach. Results From 677 initial citations, 36 studies were included in the review. Text messaging was used in a wide range of mental health situations, notably substance abuse (31%), schizophrenia (22%), and affective disorders (17%). We identified four ways in which text messages were used: reminders (14%), information (17%), supportive messages (42%), and self-monitoring procedures (42%). Applications were sometimes combined. Conclusions We report growing interest in text messaging since 2006. Text messages have been proposed as a health care tool in a wide spectrum of psychiatric disorders including substance abuse, schizophrenia, affective disorders, and suicide prevention. Most papers described pilot studies, while some randomized clinical trials (RCTs) were also reported. Overall, a positive attitude toward text messages was reported. RCTs reported improved treatment adherence and symptom surveillance. Other positive points included an increase in appointment attendance and in satisfaction with management and health care services. Insight into message content, preventative strategies, and innovative approaches derived from the mental health field may be applicable in other medical specialties.
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Affiliation(s)
- Sofian Berrouiguet
- Brest Medical University Hospital at Bohars, Adult Psychiatry, Brest, France.
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17
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Maar MA, Yeates K, Toth Z, Barron M, Boesch L, Hua-Stewart D, Liu P, Perkins N, Sleeth J, Wabano MJ, Williamson P, Tobe SW. Unpacking the Black Box: A Formative Research Approach to the Development of Theory-Driven, Evidence-Based, and Culturally Safe Text Messages in Mobile Health Interventions. JMIR Mhealth Uhealth 2016; 4:e10. [PMID: 26800712 PMCID: PMC4744330 DOI: 10.2196/mhealth.4994] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/08/2015] [Accepted: 10/09/2015] [Indexed: 12/13/2022] Open
Abstract
Background Mobile-cellular subscriptions have increased steadily over the past decade. The accessibility of SMS messages over existing mobile networks is high and has almost universal availability even on older and unsophisticated mobile phones and in geographic settings where wireless coverage is weak. There is intensive exploration of this inexpensive mobile telecommunication technology to improve health services and promote behavior change among vulnerable populations. However, a neglected area of research is the documentation and critical analysis of the formative research process required in the development and refinement of effective SMS messages. Objective The objective of this qualitative research study was to identify major factors that may impact on the effectiveness of evidence-based SMS messages designed to reduce health inequities in hypertension management in low resource settings, including Aboriginal populations in high-income countries and rural populations in low-income countries. Specifically, we were interested in uncovering the range of mediators that impact on appropriate message content transmission and, ultimately, on health behavior improvements in a range of these sociocultural settings. Methods Collaborative qualitative research with Canadian Aboriginal and Tanzanian participants was conducted to deconstruct the content and transmission of evidence-based health information contained in SMS messages in the context of an international research project designed to address health inequalities in hypertension, and to develop a grounded theory of the major factors that mediate the effectiveness of this communication. We also examined the interrelationship of these mediators with the three essential conditions of the behavior system of the Behavioral Change Wheel model (capability, opportunity, and motivation) and cultural safety. Results Four focus groups with a total of 45 participants were conducted. Our grounded theory research revealed how discrepancies develop between the evidence-based text message created by researchers and the message received by the recipient in mobile health interventions. These discrepancies were primarily generated by six mediators of meaning in SMS messages: (1) negative or non-affirming framing of advocacies, (2) fear- or stress-inducing content, (3) oppressive or authoritarian content, (4) incongruity with cultural and traditional practices, (5) disconnect with the reality of the social determinants of health and the diversity of cultures within a population, and (6) lack of clarity and/or practicality of content. These 6 mediators of meaning provide the basis for sound strategies for message development because they impact directly on the target populations’ capability, opportunity, and motivation for behavior change. Conclusions The quality of text messages impacts significantly on the effectiveness of a mobile health intervention. Our research underscores the urgent need for interventions to incorporate and evaluate the quality of SMS messages and to examine the mediators of meaning within each targeted cultural and demographic group. Reporting on this aspect of mobile health intervention research will allow researchers to move away from the current black box of SMS text message development, thus improving the transparency of the process as well as the quality of the outcomes.
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Affiliation(s)
- Marion A Maar
- Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada.
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