Preventing postpartum smoking relapse among inner city women: development of a theory-based and evidence-guided text messaging intervention

Development of a text message-based intervention for follow-up colposcopy among predominately underserved Black and Hispanic/Latinx women

PURPOSE

Underserved Black and Hispanic/Latinx women show low rates of follow-up care after an abnormal Pap test, despite the fact that cervical cancer is one of the few preventable cancers if detected early. However, extant literature falls short on efficacious interventions to increase follow-up for this population. A concurrent mixed methods study was completed to evaluate the acceptability of a text message-based intervention and identify perceived barriers and facilitators to follow-up after an abnormal Pap test among underserved predominantly Black and Hispanic/Latinx women.

METHODS

Patients who completed follow-up for an abnormal Pap test were recruited to complete a cross-sectional survey, qualitative interview assessing barriers and facilitators to follow-up, and text message content evaluation (N = 28). Descriptive statistics were performed to describe background variables and to evaluate the acceptability of text messages. A directed content analysis was completed for the qualitative interviews.

RESULTS

Participants expressed interest in a text message-based intervention to increase abnormal Pap test follow-up. In the qualitative interviews, low knowledge about cervical risk and negative affect toward colposcopy/test results were identified as barriers to follow-up. Facilitators of follow-up included feeling relieved after the colposcopy and adequate social support. Participants rated the text messages as understandable, personally relevant, and culturally appropriate.

CONCLUSION

The findings suggest that underserved Black and Hispanic/Latinx women experience cognitive and emotional barriers that undermine their ability to obtain follow-up care and a text message-based intervention may help women overcome these barriers. Future research should develop and evaluate text message-based interventions to enhance follow-up after an abnormal Pap test.

Evaluation of mHealth Apps for Diverse, Low-Income Patient Populations: Framework Development and Application Study

Background

The use of mobile technology or smartphones has grown exponentially in the United States, allowing more individuals than ever internet access. This access has been especially critical to households earning less than US $30,000, the majority of whom indicate that smartphones are their main source of internet access. The increasing ubiquity of smartphones and virtual care promises to offset some of the health disparities that cut through the United States. However, disparities cannot be addressed if the medical information offered though smartphones is not accessible or reliable.

Objective

This study seeks to create a framework to review the strengths and weaknesses of mobile Health (mHealth) apps for diverse, low-income populations.

Methods

Focusing on smoking cessation, diabetes management, and medication adherence as models of disease management, we describe the process for selecting, evaluating, and obtaining patient feedback on mHealth apps.

Results

The top 2 scoring apps in each category were QuitNow! and Smoke Free-Quit Smoking Now for smoking cessation, Glucosio and MyNetDiary for diabetes management, and Medisafe and MyMeds for medication adherence.

Conclusions

We believe that this framework will prove useful for future mHealth app development, and clinicians and patient advisory groups in connecting culturally, educationally, and socioeconomically appropriate mHealth apps with low-income, diverse communities and thus work to bridge health disparities.

Motivational interviewing telephone counseling to increase postpartum maintenance of abstinence from tobacco

Although many women quit smoking while pregnant, rates of relapse after delivery are high. We examined the effectiveness of motivational interviewing (MI) in maintaining postpartum abstinence from smoking among pregnant women who recently quit smoking (N = 382), randomized to receive five brief MI phone counseling calls or to a prenatal and postpartum care as usual control condition. Relapse to smoking was assessed at 3, 6, and 12 months postpartum based on self-report and urine cotinine. Cox regressions compared conditions on relapse outcomes and hazard ratio of total number of MI calls was examined to probe dose-response effects. Results revealed no difference in the hazard ratio of relapse between treatment condition and no dose-response effect of total number of MI calls. Phone counseling in the prenatal and postpartum period did not facilitate maintenance of abstinence among new mothers. Considerations for future intervention development studies on relapse prevention during the postpartum period are discussed.

When text simplification is not enough: could a graph-based visualization facilitate consumers' comprehension of dietary supplement information?

Objective

Dietary supplements are widely used. However, dietary supplements are not always safe. For example, an estimated 23 000 emergency room visits every year in the United States were attributed to adverse events related to dietary supplement use. With the rapid development of the Internet, consumers usually seek health information including dietary supplement information online. To help consumers access quality online dietary supplement information, we have identified trustworthy dietary supplement information sources and built an evidence–based knowledge base of dietary supplement information—the integrated DIetary Supplement Knowledge base (iDISK) that integrates and standardizes dietary supplement related information across these different sources. However, as information in iDISK was collected from scientific sources, the complex medical jargon is a barrier for consumers’ comprehension. The objective of this study is to assess how different approaches to simplify and represent dietary supplement information from iDISK will affect lay consumers’ comprehension.

Materials and Methods

Using a crowdsourcing platform, we recruited participants to read dietary supplement information in 4 different representations from iDISK: (1) original text, (2) syntactic and lexical text simplification (TS), (3) manual TS, and (4) a graph–based visualization. We then assessed how the different simplification and representation strategies affected consumers’ comprehension of dietary supplement information in terms of accuracy and response time to a set of comprehension questions.

Results

With responses from 690 qualified participants, our experiments confirmed that the manual approach, as expected, had the best performance for both accuracy and response time to the comprehension questions, while the graph–based approach ranked the second outperforming other representations. In some cases, the graph–based representation outperformed the manual approach in terms of response time.

Conclusions

A hybrid approach that combines text and graph–based representations might be needed to accommodate consumers’ different information needs and information seeking behavior.

Technology as the key to women's empowerment: a scoping review

Background

Information and communications technologies (ICTs) have empowered people to communicate and network at a global scale. However, there is lack of in-depth understanding of the use of ICTs for women's empowerment. This study examines how the concept empowerment is defined, utilized and measured in research studies, the existing evidence on the use of ICTs for women’s empowerment and the gaps in knowledge at the global level.

Methods

The authors’ conducted a scoping review using the Arksey and O’Malley methodology. The search identified papers from ten databases, including Scopus, Embase, ABI Inform, Soc Index, Sociological Abstracts, Gender Studies, Springer Link, PsychInfo, Science Direct, and Academic Search Complete over the period of 2012–2018. Search criteria included articles that focused on women’s empowerment and utilized technologies as interventions. Out of a total of 4481 articles that were initially identified, 51 were included.

Results

Technology played a variety of roles in supporting the development of women’s capacities and resources. Results revealed the use of ICT interventions in the overarching areas of outreach (e.g., health promotion), education (e.g., health literacy opportunities), lifestyle (e.g., peer coaching and planning), prevention (e.g., screening opportunities), health challenges (e.g., intimate partner violence apps), and perceptions of barriers (i.e., uptake, utilization and ubiquity to ICTs for women). Despite the positive use of technology to support women in their daily lives, there was a lack of consensus regarding the definition and use of the term empowerment. The concept of empowerment was also inconsistently and poorly measured in individual studies making it difficult to determine if it was achieved.

Conclusion

This scoping review provides a comprehensive review of current and emerging efforts to use ICTs to empower women. The findings suggest a need for collaborative efforts between researchers, program implementers and policy makers as well as the various communities of women to address the persistent gender disparities with respect to ICTs.

Persistent Barriers to Smoking Cessation Among Urban, Underserved Women: A Feasibility Study of Tailored Barriers Text Messages

OBJECTIVES

Despite health risks for themselves and their children, urban underserved women smoke at high rates postpartum. The postpartum period is a stressful transition time that presents unique barriers to sustained cessation. There is limited extant evidence of efficacious psychosocial programs to maintain postpartum smoking cessation.

METHODS

Guided by the Cognitive-Social Health Information Processing model, we explored the feasibility of TxT2Commit, a text-messaging intervention designed to prevent postpartum smoking relapse. Participants (n = 43) received supportive cessation-focused text messages for one month postpartum. Using a convergent mixed method design, surveys and interviews assessed changes in psychosocial factors and smoking status through a three month follow-up.

RESULTS

Participants reported satisfaction with TxT2Commit, rating text messages as helpful, understandable, supportive, and not bothersome. However, a majority of women (n = 28, 65.1%) relapsed by three months. Participants who stayed smoke free (i.e., non-relapsers) reported significantly less temptation to smoke at one and three months postpartum compared to relapsers (ps < .01). While relapsers had significantly less temptation at one month compared to baseline, temptation increased by three months (p < .01). Consistent with the quantitative results, qualitative interviews identified informational and coping needs, with continued temptation throughout the three months. Non-relapsers were able to manage temptation and reported greater support.

CONCLUSIONS FOR PRACTICE

TxT2Commit demonstrates preliminary feasibility and acceptability among urban, underserved postpartum women. However, most participants relapsed by three months postpartum. Additional research is needed to identify targeted messaging to best help women avoid temptation and bolster support to stay smoke free in this uniquely stressful period.

[Management of Resumption Risk in Postpartum for Women who Quit Smoking During Pregnancy - CNGOF-SFT Expert Report and Guidelines for Smoking Management During Pregnancy]

According to the 2016 National Perinatal Survey, 30.0 % of women smoked before pregnancy, 45.8 % quit smoking in the 1st or 2nd trimester. Many do this only for pregnancy and the risk of postpartum relapse is high (up to 82 % at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. No drug treatment can be recommended to prevent the smoking postpartum relapse. Only global counseling can prevent this risk.

Design, development and usability testing of Essential Coaching for Every Mother: A postnatal text message educational intervention

BACKGROUND

The transition to motherhood is an exciting yet challenging period that requires physical, emotional, and social adjustment. During the postpartum period, mothers require support and information to ensure a smooth transition and adjustment to motherhood. One innovative strategy to provide mothers with this information is mobile health (mHealth), and specifically, text messaging.

OBJECTIVE

To describe the design, development and usability testing of a postnatal text message intervention called Essential Coaching for Every Mother.

METHODS

First time mothers (n=11) and postpartum healthcare providers (n=18) were involved in iterative interviewing in Halifax, Canada. Adaption of content occurred through three rounds of user testing using semi-structured interviews. The Information Assessment Method (IAM) Parents survey was also completed by mothers.

RESULTS

Three cycles of iterative testing were conducted with eight participants (3 mothers, 5 healthcare providers), thirteen participants (8 mothers, 5 healthcare providers) and 8 participants (8 healthcare providers), respectively. Messages evolved from risk-focused to prevention and education focused. Mothers felt the messages addressed their needs and healthcare providers ensured the content was consistent with the messaging currently provided to postpartum mothers.

CONCLUSION

Essential Coaching for Every Mother is the first postnatal educational text message intervention developed for mothers in Halifax, Canada. We sought to involve first time mothers (end-users) and postpartum healthcare providers (experts) in the development and usability evaluation to ensure the intervention adequately met needs and was consistent with current practices related to postpartum education.

Influence of Puerperal Health Literacy on Tobacco Use during Pregnancy among Spanish Women: A Transversal Study

Background: Despite the fact that tobacco use during pregnancy produces adverse perinatal effects, some women continue to smoke. Health literacy (HL) is essential for health outcomes in adults. However, little is known about HL in pregnant women or postpartum women. The study aimed to analyse the relationship between the degree of HL of women during the early puerperium and tobacco use during pregnancy. Methods: A multicentre, descriptive, cross-sectional study was carried out with women in the early puerperium in a region of eastern Spain, between November 2017 and May 2018. Their HL level was obtained using the Newest Vital Sign (NVS) tool. Multivariate logistic models were adjusted to estimate the magnitude of association with tobacco use in pregnancy. Odds ratios (OR) were estimated with a 95% confidence interval. Results: 193 were included in the total. 29.5% (57) of pregnant women smoked tobacco during pregnancy, with a smoking cessation rate of 70.1% (40) while pregnant. 42.0% (81) of pregnant women had inadequate or limited HL. A low level of HL was strongly associated with tobacco use, adjusted by catchment area and age of first pregnancy (LRT p < 0.001; ROC curve = 0.71, 95% CI: 0.64–0.79). Conclusion: A low HL is associated with tobacco consumption during pregnancy. Whether low HL reflects the wide constellation of already-known socioeconomic, political and commercial determinants of tobacco use, or whether incorporating HL support interventions strengthens tobacco cessation activities in pregnancy, warrants further research. Still, it should be considered as essential to understanding the health disparities related to its consumption.

Development and usability testing of HEARTPA♀N: protocol for a mixed methods strategy to develop an integrated smartphone and web-based intervention for women with cardiac pain

INTRODUCTION

More women experience cardiac pain related to coronary artery disease and cardiac procedures compared with men. The overall goal of this programme of research is to develop an integrated smartphone and web-based intervention (HEARTPA♀N) to help women recognise and self-manage cardiac pain.

METHODS AND ANALYSIS

This protocol outlines the mixed methods strategy used for the development of the HEARTPA♀N content/core feature set (phase 2A), usability testing (phase 2B) and evaluation with a pilot randomised controlled trial (RCT) (phase 3). We are using the individual and family self-management theory, mobile device functionality and pervasive information architecture of mHealth interventions, and following a sequential phased approach recommended by the Medical Research Council to develop HEARTPA♀N. The phase 3 pilot RCT will enable us to refine the prototype, inform the methodology and calculate the sample size for a larger multisite RCT (phase 4, future work). Patient partners have been actively involved in setting the HEARTPA♀N research agenda, including defining patient-reported outcome measures for the pilot RCT: pain and health-related quality of life (HRQoL). As such, the guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols (SPIRIT-PRO) are used to report the protocol for the pilot RCT (phase 3). Quantitative data (eg, demographic and clinical information) will be summarised using descriptive statistics (phases 2AB and 3) and a content analysis will be used to identify themes (phase 2AB). A process evaluation will be used to assess the feasibility of the implementation of the intervention and a preliminary efficacy evaluation will be undertaken focusing on the outcomes of pain and HRQoL (phase 3).

ETHICS AND DISSEMINATION

Ethics approval was obtained from the University of Toronto (36415; 26 November 2018). We will disseminate knowledge of HEARTPA♀N through publication, conference presentation and national public forums (Café Scientifique), and through fact sheets, tweets and webinars.

TRIAL REGISTRATION NUMBER

NCT03800082.

Development and acceptability testing of a Facebook smoking cessation intervention for sexual and gender minority young adults

This study tested engagement in and acceptability of a digital smoking cessation intervention designed for young adults and tailored to sexual and gender minority (SGM) individuals. The intervention included 90 Facebook posts delivered in private groups tailored to readiness to quit smoking (Ready to quit in 30 days/Not Ready; 180 posts total; 101 posts SGM-tailored by content/image). Acceptability was evaluated over 30 days (3 posts/day). Participants' (N = 27) open-ended feedback was coded and tallied; posts with significant negative feedback were flagged for change. Flags and comment volume were examined by SGM tailoring (versus not tailored) and content category (motivational interviewing, experiential strategies, behavioral strategies, relevant topics). Engagement and acceptability were high. All participants reported viewing at least half of the posts, and the majority reported viewing all 90 posts (M comments per participant = 51.74). The majority of participants agreed or strongly agreed with statements about the intervention's helpfulness and clarity. Posts received an average of 8.08 comments (SD = 2.58), with 59 posts (32.8%) flagged for change. Posts engaged comments and were found to be acceptable at comparable levels regardless of SGM tailoring and content category (all p-values > .189). SGM young adult smokers were highly engaged in an SGM-tailored smoking cessation intervention on Facebook and rated the intervention positively. Both tailored and non-tailored Facebook posts in a variety of content areas were generally well-received by SGM young adults, an underserved population with high rates of smoking.

CervixCheck: A Spiritually-Based Text Messaging Intervention to Promote Cervical Cancer Awareness and Pap Test Screening Intention among African-American Women

BACKGROUND/PURPOSE

On a national level, African-American women have a 34% higher incidence of cervical cancer and are twice as likely to die of the disease when compared to White women. In response to the need to improve cervical cancer prevention and Pap test screening knowledge and utilization, we developed and pilot tested a 16-day SMS text message-based intervention. The CervixCheck study was designed to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention aimed at increasing cervical cancer awareness and Pap test screening intention in church-attending African-American women ages 21-65. Methods/Approach: The Theory of Planned Behavior guided the development of the CervixCheck intervention. This intervention utilized a non-experimental one-group pretest-posttest design. In this article, we present findings from the pilot testing phase. Of the 52 participants at baseline, 46 completed the post-program survey.

RESULTS/FINDINGS

The current study provides evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There was a significant pre-post increase observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Findings post-intervention also revealed that 83% of participants reported being either "satisfied" or "very satisfied" with the CervixCheck intervention and 85% found the SMS text messages either "useful" or "very useful".

CONCLUSIONS/SIGNIFICANCE

A spiritually-based SMS text messaging intervention could be a culturally-appropriate and cost-effective method of promoting cervical cancer early detection information to church-attending African-American women.

Healthy Beyond Pregnancy, a Web-Based Intervention to Improve Adherence to Postpartum Care: Randomized Controlled Feasibility Trial

Background

During the postpartum visit, health care providers address issues with short- and long-term implications for maternal and child health. Women with Medicaid insurance are less likely to return for a postpartum visit compared with women with private insurance. Behavioral economics acknowledges that people do not make exclusively rational choices, rather immediate gratification, cognitive and psychological biases, and social norms influence decision making. Drawing on insights from decision science, behavioral economists have examined how these biases can be modulated through carefully designed interventions. We have developed a Web-based tool, Healthy Beyond Pregnancy, that incorporates empirically derived concepts of behavioral economics to improve adherence rates to the postpartum visit.

Objectives

The primary objectives of this pilot study were to (1) refine and assess the usability of Healthy Beyond Pregnancy and (2) assess the feasibility of a randomized controlled trial (RCT) of the intervention.

Methods

We used a multistep process and multidisciplinary team of maternal-fetal medicine physicians, a behavioral economist, and researchers with expertise in behavioral interventions to design Healthy Beyond Pregnancy. We assessed the usability of the program with the Post-Study System Usability Questionnaire (PSSUQ), a validated 7-point scale, and semistructured interviews with postpartum women. We then conducted a feasibility trial to determine the proportion of eligible women who were willing to participate in an RCT of Healthy Beyond Pregnancy and the proportion of women willing to complete the Web-based program. Exploratory outcomes of the pilot trial included attendance at the postpartum visit, uptake of long-acting reversible contraception, and uptake of any contraception.

Results

The median PSSUQ score for Healthy Beyond Pregnancy was 6.5 (interquartile range: 6.1-7) demonstrating high usability. Semistructured interviews (n=10) provided in-depth comments about users’ experience and further improved the program. A total of 34 postpartum women with Medicaid insurance were approached for the pilot trial, and 30 (88%) were consented and randomized. All women randomized to Healthy Beyond Pregnancy completed the Web-based program, had text-enabled cell phones, and were willing to receive text messages from the study team. Women in the Healthy Beyond Pregnancy arm were more likely to return for a postpartum visit compared with women in the control arm with 85% of women in Healthy Beyond Pregnancy returning versus 53% in the control arm (odds ratio in the Healthy Beyond Pregnancy group: 5.3; 95% CI 0.9-32.0; P=.06).

Conclusions

We have developed a highly usable and acceptable Web-based program designed to increase attendance at the postpartum visit. Our pilot trial demonstrates that women are willing and able to participate in a randomized trial of a Web-based program and text messaging system.

Trial Registration

Clinicaltrials.gov NCT03296774; https://clinicaltrials.gov/ct2/show/NCT03296774 (Archived by WebCite at http://www.webcitation.org/6tpgXFzyk)

Development and design of an intervention to improve physical activity in pregnant women using Text4baby

Text4baby is a free, mobile health information service for pregnant and post-partum women. This study aims to understand preferences of physical activity text messages (SMS), sequentially develop prototype SMS, and determine preferred dose of SMS to inform a future study utilizing Text4baby. This study had a user-centered design with three phases: (1) literature review and interviews with pregnant women for development of prototype SMS, (2) interviews with health care professionals and pregnant women for prototype SMS feedback, and (3) survey to determine preferred dose of SMS. Data from interviews identified knowledge and support as major themes. Prototypes were developed (N = 14) and informed 168 SMS. Pregnant women (N = 326) thought three SMS/week were about right (50.2 %) and preferred three SMS/week throughout pregnancy (71.9 %). There is a need for opportunities for behavioral scientists to incorporate evidence-based practices within scalable interventions. As such, this research will inform utilization of Text4baby to potentially improve physical activity participation.

Realising the technological promise of smartphones in addiction research and treatment: An ethical review

BACKGROUND

Smartphone technologies and mHealth applications (or apps) promise unprecedented scope for data collection, treatment intervention, and relapse prevention when used in the field of substance abuse and addiction. This potential also raises new ethical challenges that researchers, clinicians, and software developers must address.

AIMS

This paper aims to identify ethical issues in the current uses of smartphones in addiction research and treatment.

METHODS

A search of three databases (PubMed, Web of Science and PsycInfo) identified 33 studies involving smartphones or mHealth applications for use in the research and treatment of substance abuse and addiction. A content analysis was conducted to identify how smartphones are being used in these fields and to highlight the ethical issues raised by these studies.

RESULTS

Smartphones are being used to collect large amounts of sensitive information, including personal information, geo-location, physiological activity, self-reports of mood and cravings, and the consumption of illicit drugs, alcohol and nicotine. Given that detailed information is being collected about potentially illegal behaviour, we identified the following ethical considerations: protecting user privacy, maximising equity in access, ensuring informed consent, providing participants with adequate clinical resources, communicating clinically relevant results to individuals, and the urgent need to demonstrate evidence of safety and efficacy of the technologies.

CONCLUSIONS

mHealth technology offers the possibility to collect large amounts of valuable personal information that may enhance research and treatment of substance abuse and addiction. To realise this potential researchers, clinicians and app-developers must address these ethical concerns to maximise the benefits and minimise risks of harm to users.

Cognitive-behavioral intervention to promote smoking cessation for pregnant and postpartum inner city women

This study evaluated a theory-guided cognitive-behavioral counseling (CBC) intervention for smoking cessation during pregnancy and postpartum. It also explored the mediating role of cognitive-affective variables on the impact of CBC. Underserved inner city pregnant women (N = 277) were randomized to the CBC or a best practice (BP) condition, each of which consisted of two prenatal and two postpartum sessions. Assessments were obtained at baseline, late pregnancy, and 1- and 5-months postpartum. An intent-to-treat analysis found no differences between the two groups in 7-day point-prevalence abstinence. However, a respondents-only analysis revealed a significantly higher cessation rate in the CBC (37.3 %) versus the BP (19.0 %) condition at 5-months postpartum follow-up. This effect was mediated by higher quitting self-efficacy and lower cons of quitting. CBC, based on the Cognitive-Social Health Information Processing model, has the potential to increase postpartum smoking abstinence by assessing and addressing cognitive-affective barriers among women who adhere to the intervention.

Development testing of mobile health interventions for cancer patient self-management: A review

As the vision of mobile health (mHealth) is beginning to be realized, rigorous intervention development protocols are needed in order to draw optimal efficacy and effectiveness to support patient-centered oncology care. The purpose of the current study was to conduct a review of published articles that describe the development process of mHealth interventions for patients' cancer care self-management. The review search yielded 11 interventions, reported by 14 manuscripts. The following trends emerged: importance of stakeholder engagement during the development process, addressing the unique needs and experiences of cancer patients and care providers, ensuring user satisfaction with the system, and identifying perceived benefits and limitations of the system. This review provides practical suggestions for mHealth intervention development. Assessments of user perceptions should be both qualitative and quantitative, and researchers should follow an established framework when developing a randomized controlled trial employing mHealth.

A content analysis of self-reported barriers and facilitators to preventing postpartum smoking relapse among a sample of current and former smokers in an underserved population

To characterize the barriers and facilitators thatprevent postpartum relapse and maintain smoking abstinence among a socioeconomically underserved population, recruited through Philadelphia-area women, infants, and children clinics, in-person interviews were conducted with 30 women who had quit smoking for one or more pregnancies in the past 3 years to retrospectively describe their attempts to remain abstinent during the postpartum period. Responses were analysed using the constructs from the Cognitive-Social Health Information Processing model, which identifies the cognitive, affective and behavioral factors involved in goal-oriented self-regulatory actions, in the context of a vulnerable population of women. Motherhood demands were a significant source of relapse stress. Stresses associated with partner and family relationships also contributed to relapse. The presence of other smokers in the environment was mentioned by many women in our sample as affecting their ability to remain smoke-free postpartum. Participants reported four main strategies that helped them to successfully cope with postpartum cravings and relapses, including being informed of smoking risks, maintaining goal-oriented thoughts, focusing on their concerns about the baby's health and receiving positive social support from families and friends. Results provide guidance for the design of smoking relapse interventions that may address the unique stressors reported by underserved postpartum women.

Qualitative feedback from a text messaging intervention for depression: benefits, drawbacks, and cultural differences

BACKGROUND

Mobile health interventions are often standardized and assumed to work the same for all users; however, we may be missing cultural differences in the experiences of interventions that may impact how and if an intervention is effective.

OBJECTIVE

The objective of the study was to assess qualitative feedback from participants to determine if there were differences between Spanish speakers and English speakers. Daily text messages were sent to patients as an adjunct to group Cognitive Behavioral Therapy (CBT) for depression.

METHODS

Messages inquired about mood and about specific themes (thoughts, activities, social interactions) of a manualized group CBT intervention. There were thirty-nine patients who participated in the text messaging pilot study. The average age of the participants was 53 years (SD 10.4; range of 23-72).

RESULTS

Qualitative feedback from Spanish speakers highlighted feelings of social support, whereas English speakers noted increased introspection and self-awareness of their mood state.

CONCLUSIONS

These cultural differences should be explored further, as they may impact the effect of supportive mobile health interventions.

TRIAL REGISTRATION

TRIAL REGISTRATION

Clinicaltrials.gov NCT01083628; http://clinicaltrials.gov/ct2/show/study/NCT01083628 (Archived by WebCite at http://www.webcitation.org/6StpbdHuq).