Academic literature on the topic 'Text messaging intervention'

Introduction—Text-messaging interventions hold promise for successful weight loss interventions. However, there is limited research on text-messaging interventions to improve dietary intake among rural adolescents, who are at greater risk for obesity and related risk factors. The goal of this study was to test an eight-week, mentor-led text-messaging intervention among 14–16-year-old rural adolescents: the “Go Big and Bring It Home” Project to improve fruit and vegetable and healthy beverage intake. Methods and Materials—Eight rural high schools in eastern Kentucky and eastern North Carolina participated (n = 4 were randomized as intervention schools and n = 4 were randomized as control schools). Adolescents were recruited to participate in the eight-week text-messaging intervention. The text messages were primarily affective messages, and included a weekly challenge related to consuming fruits, vegetables, or healthy/low-calorie beverages. Undergraduate nutrition students sent text messages on Tuesday and Saturday every week over the eight-week period via the “Group Me” mobile application. Delayed controls received no information or text messages during the eight-week intervention. Fruit and vegetable intake was measured with the National Cancer Institute Fruit and Vegetable screener and beverage intake was assessed using the Beverage Questionnaire-10 (BEVQ-10). Intention-to-treat analyses were conducted among all those that completed the baseline and post-intervention survey (n = 277 intervention students and n = 134 delayed control students). All linear regression models were adjusted for race and were clustered on school to control for intraclass correlation. Results—In adjusted analyses, there was a statistically significant positive intervention effect on the primary outcome of fruit and vegetable servings/day with a mean difference between intervention and control participants of 1.28 servings/day (95% Confidence Interval 1.11, 1.48). There was no intervention effect on beverage intake. There was a statistically significant increase in the odds of goal setting for healthier dietary behaviors among intervention participants relative to controls. Conclusion—An eight-week text-messaging intervention led to increases in self-reported fruit and vegetable intake and improvements in goal setting for healthier dietary behaviors. Due to the use of undergraduate students to deliver the messages, and use of an existing web application, this text-messaging intervention can be sustained in underserved, rural environments. Thus there is potential for significant reach and public health impact to improve dietary patterns.

Text messaging via short messaging service (SMS) is a common route of communication in the United States and offers many advantages to improve health care delivery compared with other forms of mHealth. Text messaging is easy to use, is convenient, is more likely to be viewed than e-mail, and can be tailored to an individual recipient’s needs. Despite evidence that patients with cancer desire more mobile-based communication, there are few examples of successful text messaging interventions in the literature. This narrative review examines the current landscape of SMS-based interventions across the continuum of cancer care, including addressing behavioral change, attendance to screening and follow-up appointments, adherence to treatment, and assessment of symptoms and quality of life. Finally, we explore some of the barriers to implementation of a successful text messaging intervention.

Background Deliberate self-harm is common during adolescence and can have detrimental consequences for the well-being of adolescents. Although it is sometimes difficult to engage adolescents in traditional psychotherapies for deliberate self-harm, SMS text messaging has been shown to be promising for cost-effective and low-intensity interventions. Objective This study aimed to investigate the views of Chinese adolescents with deliberate self-harm about SMS text messaging interventions in order to develop an acceptable and culturally competent intervention for adolescents with deliberate self-harm. Methods Semistructured interviews were conducted with 23 adolescents who had experience with deliberate self-harm. The transcripts of the interviews were analyzed using thematic analysis. Results Four themes were identified: beneficial perception of receiving messages, short frequency and duration of messages, caring content in messages, and specific times for sending messages. Most of the participants perceived SMS text messaging interventions to be beneficial. The key factors that emerged for the content of the intervention included encouragement and company, feeling like a virtual friend, providing coping strategies, and individualized messages. In addition, the preferred frequency and duration of the SMS text messaging intervention were identified. Conclusions Our study will help in the development of a culturally appropriate SMS text messaging intervention for adolescents with deliberate self-harm. It has the potential to decrease deliberate self-harm instances by providing acceptable support for adolescents with deliberate self-harm who may be reluctant to seek face-to-face psychotherapies.

Abstract Introduction Up to half of people with long-term conditions (LTCs) do not take their medicines as prescribed. Mobile health interventions, such as text messaging, have been shown to have positive impact on medication adherence.1 However, interventions for patients with multiple LTCs are lacking, and there are limited examples of their delivery from community pharmacy settings. We have developed a new intervention which combines a pharmacist consultation and automated two-way text messaging to support medicines taking. This has been developed using peer-reviewed literature and focus groups with patients and healthcare professionals (GPs, pharmacists, nurses). The intervention is tailored to the individual using a questionnaire and delivers content for up to eight LTCs. Aim To explore the acceptability of our new intervention with patients. Methods The new intervention was delivered to patients in a simulated environment, including a consultation with a pharmacist and two weeks of text messaging. Diary-interviews were used to gather feedback from eight patients, recruited through a public, patient and carer involvement group based at a university. Patients kept a diary during the period of text messaging and follow-up semi-structured interviews were conducted. Interviews were audio recorded and transcribed verbatim for analysis. Transcripts were coded for aspects of the intervention that the patients liked and ideas on how the intervention could be changed, including the impact of delivering the intervention from community pharmacies. Ethical approval for this study was granted by the University of Sunderland Research Ethics Committee. Results The intervention had good acceptability with patients. Patients were happy to interact with the text messaging content, including providing information about symptoms of their long-term condition and result of home monitoring. Patients liked that the intervention was linked to a pharmacist consultation, where there were opportunities to identify medication issues which text messaging could not solve. Delivering the intervention from a community pharmacy setting was felt to promote stronger engagement with the text messaging component, including the opportunity to build rapport with the pharmacist who would be overseeing the intervention. The mechanism to monitor medication adherence using two-way text messaging was suggested to be made more streamlined, and patients also wanted more examples of text message responses included in the patient information leaflet for the intervention. Discussion/Conclusion We found that our intervention to support medication taking from community pharmacies has initial acceptability with patients. Whilst others have trialled similar technologies from community pharmacies2 our intervention focussed solely on medication taking, and this seemed to result in positive attitudes towards its delivery from community pharmacies. The consultation was found to be an important component alongside the text messaging, how combining digital and non-digital components work together to support medication adherence was a gap highlighted in our previous review of similar interventions.3 Our intervention now requires changes based on the feedback gathered in this study and further testing in a larger and more diverse group. References 1. Thakkar J, Kurup R, Laba T-L, Santo K, Thiagalingam A, Rodgers A, et al. Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease: A Meta-analysis. JAMA Intern Med. 2016;176:340–9. 2. Cork T, Sanzeri D, Chambers R, Chamber C. Can pharmacists promote self-care using digital technology? Prescriber. 2018;29:21–4. 3. Donovan G, Hall N, Ling J, Smith F, Wilkes S. Influencing medication taking behaviors using automated two-way digital communication: A narrative synthesis systematic review informed by the Behavior Change Wheel. Br J Health Psychol. n/a n/a. https://doi.org/10.1111/bjhp.12580.

African Americans’ greater access to mobile phones makes short messaging service technology a promising complement to health promotion interventions. Short messaging service text messages were added to the Men’s Prostate Awareness Church Training project, a men’s health intervention for African American men. We report on the feasibility and acceptability of the use of short messaging service text messages in the intervention. Short messaging service text messages served as (1) workshop reminders; (2) post-workshop message reinforcement; (3) spiritual/motivational messages; and (4) participant retention. At workshop 4, over 65 percent of participants wished to continue receiving the messages. While there was an increase in recall over time, more than one-third of the participants did not recall receiving the 53 text messages. However, recall was considerably greater among men who attended the Men’s Prostate Awareness Church Training workshops. Overall, the inclusion of text messages in health promotion interventions targeting mature African American men was found to be feasible and acceptable.

Background Antenatal care (ANC) has the potential to improve maternal health, but it remains underutilized and unevenly implemented in many low- and middle-income countries. Increasingly, text messaging programs for pregnant women show evidence that they can improve the utilization of ANC during pregnancy; however, gaps remain regarding how implementation affects outcomes. Objective This study aimed to assess facilitators and barriers to implementation of an SMS text messaging intervention for pregnant women in Samoa and to assess its impact on ANC attendance. Methods This study took place in Upolu, Samoa, from March to August 2014 and employed a quasi-experimental design. Half (n=3) of the public antenatal clinics on the island offered adult pregnant women the SMS text messaging intervention, with 552 women registering for the messages. At the comparison clinics (n=3), 255 women registered and received usual care. The intervention consisted of unidirectional text messages containing health tips and appointment reminders. The outcome of interest was the number of attended antenatal visits. Implementation data were also collected through a survey of the participating midwives (n=7) and implementation notes. Data analysis included a comparison of women’s baseline characteristics between the two groups, followed by the use of negative binomial regressions to test for associations between participation in the intervention and increased ANC attendance, controlling for individual characteristics and accounting for the clustering of women within clinics. Results The comparison of ANC attendance rates found that women receiving the SMS text messaging intervention attended 15% fewer ANC visits than the comparison group (P=.004), controlling for individual characteristics and clustering. Data analysis of the implementation process suggests that barriers to successful implementation include women registering very late in pregnancy, sharing their phone with others, and inconsistent explanation of the intervention to women. Conclusions These results suggest that unidirectional text messages do not encourage, and might even discourage, ANC attendance in Samoa. Interpreted with other evidence in the literature, these results suggest that SMS text messaging interventions are more effective when they facilitate better communication between patients and health workers. This study is an important contribution to our understanding of when SMS text messaging interventions are and are not effective in improving maternal health care utilization.

Abstract Objectives Text-messaging interventions are a promising approach to increasing physical activity in vulnerable populations. To better inform the development of a text-messaging intervention, we sought to identify barriers and facilitators to using text messaging and engaging in physical activity among patients with diabetes and comorbid depression. Materials and Methods We conducted interviews with primary care patients at a safety-net health care system (N = 26). Data were collected at 3 stages, including a focus group (stage 1), and individual interviews (stage 2 and 3). Patients in stage 1 and 2 previously participated in a text-messaging intervention as part of depression treatment. Discussions focused on participant experience of previously using a text-messaging intervention, influences and perceptions of physical activity, and mobile phone use. We analyzed all transcripts for emerging themes. Results Participants were 56.2 years (±9.7); 69.2% were female, 65.4% identified as Hispanic/Latino(a), and 46.2% reported having less than a high school education. All had depression and 61.5% had diabetes. Specific barriers that emerged included low literacy and only basic use of mobile phones in everyday life, in combination with a high prevalence of comorbid health conditions and limited mobility. These were each addressed with a specific content or intervention delivery change in the overall intervention design. Conclusions Conducting a focus group and individual interviews with end users of an mHealth intervention under development has implications for tailoring and modifying components of the content and format to ensure that the final intervention will engage end users most effectively.

Background: Smoking during pregnancy has detrimental effects on mother and fetus. Text messaging has been utilized to improve patient care. Objective: To evaluate the impact of text messaging on smoking cessation rates among pregnant women in addition to standard of care (SOC) smoking cessation services. Our SOC includes pharmacist-driven education with or without nicotine patch or bupropion. Methods: This randomized, open-label, prospective trial was conducted at a maternal fetal care center from May 2014 to January 2016. Pregnant patients in the preparation stage of change were randomized to text messaging or SOC. The primary outcome was smoking cessation verified with exhaled carbon monoxide levels (eCO) 2 weeks from quit date. All received clinical pharmacist weekly calls for 3 weeks and biweekly visits until pharmacotherapy completion. The text messaging group also received predetermined motivational messages. Results: Of 49 randomized patients, 13 withdrew, and 6 were lost to follow-up. The remaining included 14 texting and 16 SOC patients. eCO-verified cessation was achieved by 57.1% in the texting group versus 31.3% in the control ( P = 0.153). Overall, 64.3% of the texting group achieved an eCO below 8 ppm at ≥1 visit versus 37.5% in the control group ( P = 0.143). No difference was found in birth outcomes. The study was underpowered because of slow enrollment and high drop-out rates. Conclusions and Relevance: Text messaging had minimal impact on improving smoking cessation rates in the obstetric population. However, further research is warranted because of the underpowered nature of this trial. Given the detrimental effects of smoking in pregnancy, more comprehensive cessation strategies are warranted.

This thesis involved the development, delivery and evaluation of an SMS based mHealth intervention targeting fathers and mothers to improve exclusive breastfeeding at three months in Tigray, Ethiopia. Parents and health professionals co-designed the content of the intervention. The four-month trial identified that an SMS based breastfeeding intervention targeting fathers and mothers was more effective in improving exclusive breastfeeding than no intervention or an intervention to mothers only.

Thesis (M.S.)--University of Cincinnati, 2009.
Advisor: Paul Succop. Title from electronic thesis title page (viewed Jan. 13, 2010). Includes abstract. Keywords: childhood SLE; adherence; text messaging. Includes bibliographical references.

This project assessed the cost and cost-effectiveness of hypertension management in South Africa within the context of a text messaging-based intervention (StAR* study) conducted in an urban public-sector clinic in Cape Town. The StAR* study is a community randomized trial that investigated the effect of adherence support via short messaging service (SMS) on treatment adherence and patient outcomes for the management of hypertension at Vanguard CHC in Cape Town (Bobrow et al. 2016). Patients received behavioral text messages as reminders for them to collect and take their medication on time. The StAR* study, consisted of three arms that ran in parallel: participants in the control arm received unrelated messages; patients in the information-only arm received one-way information messages twice a week; and patients in the interactive arm received interactive SMS-texts at the same frequency as those in the information only arm (Bobrow et al. 2016). Patients in the interactive arm could respond to the messages and trigger a response from the healthcare provider. The text messaging based intervention was shown to improve hypertension outcomes over a 12-month period in hypertension patients by improving adherence and retention in care. The study showed, in the one-way intervention arm an improvement in adherence (measured by medication refill rates) and a small reduction in systolic blood pressure (2.2mm Hg reduction over 12months) (Bobrow et al. 2016). In this study, we assessed the cost and cost effectiveness of the StAR* intervention under routine care management at Vanguard CHC. We also assessed the cost of hypertension management from the health system perspective and the cost of accessing hypertension care from the patient perspective. A combination of the ingredients approach and step-down costing was used to cost hypertension care from a health system perspective while a questionnaire was administered to 250 patients to estimate patient costs. The primary outcomes were the average cost of hypertension care and the incremental cost of the text message-based adherence intervention (StAR* intervention), compared to usual care, per millimetre of mercury (mmHg) reduction in systolic blood pressure. Results of the study show that the average health system cost for hypertension management is R262 per visit and the patient cost of accessing hypertension care is R172 per visit. The text messaging based intervention was found to have low implementation costs in this pilot phase. The monthly incremental cost of the text messaging based intervention cost was R4 per person. The incremental cost-effectiveness ratio of the intervention was R22 per mm Hg reduction. This study provides the first contemporary assessment of hypertension management costs and the cost-effectiveness of mobile-based hypertension adherence support in South Africa. Future work will seek to estimate the long-term cost-effectiveness of this intervention and the cost of scaling it to the provincial and national levels.

Introduction: This thesis seeks to explore the feasibility and effectiveness of using text messages (SMS) to improve psychological wellbeing amongst young people involved in the Youth Justice System. As this group are likely to be exposed to risk factors impacting on their psychological health, yet unlikely to access mainstream health services, the provision of alternative and accessible interventions for this group should be a key priority for service providers, commissioners and academics alike. Method: A systematic review of the literature and meta analyses to explore current findings in relation to the use of text message interventions to improve psychological wellbeing in the broader adolescent population is presented in Chapter Two. In total 2,496 studies were identified, ten of which met full inclusion criteria. No significant pooled differences were evident between intervention and control groups. Reported effects and the feasibility of the approach are discussed. Findings indicate that, to date, there is no available research in relation to the use of an SMS approach to promote wellbeing amongst young people in the YJS. In preparation for a feasibility study to explore this, the psychometric properties of the KIDSCREEN questionnaires are considered in Chapter Three. Here the reliability and the validity of the tool is evidenced indicating its appropriateness for the use in the proceeding empirical research. The rationale and development of an SMS intervention to encourage self-determination and improve psychological wellbeing, co-designed with service users, are discussed in Chapter Four. In Chapter Five, the findings of the mixed methods feasibility study are presented. Conclusion: No significant differences in wellbeing were found between participants’ pre and post KIDSCREEN scores. Significant findings indicate that the intervention may be more acceptable for those with poorer wellbeing and for those subject to diversionary intervention as VAS scores (assessing acceptability of the approach) correlated with lower KIDSCREEN scores (pre intervention) and type of intervention (diversionary or statutory) respectively. Five themes emerged from the semi- structured interviews highlighting important factors to consider when designing or implementing an intervention of this nature for this hard to reach population. A synthesis of the findings is presented in the concluding chapter where recommendations for future enquiry are considered.

abstract: This study tested the preliminary effectiveness of a health belief and text messaging intervention for parents of five- to eight-year-old children to determine whether health beliefs and influenza vaccine receipt differ when compared to a text messaging control group. Children are almost four times more likely to be infected with influenza than adults (Belshe Piedra, & Block, 2009), shed the greatest quantities of influenza virus, and have been recognized as vectors for spread of disease (Neuzil, Mellen, Wright, Mitchel, Jr., & Griffin, 2002b). The influenza immunization rate for school-age children is less than 56% (Centers for Disease Control and Prevention [CDC], 2014). Reasons for the low vaccination rate include parents’ misperceptions of influenza disease and vaccinations (Bhat-Schelbert et al., 2012; Taylor et al., 2002). There are few theory-based interventions for increasing influenza vaccination rates of school-age children; however, promising results have been found when using the constructs of the health belief model (HBM) (Chen et al., 2011; Coe, Gatewood, Moczygemba, Goode, & Beckner, 2012). Mobile technology using Short Message Service (SMS) text messaging may increase vaccination rates to a greater extent than traditional vaccine reminders (Daley et al., 2002; Grajalva, 2006). Prior to starting this study, only one randomized controlled trial testing text messaging to increase children’s influenza vaccination rates was found (Stockwell et al., 2012). In this study, text messaging was effective in promoting behavioral changes leading to a 4% increase in influenza vaccination (27.1% vs. 22.8%, RR = 1.19, p < .001). This study was a randomized controlled trial using a two-group pre- and posttest experimental design. This study found that a theory-based intervention (SayNo2Flu) guided by the HBM and combined with the use of mobile technology (SMS text messaging) did change parents’ influenza vaccination perceptions. It had an overall increase of 38.1% in Influenza vaccination rates in the intervention group (OR: 4.46, 95% CL, 1.705-11.706, p < .001). These results offer some insight into the use of theory-based preventative interventions for parents of young school-age children.
Dissertation/Thesis
Doctoral Dissertation Nursing and Healthcare Innovation 2015

Background: Obesity is the number one health risk facing Americans. The obesity epidemic in America is attributed to physical inactivity, unhealthy food choices, and excessive food intake. Structured weight loss programs have been successful in initiating behavior change and weight loss; however, weight is almost always regained over time. The rate of weight gain is highest immediately after cessation of a structured weight loss program. Thus, effective interventions are needed that can successfully be used following a structured weight loss program to sustain weight loss and prevent weight relapse. Due to low cost, ubiquity, and ease of use, healthcare communicated through mobile technology, or "mHealth", may be able to serve as an effective medium to reach a large number of people to facilitate weight loss behaviors. Short message service (SMS), also known as text messaging, is easy to use, ubiquitous, affordable, and can target people directly where they are regardless of geographic location, socioeconomic status, or demographic factors. A review of the literature demonstrated limited information regarding message content, timing and frequency of message delivery and only 3 of 14 SMS-related interventions reviewed demonstrated a statistically significant effect on weight loss, diet or exercise. Additionally, information on how to integrate and leverage SMS as a health promotion tool for weight loss was also limited in the literature.

The Behavior Change Process model was used as a guide to understand how to develop an intervention to help people sustain recent weight loss. Furthermore, research suggests interventions that target and frame messages about how people reach goals in their life through either a prevention or promotion focus may be beneficial at motivating people to self-regulate and sustain recent behavioral changes. The goal of this study was to design an intervention that would help people stay in the continued response phase of the Behavior Change Process and help prevent weight relapse. Using the Behavior Change Process and regulatory focus theory, an intervention was developed that leveraged short message service (SMS) to deliver messages to people who have recently lost weight in attempt to help them sustain weight loss and prevent relapse.

Methods: First, a pilot study was conducted to inform the development of a SMS software application, the development of message content and the frequency and timing of message delivery. Second, an exploratory 3-arm mixed methods randomized controlled trial was conducted to test the feasibility, acceptability, perception of the usefulness, and efficacy of a weight loss sustaining mHealth SMS intervention among people with obesity. Participants (N=120) were randomized to a promotion message group, a prevention message group, or an attention-control general health message group. Participants completed baseline assessments, and reported their weight at 1 and 3 months post-baseline to assess efficacy of the intervention on sustaining weight loss. In addition, participants partook in a phone interview follow completion of the intervention to assess acceptability and usefulness.

Results: Participants found the message content and intervention acceptable and a majority perceived value in receiving messages via SMS that promote weight loss sustaining behaviors. Interview data implied that the intervention served as a reminder and daily cue to action. Participants were favorable towards receiving a daily reminder, which they noted helped them to stay focused, and in some cases to keep them motivated to continue losing weight. And a majority, 42 (91%) who participated in a telephone interview said that they preferred to get messages on their cell phone due to accessibility and convenience. A minimum of one message per day delivered at approximately 8:00 A.M. was deemed the optimal delivery time and frequency. This was particularly true for weight loss, which many participants reported as a daily struggle that begins every morning. With regards to sustaining weight loss, there was a statistical trend in sustained weight loss at months 1 and 3 in the promotion and prevention framed message groups compared to the control group in both the intent-to-treat and evaluable case analyses. Clinically, there was a significant decrease in mean weight of approximately 5 pounds at month 3 in the promotion and prevention groups compared to the control. Additionally, effect sizes indicated a large effect of the intervention on sustaining weight loss in the promotion and prevention groups relative to the control group.

Conclusion: Overall results showed that at the continued response phase of the behavioral change process, it was feasible to design an application to deliver promotion and prevention framed weight loss sustaining messages. In particular, prevention framed messages may have been more useful in helping participants sustain weight loss. Though there was less than 80% power to detect a statistically significant difference, the observed effect sizes in this study were significant and demonstrated a large effect of the promotion and prevention interventions on sustaining weight loss relative to control. Furthermore, there was a clinically significant increase in mean weight loss and in the number of people who sustained weight loss in the promotion and prevention intervention groups compared to control.

These findings may serve as a reference for future interventions designed to help people thwart relapse and transition from a state of sustaining recent weight loss behaviors to a state of maintenance. Technological tools such as this SMS intervention that are constructed and guided by evidence-based content and theoretical constructs show promise in helping people sustain healthy behaviors that can lead to improved health outcomes.

Dissertation

Type 2 diabetes is a life-threatening condition, and it is rapidly growing in the world. If patients receive adequate education and support, they can manage their diabetes-related tasks effectively and reduce the severe complications of this disease. However, traditional self-management education and practices were not very effective in stimulating behaviour change and addressing patients’ diversified needs and expectations. Mobile text messaging is a promising method for type 2 diabetes self-management as it can provide continuous and customized support to these patients. However, there is a lack of knowledge about the optimal approach to designing and delivering mobile text messages. Hence, this dissertation aimed to define effective message strategies for mobile text messaging interventions targeting type 2 diabetes self-management. This manuscript-based dissertation consists of three complementary studies. The first manuscript includes a systematic review and a meta-analysis of tailored mobile text messaging interventions on type 2 diabetes self-management. It examines the tailoring strategies, message content, and structure and identifies the moderators of effectiveness in these interventions. The second manuscript includes a systematic review and a meta-synthesis of qualitative evidence on patients’ experiences and perspectives of mobile text messaging studies. The third manuscript consists of a prospective qualitative study to explore the text messaging design and delivery preferences of patients. In the first and second studies, the comprehensive search strategy included major electronic databases, key journal searches, and hand searches of the reference lists of related systematic reviews and meta-analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Collaboration's guidelines and recommended tools were used for data extraction, risk of bias and critical appraisal assessments, data analysis and reporting. Within a social marketing framework, the third study included semi-structured interviews and a thematic analysis of the main findings. In the first manuscript, 13 eligible trials were included for the systematic review and 11 eligible trials were further analyzed in the meta-analysis. This study concluded that tailored mobile text messaging interventions could improve glycemic control in patients with type 2 diabetes. The subgroup analyses revealed the importance of some moderators such as message delivery, message direction, message frequency, and using multi-modalities. In the second manuscript, the systematic review included 14 eligible studies, and the thematic synthesis included 13 eligible studies. Patients emphasized the importance of tailored text message design and delivery. They felt “supported” by using text messaging and improved their communication with family/friends and care providers. Mobile text messaging increased patients’ self-awareness, knowledge and control of diabetes. The third study explored that mobile text messages could be more effective if they are gain-framed and written in a standard format. Patients favoured the text messages that included simple and direct tone and provided statistical evidence. The findings demonstrated patients’ needs and expectations for advanced tailoring strategies in both message content and delivery. Together, the manuscripts fill a significant gap and inform research and practice for the development of more effective message strategies that could lead to reducing the spread of type 2 diabetes worldwide.
Graduate
2022-05-12

Regular physical activity and the inclusion of fruits and vegetables in dietary intake contribute to a variety of positive health outcomes and improve quality of life. With more than half of college students falling short of government guidelines for exercise and nutrition (ACHA, 2009), effective interventions targeting young adults during this transitional time are critical. Mobile phone use has become increasingly common among college students, providing an opportunity to develop intervention strategies that may be better integrated into their daily lives. Research on intervention components delivered by phone is essential for developing easily utilized, efficacious nutrition and physical activity interventions for students. Study objectives were (1) to examine the utility of a combined web-based and text-messaging intervention for physical activity and nutrition among college students, and (2) to examine the value of text message tailoring to maximize improvement in these outcomes. Students recruited from introductory psychology classes (n=151) completed measures of physical activity and nutrition at baseline and one-month follow-up. Students were randomized into one of four conditions: assessment only, web-based health behaviors feedback only, web-based feedback with standardized daily text-messages, web-based feedback with tailored daily text-messages. Primary hypotheses were that the intervention that combined web-based feedback with tailored daily text-messages would result in increased physical activity, increased fruit and vegetable intake, and greater likelihood of meeting government standards for these behaviors at follow-up compared to the assessment control condition. Regression analyses were performed with planned contrasts between experimental conditions to examine the additive impact of each intervention component on primary outcomes. Secondary analyses were conducted on additional nutrition and physical activity outcomes. Exploratory analyses were conducted to examine whether individual difference variables moderated the influence of the intervention on outcomes. Study hypotheses were not supported. No significant effect was observed for the intervention on physical activity or nutrition outcomes. These findings may suggest the need for more intensive intervention strategies to impact behavior. Future iterations should include two-way text-message communication and feedback to increase depth-of-processing, alternative tailoring approaches based on self-reported goal-systems variables, and further exploration of intervention components that may improve physical activity and nutrition among college students.

In the last decade, the explosive growth and adoption of mobile phones has become commonplace in our everyday lives (Haghirian, Madlberger, & Tanuskova, 2005). In 1997, there were only 215 million people worldwide who used mobile phones as communication devices (Bauer, Barnes, Reichardt, & Neumann, 2005). Today, it is estimated that 2 billion people own a mobile phone worldwide and this number makes up a third of the entire human population (Wireless Intelligence, 2005). Mobile phones are no longer thought of as mere personal communication tools (Cheong & Park, 2005; Ito & Okabe, 2005). They have become a fashion symbol for teenagers and young adults (Katz & Sugiyama, 2005). Personalised ring tones, colours, display logos and accessories are individualised accordingly to suit individuals’ preferences (Bauer, Barnes, Reichardt, & Neumann, 2005). Furthermore, mobile phones are no longer just a platform for voice calls and sending and receiving text messages such as short messaging service (SMS). Photos, pictures and video clips can be attached as a multimedia message service (MMS) for communication purposes too (Okazaki, 2005a). With the recent introduction of 3G mobile technology, mobile phone users are able to perform more activities via their 3G enabled phone sets. They are able to browse the Internet fairly quickly, access online banking, play video games wirelessly, watch television programs, check for weather forecasts, allow instant messaging, and perform live video-conferencing (Okazaki, 2005b).

The health status of the people in rural areas is faced with challenges primarily due to availability, acceptability, financial accessibility to healthcare services. These include traditional and cultural beliefs, behavioural norms that explain community viewpoints of social roles and various community members’ functions. Rural and remote areas are medically underserved, access to healthcare services is difficult sometimes. Distance covered to access the nearest available health facility by some rural dwellers is discouraging. Thus, moving critically ill or injured persons is hampered because of long-distance or poor transportation means. In the end, many prefer to use traditional medicine than travel that long distance for medical treatment. Recently, healthcare delivery systems have focused on innovative approaches to improve health outcomes, control costs, and foster achieving the Sustainable Development Goals (SDGs). One of these innovations is mHealth (Short Messaging Service) [SMS] texts, which have peculiar attributes, making it particularly suitable for health care in rural and hard-to-reach areas in Low and Middle-Income Countries (LMICs). Moreover, text-messaging interventions are uniquely suited for underserved populations. This chapter highlights some interventions on the uses and benefits of SMS text applications in healthcare service delivery.

Background: Substance-impaired driving continues to be a national public health concern and data suggests that up to one-third of college students report driving after drinking and/or cannabis use in the past year. To date, little research has investigated whether brief, technology-based interventions can be used to reduce substance-impaired driving among young adults. Recent research indicates that interventions that incorporate personal contact lead to larger effect sizes than fully automated interventions. The present study compared an interactive text-messaging intervention to an automated text-messaging intervention in the context of a brief, mobile-phone based substance-impaired driving intervention. Method: Participants were recruited through the university’s subject pool (n = 46) and completed measures that assessed impaired driving at baseline and three-month follow-up. In order to be eligible, students had to be at least 18 years or older, have access to a motor vehicle, and report driving after drinking two or more drinks and/or driving after cannabis use at least three times in the past three months. Participants were randomly assigned into four conditions: personalized feedback plus text-messaging (n = 12), personalized feedback plus automated text messaging (n = 11), an active control condition- (substance use information, n = 12), and an assessment only control condition (n = 11). Results: Repeated measures ANOVAs were run to compare the number of times driving while impaired over time across conditions. Analyses revealed the personalized feedback plus text-messaging led to significantly greater reductions over time in the number of times driving while impaired compared to participants in the assessment-only condition (p = .022). Additionally, participants in the personalized feedback plus text-messaging condition reported a greater reduction over time in the number of times driving while impaired than those in the personalized feedback plus automated text messaging condition, though this difference was not significantly significant (p = .066). Surprisingly, the text-messaging conditions did not result in significantly greater reductions in substance-impaired driving compared to the active control condition (p = .227). Discussion: Overall, these findings provide preliminary support for the short-term efficacy of a mobile-delivered personalized feedback intervention with interactive text-messaging in reducing substance-impaired driving among young adults. Due to Covid-19, three-month follow-up data could not be collected from half of the originally enrolled sample, resulting in underpowered analyses. Additional data will be collected as part of this pilot trial in the coming year.

Cannabis is commonly used by young adults (18-25), and these transitional years can be crucial as they tend to have the highest rates (5%; 1.8 million in the U.S.) of Cannabis Use Disorder (CUD; SAMHSA, 2016). Current survey data suggest 25% of university students use cannabis monthly or greater and 6% daily (Schulenberg et al., 2019) and even higher (38-39%) in states with legal recreational cannabis use (Pearson et al., 2017). Burgeoning research has shown that chronic, heavy cannabis use is associated with a host of negative consequences, including symptoms/diagnosis of CUD, as well as anxiety, depression, and psychosis, among other health issues (Arseneault et al., 2002; Buckner et al., 2010; Degenhardt et al., 2003; Midanik, Tam, & Weisner, 2007; Simons et al., 2010; Solowij & Pesa, 2010). With the number of young adults diagnosed with CUD, there is a growing need for intervention strategies. However, rates of individuals seeking formal treatment for cannabis use has been low (Prince et al., 2020). With widespread access, it has become easier to employ mobile technology for health interventions (Kumar et al., 2013). The overall objective of this systematic review was to explore the utilization of different mHealth interventions for cannabis users to investigate different types and ways these interventions are implemented, targeted outcomes, along with the types of studies being conducted (e.g., RCT, feasibility, interviews, usability, etc.). Methods: A search of PsycInfo and PubMed was conducted for relevant articles with the following search terms: mHealth app/web-based intervention/internet-based intervention/telehealth/JITAI/EMI/Ecological Momentary Intervention/Just-in-Time Adaptive Intervention/in the moment/Mobile Intervention/Smartphone Intervention/Wearable Devices AND Cannabis/Marijuana Peer-reviewed original research in English was targeted, which focused on mHealth interventions for adults (over 18 years of age) targeting cannabis use and needed both a mobile intervention and provided data on at least one outcome (e.g., reduced craving or cannabis use) or feasibility of intervention. Qualitative, quantitative, and mixed methods were all included. Results: The total number of records identified that fit the criteria based on a review of titles and abstracts were 33 (9 from PsycInfo and 24 from PubMed). After duplicates were removed, 27 were screened and 9 records were excluded for failure to meet search criteria after full review of the articles. The remaining records (n=18) were assessed for eligibility and data were extracted. Based on preliminary findings, the majority have been feasibility and usability studies (83%). Roughly half were conducted in the U.S., with the rest in European countries, and one in Singapore. The timeframe for using the mobile intervention ranged from 1-hour (for usability studies) to 8 months in duration. The types of mobile interventions have varied from text messaging, using a smartphone app, to directing individuals to websites. Roughly 50% have been standalone mHealth interventions, while the other half have been paired with face-to-face counseling sessions. The majority of these interventions have personalized intervention strategies for their participants.

Failure to attend healthcare appointments impacts on patient health and health system costs. Sending patients appointment reminders using mobile phone text messages (Short Message Service (SMS) and Multimedia Message Service (MMS)) could improve attendance compared to no reminders, or other types of reminders, such as postal or phone call reminders. The broad penetration of mobile phones in several low-income countries makes this intervention particularly promising.

Background Australia is a multi-cultural society with increasing rates of people from culturally and linguistically diverse (CALD) backgrounds. On average, CALD groups have higher rates of tobacco use, lower participation in cancer screening programs, and poorer health outcomes than the general Australian population. Lower cancer screening and smoking cessation rates are due to differing cultural norms, health-related attitudes, and beliefs, and language barriers. Interventions can help address these potential barriers and increase tobacco cessation and cancer screening rates among CALD groups. Cancer Council NSW (CCNSW) aims to reduce the impact of cancer and improve cancer outcomes for priority populations including CALD communities. In line with this objective, CCNSW commissioned this rapid review of interventions implemented in Australia and comparable countries. Review questions This review aimed to address the following specific questions: Question 1 (Q1): What smoking cessation interventions have been proven effective in reducing or preventing smoking among culturally and linguistically diverse communities? Question 2 (Q2): What screening interventions have proven effective in increasing participation in population cancer screening programs among culturally and linguistically diverse populations? This review focused on Chinese-, Vietnamese- and Arabic-speaking people as they are the largest CALD groups in Australia and have high rates of tobacco use and poor screening adherence in NSW. Summary of methods An extensive search of peer-reviewed and grey literature published between January 2013-March 2022 identified 19 eligible studies for inclusion in the Q1 review and 49 studies for the Q2 review. The National Health and Medical Research Council (NHMRC) Levels of Evidence and Joanna Briggs Institute’s (JBI) Critical Appraisal Tools were used to assess the robustness and quality of the included studies, respectively. Key findings Findings are reported by components of an intervention overall and for each CALD group. By understanding the effectiveness of individual components, results will demonstrate key building blocks of an effective intervention. Question 1: What smoking cessation interventions have been proven effective in reducing or preventing smoking among culturally and linguistically diverse communities? Thirteen of the 19 studies were Level IV (L4) evidence, four were Level III (L3), one was Level II (L2), none were L1 (highest level of evidence) and one study’s evidence level was unable to be determined. The quality of included studies varied. Fifteen tobacco cessation intervention components were included, with most interventions involving at least three components (range 2-6). Written information (14 studies), and education sessions (10 studies) were the most common components included in an intervention. Eight of the 15 intervention components explored had promising evidence for use with Chinese-speaking participants (written information, education sessions, visual information, counselling, involving a family member or friend, nicotine replacement therapy, branded merchandise, and mobile messaging). Another two components (media campaign and telephone follow-up) had evidence aggregated across CALD groups (i.e., results for Chinese-speaking participants were combined with other CALD group(s)). No intervention component was deemed of sufficient evidence for use with Vietnamese-speaking participants and four intervention components had aggregated evidence (written information, education sessions, counselling, nicotine replacement therapy). Counselling was the only intervention component to have promising evidence for use with Arabic-speaking participants and one had mixed evidence (written information). Question 2: What screening interventions have proven effective in increasing participation in population cancer screening programs among culturally and linguistically diverse populations? Two of the 49 studies were Level I (L1) evidence, 13 L2, seven L3, 25 L4 and two studies’ level of evidence was unable to be determined. Eighteen intervention components were assessed with most interventions involving 3-4 components (range 1-6). Education sessions (32 studies), written information (23 studies) and patient navigation (10 studies) were the most common components. Seven of the 18 cancer screening intervention components had promising evidence to support their use with Vietnamese-speaking participants (education sessions, written information, patient navigation, visual information, peer/community health worker, counselling, and peer experience). The component, opportunity to be screened (e.g. mailed or handed a bowel screening test), had aggregated evidence regarding its use with Vietnamese-speaking participants. Seven intervention components (education session, written information, visual information, peer/community health worker, opportunity to be screened, counselling, and branded merchandise) also had promising evidence to support their use with Chinese-speaking participants whilst two components had mixed (patient navigation) or aggregated (media campaign) evidence. One intervention component for use with Arabic-speaking participants had promising evidence to support its use (opportunity to be screened) and eight intervention components had mixed or aggregated support (education sessions, written information, patient navigation, visual information, peer/community health worker, peer experience, media campaign, and anatomical models). Gaps in the evidence There were four noteworthy gaps in the evidence: 1. No systematic review was captured for Q1, and only two studies were randomised controlled trials. Much of the evidence is therefore based on lower level study designs, with risk of bias. 2. Many studies provided inadequate detail regarding their intervention design which impacts both the quality appraisal and how mixed finding results can be interpreted. 3. Several intervention components were found to have supportive evidence available only at the aggregate level. Further research is warranted to determine the interventions effectiveness with the individual CALD participant group only. 4. The evidence regarding the effectiveness of certain intervention components were either unknown (no studies) or insufficient (only one study) across CALD groups. This was the predominately the case for Arabic-speaking participants for both Q1 and Q2, and for Vietnamese-speaking participants for Q1. Further research is therefore warranted. Applicability Most of the intervention components included in this review are applicable for use in the Australian context, and NSW specifically. However, intervention components assessed as having insufficient, mixed, or no evidence require further research. Cancer screening and tobacco cessation interventions targeting Chinese-speaking participants were more common and therefore showed more evidence of effectiveness for the intervention components explored. There was support for cancer screening intervention components targeting Vietnamese-speaking participants but not for tobacco cessation interventions. There were few interventions implemented for Arabic-speaking participants that addressed tobacco cessation and screening adherence. Much of the evidence for Vietnamese and Arabic-speaking participants was further limited by studies co-recruiting multiple CALD groups and reporting aggregate results. Conclusion There is sound evidence for use of a range of intervention components to address tobacco cessation and cancer screening adherence among Chinese-speaking populations, and cancer screening adherence among Vietnamese-speaking populations. Evidence is lacking regarding the effectiveness of tobacco cessation interventions with Vietnamese- and Arabic-speaking participants, and cancer screening interventions for Arabic-speaking participants. More research is required to determine whether components considered effective for use in one CALD group are applicable to other CALD populations.

Discussions of extremist ideologies naturally focus on how in-groups criticize and attack out-groups. But many important extremist ideological texts are disproportionately focused criticizing their own in-group. This research report will use linkage-based analysis to examine Siege, a White nationalist tract that has played an important role shaping modern neo-Nazi movements, including such violent organizations as Atomwaffen Division and The Base. While Siege strongly attacks out-groups, including Jewish and Black people, the book is overwhelmingly a critique of how the White people of its in-group fall short of Nazi ideals. Siege’s central proposition—that the White in-group is disappointing, deeply corrupt, and complacent—shapes its argument for an “accelerationist” strategy to hasten the collapse of society in order to build something entirely new. Finally, this report briefly reviews comparable extremist texts from other movements to draw insights about how in-group critiques shape extremist strategies. These insights offer policymakers and law enforcement tools to anticipate and counter violent extremist strategies. They also highlight less-obvious avenues for potential counter-extremist interventions and messaging campaigns.