Using Text Messages to Bridge the Intention-Behavior Gap? A Pilot Study on the Use of Text Message Reminders to Increase Objectively Assessed Physical Activity in Daily Life

Background: In China, where follow-up with hospitalized attempters is generally lacking, there is a great need for inexpensive and effective means of maintaining contact and decreasing recidivism. Aims: Our objective was to test whether mobile telephone message contacts after discharge would be feasible and acceptable to suicide attempters in China. Methods: Fifteen participants were recruited from suicide attempters seen in the Emergency Department in Wuhan, China, to participate in a pilot study to receive mobile telephone messages after discharge. All participants have access to a mobile telephone, and there is no charge for the user to receive text messages. Results: Most participants (12) considered the text message contacts an acceptable and useful form of help and would like to continue to receive them for a longer period of time. Conclusions: This suggests that, as a low-cost and quick method of intervention in areas where more intensive follow-up is not practical or available, telephone messages contacts are accessible, feasible, and acceptable to suicide attempters. We hope that this will inspire future research on regular and long-term message interventions to prevent recidivism in suicide attempters.

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Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology

HRB Open Research ◽

10.12688/hrbopenres.13025.2 ◽

2020 ◽

Vol 3 ◽

pp. 21

Author(s):

Maire Curran ◽

Audrey C. Tierney ◽

Louise Collins ◽

Lauren Kennedy ◽

Ciara McDonnell ◽

...

Keyword(s):

Physical Activity ◽

Cystic Fibrosis ◽

Remote Monitoring ◽

Randomised Trial ◽

Text Message ◽

Wearable Technology ◽

Structured Interview ◽

Text Messages ◽

University Hospital ◽

Active Comparator

Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology, smartphone use and remote monitoring, all of which may have potential to impact on PA in adults with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA in adults with CF. Trial registration: ClinicalTrials.gov NCT03672058 (14/09/2018)

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An Adaptive, Algorithm-based Text Message Intervention to Promote Health Behavior Adherence in Type 2 Diabetes: Treatment Development and Proof-of-Concept Trial

Journal of Diabetes Science and Technology ◽

10.1177/19322968211065067 ◽

2021 ◽

pp. 193229682110650

Author(s):

Christopher M. Celano ◽

Christina Massey ◽

Jessica Long ◽

Sonia Kim ◽

Olivia Velasquez ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Adaptive Algorithm ◽

Controlled Trial ◽

Text Message ◽

Self Care ◽

Well Being ◽

Psychological Outcomes ◽

Text Messages

Background: Most individuals with type 2 diabetes (T2D) struggle to adhere to one or more health behaviors. Text message interventions (TMIs) have the potential to improve adherence but have had mixed effects on diet and activity in T2D. We developed an eight-week, adaptive, algorithm-driven TMI to promote physical activity, diet, self-care, and well-being. Then, in a single-arm trial, we assessed its feasibility, acceptability, and preliminary efficacy in 15 individuals with T2D and suboptimal adherence. Methods: Participants received daily text messages and were asked to rate the utility of each message (0=not helpful, 10=very helpful). These ratings were used by an algorithm to select subsequent messages based on each participant’s prior ratings. We assessed intervention feasibility by rates of message transmission/response and acceptability through ratings of message utility and burden. Finally, we examined pre-post changes in diabetes self-care, diet, physical activity, and psychological outcomes and calculated effect sizes (Cohen’s d). Results: All text messages were delivered, and participants provided ratings for 79% of messages, above our a priori thresholds for feasibility. Participants rated the individual messages and overall TMI as subjectively useful (utility: 8.1 [SD=2.1] and 7.8 [SD=2.0], respectively) and not burdensome (burden: 0.8 [SD=1.8]). The intervention led to significant, medium- to large-sized improvements in self-care ( d=0.77), diet ( d=0.99), and activity ( d=0.61) but minimal change in psychological outcomes. Conclusions: The TMI was feasible and well-accepted, and it led to promising improvements in adherence-related outcomes. These findings should be confirmed in a larger randomized controlled trial.

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Abstract P196: Personalized Dynamical System Models Of Individual Text Message Effects On Changes In Physical Activity

Circulation ◽

10.1161/circ.141.suppl_1.p196 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Sarah Hojjatinia ◽

Constantino M Lagoa ◽

Ashley B West ◽

Sahar Hojjatinia ◽

Taylor Turrisi ◽

...

Keyword(s):

Physical Activity ◽

Emerging Adults ◽

Systems Engineering ◽

Computational Models ◽

Cardiovascular Health ◽

Decision Rules ◽

Text Message ◽

Text Messages ◽

Dynamical Models ◽

Step Counts

Introduction: Text-message interventions with universal decision rules (treatment algorithms) demonstrate modest and inconsistent effects on physical activity. Efforts to increase effect sizes by targeting, tailoring or generically customizing content have largely been unsuccessful. In this study, system identification methods from control systems engineering were applied to develop person-specific dynamical models of individual responses to motivational text messages. Methods: Emerging adults not meeting aerobic physical activity guidelines (verified by accelerometer during a 1-week run-in period) received 0-6 messages/day while wearing a Fitbit Versa watch for 3 months. Experimental messages targeted cognitive or affective determinants of physical activity (move more) or sedentary behavior (sit less); comparator messages were inspirational quotes. For each participant, two dynamical models were estimated using difference equations: one to model the effects of move more and sit less messages and the other to model the effects of affectively- and cognitively-targeted messages. Both models included comparator messages. Effects represent the expected change in behavior immediately after message receipt (vs expected behavior without a message). Model order was determined individually to balance uncertainty and overfitting (range = 2-9). Results: The sample (n = 20) was mostly female (60%), White (65%), and not Hispanic or Latino (95%) with a mean age of 24.4 years (SD = 3.3; range = 19-29). Idiographic patterns of behavior change were readily observed from the personalized dynamical models. Most participants’ step counts increased after messages to move more (60% of participants’ responses exceeded the 95% error interval [responders], M = 94.3 steps; 83% of responders increased steps) and sit less (50% responders, M = 114.6 steps; 90% of responders increased steps), as well as control messages (75% responders, M = 59.5 steps; 60% of responders increased steps). Step counts also increased after messages targeting cognitive determinants (80% responders, M = 97.1 steps; 75% of responders increased steps) and affective determinants (75% responders, M = 52.9 steps, 67% of responders increased steps), as well as control messages (75% responders, M = 57.8 steps; 60% of responders increased steps). Conclusions: Motivational text messages can alter physical activity dynamics, and responses to different message types are highly personalized. Among responders, most message types increased expected step counts but some messages were iatrogenic and decreased expected step counts. Computational models of those dynamics provide a foundation for personalizing decision rules to select the type and time the delivery of messages to promote physical activity and improve cardiovascular health.

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Does exercise-induced bronchoconstriction affect physical activity patterns in asthmatic children?

Journal of Child Health Care ◽

10.1177/1367493519881257 ◽

2019 ◽

Vol 24 (4) ◽

pp. 577-588 ◽

Cited By ~ 1

Author(s):

MR van der Kamp ◽

BJ Thio ◽

M Tabak ◽

HJ Hermens ◽

JMM Driessen ◽

...

Keyword(s):

Physical Activity ◽

Pilot Study ◽

Childhood Asthma ◽

Daily Life ◽

Activity Patterns ◽

Physically Active ◽

Asthmatic Children ◽

Activity Tracker ◽

Exercise Induced ◽

Severe Type

Exercise-induced bronchoconstriction (EIB) is a sign of uncontrolled childhood asthma and classically occurs after exercise. Recent research shows that EIB frequently starts during exercise, called breakthrough-EIB (BT-EIB). It is unknown whether this more severe type of EIB forces children to adapt their physical activity (PA) pattern in daily life. Therefore, this pilot study aims to investigate daily life PA (amount, intensity, duration, and distribution) in children with BT-EIB, ‘classic’ EIB, and without EIB. A Fitbit Zip activity tracker was used for one week to objectively measure daily life PA at one-minute intervals. Thirty asthmatic children participated. Children with BT-EIB were less physically active compared to children without EIB (respectively 7994 and 11,444 steps/day, p = .02). Children with BT-EIB showed less moderate-to-vigorous PA compared to the children without (respectively 117 and 170 minutes/day, p = .02). Children with EIB (both BT and classic) had significant shorter bouts of activity and a less stretched distribution of bout lengths compared to the non-EIB group (all p < .05). These results emphasize a marked association between EIB severity and PA patterns in daily life, stressing the need for a thorough clinical evaluation of exercise-induced symptoms in childhood asthma.

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Increasing Physical Activity Efficiently: An Experimental Pilot Study of a Website and Mobile Phone Intervention

International Journal of Telemedicine and Applications ◽

10.1155/2014/746232 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 22

Author(s):

Kjærsti Thorsteinsen ◽

Joar Vittersø ◽

Gunnvald Bendix Svendsen

Keyword(s):

Physical Activity ◽

Pilot Study ◽

Progress Monitoring ◽

Physical Activity Intervention ◽

Intervention Group ◽

Text Messages ◽

Local Newspapers ◽

Physical Activity Interventions ◽

Daily Report ◽

Intensity Of Exercise

The main objective of this pilot study was to test the effectiveness of an online, interactive physical activity intervention that also incorporated gaming components. The intervention design included an activity planner, progress monitoring, and gamification components and used SMS text as a secondary delivery channel and feedback to improve engagement in the intervention content. Healthy adults (n=21) recruited through ads in local newspapers (age 35–73) were randomized to the intervention or the control condition. Both groups reported physical activity using daily report forms in four registration weeks during the three-month study: only the experiment condition received access to the intervention. Analyses showed that the intervention group had significantly more minutes of physical activity in weeks five and nine. We also found a difference in the intensity of exercise in week five. Although the intervention group reported more minutes of physical activity at higher intensity levels, we were not able to find a significant effect at the end of the study period. In conclusion, this study adds to the research on the effectiveness of using the Internet and SMS text messages for delivering physical activity interventions and supports gamification as a viable intervention tool.

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A Mobile Health Intervention for Adolescents Exposed to Secondhand Smoke: Pilot Feasibility and Efficacy Study

JMIR Formative Research ◽

10.2196/18583 ◽

2020 ◽

Vol 4 (8) ◽

pp. e18583

Author(s):

Natalie Nardone ◽

Jeremy Giberson ◽

Judith J Prochaska ◽

Shonul Jain ◽

Neal L Benowitz

Keyword(s):

Pilot Study ◽

Mobile Health ◽

Secondhand Smoke ◽

Text Messaging ◽

Text Message ◽

Preliminary Evidence ◽

Text Messages ◽

Urinary Cotinine ◽

Mhealth Intervention ◽

Shs Exposure

Background Secondhand smoke (SHS) exposure in children and adolescents has adverse health effects. For adolescents of lower socioeconomic status (SES), exposure is widespread, evidenced in the measurement of urinary cotinine, a major metabolite of nicotine. Direct intervention with exposed children has been proposed as a novel method, yet there is minimal evidence of its efficacy. Combining this approach with a mobile health (mHealth) intervention may be more time and cost-effective and feasible for adolescent populations. Objective In this pilot study, we assessed the feasibility and preliminary evidence of efficacy of a 30-day text message–based mHealth intervention targeted at reducing SHS exposure in adolescent populations of low SES. Methods For the study, 14 nonsmoking and nonvaping participants between the ages of 12-21 years exposed to SHS were enrolled. The intervention consisted of a daily text message sent to the participants over the course of a month. Text message types included facts and information about SHS, behavioral methods for SHS avoidance, or true-or-false questions. Participants were asked to respond to each message within 24 hours as confirmation of receipt. Feasibility outcomes included completion of the 30-day intervention, receiving and responding to text messages, and feedback on the messages. Efficacy outcomes included a reduction in urinary cotinine, accuracy of true-or-false responses, and participants’ perceptions of effectiveness. Results Of the 14 participants that were enrolled, 13 completed the intervention. Though not required, all participants had their own cell phones with unlimited text messaging plans. Of the total number of text messages sent to the 13 completers, 91% (372/407) of them received on-time responses. Participant feedback was generally positive, with most requesting more informational and true-or-false questions. In terms of efficacy, 54% (6/11) of participants reduced their cotinine levels (however, change for the group overall was not statistically significant (P=.33) and 45% (5/11) of participants increased their cotinine levels. Of the total number of true-or-false questions sent across all completers, 77% (56/73) were answered correctly. Participants’ ratings of message effectiveness averaged 85 on a scale of 100. Conclusions In this pilot study, the intervention was feasible as the majority of participants had access to a cell phone, completed the study, and engaged by responding to the messages. The efficacy of the study requires further replication, as only half of the participants reduced their cotinine levels. However, participants answered the majority of true-or-false questions accurately and reported that the messages were helpful.

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Feasibility and Acceptability of a Physical Activity Tracker and Text Messages to Promote Physical Activity During Chemotherapy for Colorectal Cancer: Pilot Randomized Controlled Trial (Smart Pace II)

JMIR Cancer ◽

10.2196/31576 ◽

2022 ◽

Vol 8 (1) ◽

pp. e31576

Author(s):

Erin L Van Blarigan ◽

Anand Dhruva ◽

Chloe E Atreya ◽

Stacey A Kenfield ◽

June M Chan ◽

...

Keyword(s):

Physical Activity ◽

Digital Health ◽

Controlled Trial ◽

Text Message ◽

Text Messages ◽

Walk Test ◽

Randomized Controlled ◽

6 Minute Walk Test ◽

Minute Walk

Background We conducted a pilot 2-arm randomized controlled trial to assess the feasibility of a digital health intervention to increase moderate-to-vigorous physical activity in patients with colorectal cancer (CRC) during chemotherapy. Objective This study aimed to determine whether a digital health physical activity intervention is feasible and acceptable during chemotherapy for CRC. Methods Potentially eligible patients with CRC expected to receive at least 12 weeks of chemotherapy were identified in person at the University of California, San Francisco, and on the web through advertising. Eligible patients were randomized 1:1 to a 12-week intervention (Fitbit Flex, automated SMS text messages) versus usual care. At 0 and 12 weeks, patients wore an Actigraph GT3X+ accelerometer for 7 days and completed surveys, body size measurements, and an optional 6-minute walk test. Participants could not be masked to their intervention arm, but people assessing the body size and 6-minute walk test outcomes were masked. The primary outcomes were adherence (eg, Fitbit wear and text response rate) and self-assessed acceptability of the intervention. The intervention would be considered feasible if we observed at least 80% complete follow-up and 70% adherence and satisfaction, a priori. Results From 2018 to 2020, we screened 240 patients; 53.3% (128/240) of patients were ineligible and 26.7% (64/240) declined to participate. A total of 44 patients (44/240, 18%) were randomized to the intervention (n=22) or control (n=22) groups. Of these, 57% (25/44) were women; 68% (30/44) identified as White and 25% (11/44) identified as Asian American or Pacific Islander; and 77% (34/44) had a 4-year college degree. The median age at enrollment was 54 years (IQR 45-62 years). Follow-up at 12 weeks was 91% (40/44) complete. In the intervention arm, patients wore Fitbit devices on a median of 67 out of 84 (80%) study days and responded to a median of 17 out of 27 (63%) questions sent via SMS text message. Among 19 out of 22 (86%) intervention patients who completed the feedback survey, 89% (17/19) were satisfied with the Fitbit device; 63% (12/19) were satisfied with the SMS text messages; 68% (13/19) said the SMS text messages motivated them to exercise; 74% (14/19) said the frequency of SMS text messages (1-3 days) was ideal; and 79% (15/19) said that receiving SMS text messages in the morning and evening was ideal. Conclusions This pilot study demonstrated that many people receiving chemotherapy for CRC are interested in participating in digital health physical activity interventions. Fitbit adherence was high; however, participants indicated a desire for more tailored SMS text message content. Studies with more socioeconomically diverse patients with CRC are required. Trial Registration ClinicalTrials.gov NCT03524716; https://clinicaltrials.gov/ct2/show/NCT03524716

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Beneficial Influence of Mindfulness Training Promoted by Text Messages on Self-Reported Aerobic Physical Activity in Older Adults: A Randomized Controlled Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2019-0002 ◽

2020 ◽

Vol 28 (3) ◽

pp. 406-414

Author(s):

Nicolas Robin ◽

Lucette Toussaint ◽

Stéphane Sinnapah ◽

Olivier Hue ◽

Guillaume R. Coudevylle

Keyword(s):

Physical Activity ◽

Older Adults ◽

Positive Impact ◽

Text Message ◽

Text Messages ◽

Mindfulness Training ◽

Controlled Study ◽

Control Group ◽

Physical And Mental Health ◽

Experimental Conditions

Inactivity is known to have harmful effects on the physical and mental health of older adults. This study used a randomized, parallel trial design to evaluate whether daily text prompts to practice mindfulness would have a positive impact on the time that adults aged 50 years or older spend in aerobic physical activity. The participants were recruited from a certified fitness center and divided into mindfulness and control groups. For 4 weeks, they were exposed to the experimental conditions, with or without the morning text message. In the morning message condition, the mindfulness groups received a text message with the instruction to practice audio-guided mindfulness for 10 min, and the control group received a placebo message. The participants practicing mindfulness reported significantly more weekly minutes of aerobic physical activity and higher intrinsic motivation than the control participants. Mindfulness training was effective at increasing aerobic physical activity duration and might complement physical activity programs.

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Text Message Medication Adherence Reminders Automated and Delivered at Scale Across Two Institutions: Testing the Nudge System: Pilot Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.120.007015 ◽

2021 ◽

Author(s):

Phat Luong ◽

Thomas J. Glorioso ◽

Gary K. Grunwald ◽

Pamela Peterson ◽

Larry A. Allen ◽

...

Keyword(s):

Medication Adherence ◽

Pilot Study ◽

Phase I ◽

Phase Ii ◽

Text Messaging ◽

Care Delivery ◽

Text Message ◽

Text Messages ◽

Medication Refill ◽

The Impact

Background: Medication refill behavior in patients with cardiovascular diseases is suboptimal. Brief behavioral interventions called Nudges may impact medication refill behavior and can be delivered at scale to patients using text messaging. Methods: Patients who were prescribed and filled at least one medication for hypertension, hyperlipidemia, diabetes, atrial fibrillation, and coronary artery disease were identified for the pilot study. Patients eligible for the pilot (N=400) were enrolled with an opportunity to opt out. In phase I of the pilot, we tested text message delivery to 60 patients. In phase II, we tested intervention feasibility by identifying those with refill gap of ≥7 days and randomized them to intervention or control arms. Patients were texted Nudges and assessed whether they refilled their medications. Results: Of 400 patients sent study invitations, 56 (14%) opted out. In phase I, we successfully delivered text messages to 58 of 60 patients and captured patient responses via text. In phase II, 207 of 286 (72.4%) patients had a medication gap ≥7 days for one or more cardiovascular medications and were randomized to intervention or control. Enrolled patients averaged 61.7 years old, were primarily male (69.1%) and White (72.5%) with hypertension being the most prevalent qualifying condition (78.7%). There was a trend towards intervention patients being more likely to refill at least 1 gapping medication (30.6% versus 18.0%; P =0.12) and all gapping medications (17.8% versus 10.0%; P =0.27). Conclusions: It is possible to set up automated processes within health care delivery systems to identify patients with gaps in medication adherence and send Nudges to facilitate medication refills. Text message Nudges could potentially be a feasible and effective method to facilitate medication refills. A large multi-site randomized trial to determine the impact of text-based Nudges on overall CVD morbidity and mortality is now underway to explore this further. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03973931.

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