Health- or Environment-Focused Text Messages as a Potential Strategy to Increase Plant-Based Eating among Young Adults: An Exploratory Study

Previous plant-based diet (PBD) adoption strategies have primarily focused on health rather than environmental rationale and meat reduction rather than plant-based protein promotion. In this study, we explored the effect of a theory-informed text-message intervention on dietary intentions and behaviors in young adult omnivores and the potential explanatory role of PBD beliefs, subjective norm, self-efficacy, moral norm, and health and environmental values. Participants completed baseline questionnaires and reported dietary intake before being randomly assigned to receive 2–3 health- or environment-focused text messages per week for eight weeks and then repeated baseline assessments. Although we did not see significant changes in meat or plant protein intake, we did observe a marked decrease in intentions to consume animal protein and a marginal increase in fruit and vegetable consumption intention. We identified subjective norms, self-efficacy, and moral satisfaction as the strongest predictors of changes in intention to consume animal or plant protein. Although few group differences were observed, those receiving environment-focused text messages experienced a greater change in values and were more likely to increase vegetable intake. Messages that improve sustainability awareness and provide practical adoption strategies may be part of an effective strategy to influence PBD intake among young adults.

Development of CuidaTEXT: a text message intervention to support Latino dementia family caregivers

ObjectivesTo describe the development of CuidaTEXT: a tailored text message intervention to support Latino dementia family caregivers.MethodsCuidaTEXT is informed by the Stress Process Framework and Social Cognitive Theory. We developed and refined CuidaTEXT using a mixed-method approach that included thematic analysis and descriptive statistics. We followed six user-centered design stages, including the selection of design principles, software vendor collaboration, evidence-based foundation, caregiver and research/clinical advisory board guidance, sketching and prototyping, and usability testing among five Latino caregivers.ResultsCuidaTEXT is a bilingual 6-month long intervention tailored to caregiver needs that includes: 1) 1-3 daily automatic messages (n=244) about logistics, dementia education, self-care, social support, end-of-life, care of the person with dementia, behavioral symptoms and problem-solving strategies; 2) 783 keyword-driven text messages for further help with the above topics; 3) live chat interaction with a coach for further help; 4) a 19-page reference booklet summarizing the purpose and functions of the intervention. CuidaTEXT’s prototype scored 97 out of 100 in the System Usability Scale.ConclusionsCuidaTEXT’s prototype demonstrated high usability among Latino caregivers. CuidaTEXT’s feasibility is ready to be tested.Clinical ImplicationsCuidaTEXT’s usability and its potential for widespread implementation holds promise in supporting Latino caregivers.

Factors influencing participants’ engagement with an interactive text-message intervention to improve sun protection behaviors: “SunText” randomized controlled trial

There is growing evidence suggesting that text-message-based interventions are effective to promote sun protection behaviors. However, it is still unclear how engagement and adherence with the intervention messages can be optimized through intervention design. This study evaluated the effect of different combinations of personalized and two-way interactive messages on participant engagement with a theory-based skin cancer prevention intervention. In the SunText study conducted in February–July 2019 in Queensland, Australia participants 18–40 years were randomized to four different text message schedules using a Latin square design. This study analyzed if the order and intensity in which the schedules were received were associated with participants’ level of engagement, and if this differed by demographic factors. Out of the 389 participants enrolled in the study, 375 completed the intervention period and remained for analysis. The overall intervention engagement rate was 71% and decreased from the beginning to the end of the study (82.2%–61.4%). The group starting with personalized, but not interactive messaging showed the lowest engagement rate. The intervention involving interactive messages three times a week for 4 weeks achieved the highest engagement rate. The intervention with increasing frequency (personalized and interactive three times a week for 2 weeks; then daily for 2 weeks) had lower engagement than intervention with constant or decreasing frequency. Engagement with two-way interactive messages was high across all intervention groups. Results suggest enhanced engagement with constant or decreasing message frequency compared to increasing frequency.

Evaluation of the Healthy Living after Cancer text message-delivered, extended contact intervention using the RE-AIM framework

Background Text message-delivered interventions have potential to prevent weight regain and maintain diet and physical activity behaviours through extending contact with participants following initial weight loss, lifestyle interventions. Using the RE-AIM Framework, this study evaluated the adoption, reach, implementation, effectiveness, and maintenance of an extended contact text-message intervention following the Healthy Living after Cancer (HLaC) program. HLaC was a 6-month, telephone-delivered intervention targeting healthy diet, physical activity and weight loss for adult cancer survivors, offered by Cancer Councils (CCs) in Australia. Methods HLaC completers (n = 182) were offered extended contact via text messages for 6-months (HLaC+Txt). Text message content/frequency was individually tailored to participant’s preferences, ascertained through two telephone-tailoring interviews with CC staff. Adoption (HLaC+Txt uptake among eligible CCs), reach (uptake by HLaC completers) and implementation (intervention cost/length; text dose) were assessed. The effectiveness of extended contact relative to historic controls was quantified by pre-to-post HLaC+Txt changes in self-reported: weight, moderate-vigorous physical activity (MVPA), fruit and vegetable intake, fat and fibre behaviour. Maintenance, following 6-months of noncontact for the intervention cohort, was assessed for these same variables. Semi-structured interviews with CC staff and participants contextualised outcomes. Results HLaC+Txt was adopted by all four CCs who had delivered HLaC. In total, 115 participants commenced HLaC+Txt, with reach ranging across CCs from 47 to 80% of eligible participants. The mean number of weeks participants received the text message intervention ranged across CCs from 18.5–22.2 weeks. Participants received (median, 25th,75th percentile) 83 (48, 119) texts, ranging across CCs from 40 to 112. The total cost of HLaC+Txt delivery was on average $AUD85.00/participant. No meaningful (p < 0.05) differences in self-reported outcomes were seen between HLaC+Txt and control cohorts. After 6-months no contact the intervention cohort had maintained weight, fruit intake, fat and fibre index scores relative to end of HLaC+Txt outcomes. Participants/CC staff perceived an important intervention component was maintaining accountability. Conclusions While feasible to implement, HLaC+Txt was not effective in the short term. However, intervention effects during the non-contact period suggest the program supports longer term maintenance of weight and diet behaviour. Intervention delivery in this real-world context highlighted key considerations for future implementation. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

1527Effect of a text-messaging intervention on oral self-care practices in antenatal women in Delhi, India

Objective to determine the effect of a mHealth (text-message) intervention compared with a structured health educational session on the oral care and hygiene practices of pregnant women. Methods We conducted a pilot Randomized Control Trial parallel design superiority trial with a 1:1 allocation ratio. A total of 76 pregnant women up-to 20 weeks of gestational age and capable of reading mobile phone text-messages were recruited during August-October’ 2020 from the antenatal clinic of a primary health centre in a low-income urban agglomeration in Delhi, India. The mHealth intervention arm participants were sent a daily text-message for 30 days while all participants were provided a face-face, brief didactic structured educational sessions towards oral health promotion. Results The baseline characteristics of both groups were comparable in terms of age-structure, education, parity, and oral hygiene but differed in terms of oral health problems. Post-intervention, although, the twice-brushing frequency increased in both arms, only the mHealth arm revealed a statistically significant reduction in the incidence of missed twice daily brushing episodes (p = 0.016). The absolute effect size for the primary outcome signifying the difference in the proportion of participants reporting twice daily brushing frequency habit between the mHealth and comparison arms’ was 0.090, the Cohen’s H was 0.182, and the odds of twice brushing habit in the mHealth arm was 1.44 times higher than in the comparison arm. Conclusions a mHealth based daily text-message intervention for one month was not superior to a one-time brief didactic structured educational intervention for oral health promotion in antenatal women. Keywords mHealth; Dental health promotion; Dental health education; Antenatal care

Evaluation of the Healthy Living after Cancer Text Message-Delivered, Extended Contact Intervention using the RE-AIM Framework

Background: Text message-delivered interventions have potential to prevent weight regain and maintain diet and physical activity behaviours through extending contact with participants following initial weight loss, lifestyle interventions. This study evaluated the adoption, reach, implementation, effectiveness and maintenance of an extended contact text-message intervention following the Healthy Living after Cancer (HLaC) program. HLaC was a 6-month, telephone-delivered intervention targeting healthy diet, physical activity and weight loss for adult cancer survivors, offered by Cancer Councils (CCs) in Australia. Methods: HLaC completers (n=182) were offered extended contact via text messages for 6-months (HLaC+Txt). Text message content/frequency was individually tailored to participant’s preferences, ascertained through two telephone-tailoring interviews with CC staff. Adoption (HLaC+Txt uptake among eligible CCs), reach (uptake by HLaC completers) and implementation (intervention cost/length; text dose) were assessed. The effectiveness of extended contact relative to historic controls was quantified by pre-to-post HLaC+Txt changes in self-reported: weight, moderate-vigorous physical activity (MVPA), fruit and vegetable intake, fat and fibre behaviour. Maintenance, following 6-months of noncontact for the intervention cohort, was assessed for these same variables. Semi-structured interviews with CC staff and participants contextualised outcomes. Results: HLaC+Txt was adopted by all four CCs who had delivered HLaC. In total, 115 participants commenced HLaC+Txt, with reach ranging across CCs from 47–80% of eligible participants. The mean number of weeks participants received the text message intervention ranged across CCs from 18.5 – 22.2 weeks. Participants received (median, 25th,75th percentile) 83 (48, 119) texts, ranging across CCs from 40 to 112. The total cost of HLaC+Txt delivery was on average $AUD85.00/participant. No meaningful (p<0.05) differences in self-reported outcomes were seen between HLaC+Txt and control cohorts. After 6-months no contact the intervention cohort had maintained weight, fruit intake, fat and fibre index scores relative to end of HLaC+Txt outcomes. Participants and CC staff perceived an important intervention component was maintaining accountability. Conclusions: While feasible to implement, HLaC+Txt was not effective in the short term. However, intervention effects during the first 6-months of non-contact suggest the program supports longer term maintenance of weight and diet behaviour. Intervention delivery in this real-world context highlighted key considerations for future implementation.Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015)