Cost-effectiveness of a text message programme for the prevention of recurrent cardiovascular events Design and rationale of the tobacco, exercise and diet messages (TEXT ME) trial of a text message-based intervention for ongoing prevention of cardiovascular disease in people with coronary disease: a randomised controlled trial protocol Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Clinical Trial. Effectiveness of Text Messaging as an Adjuvant to Health Advice in Smoking Cessation Programs in Primary Care. A Randomized Clinical Trial Development of a set of mobile phone text messages designed for prevention of recurrent cardiovascular events Design Considerations in Development of a Mobile Health Intervention Program: The TEXT ME and TEXTMEDS Experience Development and Outcomes of a Text Messaging Tobacco Cessation Intervention With Urban Adolescents. Behavioural intervention to increase physical activity among patients with coronary heart disease: protocol for a randomised controlled trial. Text Message Delivered Peer Network Counseling for Adolescent Smokers: A Randomized Controlled Trial Patterns, predictors and effects of texting intervention on physical activity in CHD – insights from the TEXT ME randomized clinical trial Antenatal health promotion via short message service at a Midwife Obstetrics Unit in South Africa: a mixed methods study Perception of patients with alcohol use disorder and comorbid depression about the usefulness of supportive text messages. Can the effects of implementation intentions on exercise be enhanced using text messages? Text message-based diabetes self-management support (SMS4BG): study protocol for a randomised controlled trial Young People’s Views and Experiences of a Mobile Phone Texting Intervention to Promote Safer Sex Behavior Smoking Cessation Support by Text Message During Pregnancy: A Qualitative Study of Views and Experiences of the MiQuit Intervention Feasibility of a text-based smoking cessation intervention in rural older adults Improving treatment adherence for blood pressure lowering via mobile phone SMS-messages in South Africa: a qualitative evaluation of the SMS-text Adherence SuppoRt (StAR) trial Impact of an SMS advice programme on maternal and newborn health in rural China: study protocol for a quasi-randomised controlled trial Smoking cessation using mobile phone text messaging is as effective in Maori as non-Maori. A Qualitative Study of Client–Clinician Text Exchanges in a Mobile Health Intervention for Individuals With Psychotic Disorders and Substance Use A study to assess the feasibility of Text Messaging Service in delivering maternal and child healthcare messages in a rural area of Tamil Nadu, India. Efficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial
Objective To estimate the cost-effectiveness of Tobacco , Exercise and Diet Messages ( TEXT ME ) , a text message-based intervention that provides advice , motivation , information and support to improve health-related behaviours . Methods A lifetime Markov model was used to estimate major vascular events ( myocardial infa rct ions and strokes ) avoided , quality -adjusted life years ( QALYs ) gained , costs to the health system and the incremental cost per QALY gained . The model was informed by data from a r and omised controlled trial of TEXT ME , with evidence from systematic review s and meta-analyses used to estimate the effects of changes in risk factors on the risk of major vascular events . Expected costs and health outcomes were estimated with uncertainty surrounding these characterised using probabilistic sensitivity analysis and a number of scenario analyses . Results For a target population of 50 000 patients with documented coronary heart disease , the intervention is expected to lead to 563 fewer myocardial infa rct ions , 361 fewer strokes and 1143 additional QALYs .  TEXT ME is expected to lead to an overall saving of $ 10.56 million for the health system over the patients ’ lifetimes . The intervention can therefore be considered cost-saving and health-improving . Neither parameter nor structural uncertainty had a significant impact on the conclusion that TEXT ME is cost-effective . Conclusions The provision of TEXT ME is predicted to lead to better health outcomes and an overall saving in costs for the health system . Trial registration number anzctr.org.au identifier : ACTRN12611000161921 Background Although supporting lifestyle change is an effective way of preventing further events in people with cardiovascular disease , providing access to such interventions is a major challenge . This study aims to investigate whether simple reminders about behaviour change sent via mobile phone text message decrease cardiovascular risk . Methods and analysis R and omised controlled trial with 6 months of follow-up to evaluate the feasibility , acceptability and effect on cardiovascular risk of repeated lifestyle reminders sent via mobile phone text messages compared to usual care .  A total of 720 patients with coronary artery disease will be r and omised to either st and ard care or the TEXT ME intervention . The intervention group will receive multiple weekly text messages that provide information , motivation , support to quit smoking ( if relevant ) and recommendations for healthy diets and exercise . The primary end point is a change in plasma low-density lipoprotein cholesterol at 6 months . Secondary end points include a change in systolic blood pressure , smoking status , quality of life , medication adherence , waist circumference , physical activity levels , nutritional status and mood at 6 months . Process outcomes related to acceptability and feasibility of TEXT ME will also be collected . Ethics and dissemination Primary ethics approval was received from Western Sydney Local Health Network Human Research Ethics Committee — Westmead . Results will be disseminated via the usual scientific forums including peer- review ed publications and presentations at international conferences . Clinical trials registration number ACTRN12611000161921 IMPORTANCE Cardiovascular disease prevention , including lifestyle modification , is important but underutilized . Mobile health strategies could address this gap but lack evidence of therapeutic benefit . OBJECTIVE To examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors . DESIGN AND SETTING The Tobacco , Exercise and Diet Messages ( TEXT ME ) trial was a parallel-group , single-blind , r and omized clinical trial that recruited 710 patients ( mean age , 58 [ SD , 9.2 ] years ; 82 % men ; 53 % current smokers ) with proven coronary heart disease ( prior myocardial infa rct ion or proven angiographically ) between September 2011 and November 2013 from a large tertiary hospital in Sydney , Australia . INTERVENTIONS Patients in the intervention group ( n = 352 ) received 4 text messages per week for 6 months in addition to usual care . Text messages provided advice , motivational reminders , and support to change lifestyle behaviors . Patients in the control group ( n=358 ) received usual care . Messages for each participant were selected from a bank of messages according to baseline characteristics ( eg , smoking ) and delivered via an automated computerized message management system . The program was not interactive . MAIN OUTCOMES AND MEASURES The primary end point was low-density lipoprotein cholesterol ( LDL-C ) level at 6 months . Secondary end points included systolic blood pressure , body mass index ( BMI ) , physical activity , and smoking status . RESULTS At 6 months , levels of LDL-C were significantly lower in intervention participants , with concurrent reductions in systolic blood pressure and BMI , significant increases in physical activity , and a significant reduction in smoking . The majority reported the text messages to be useful ( 91 % ) , easy to underst and ( 97 % ) , and appropriate in frequency ( 86 % ) . [ table : see text ] . CONCLUSIONS AND RELEVANCE Among patients with coronary heart disease , the use of a lifestyle-focused text messaging service compared with usual care result ed in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors . The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12611000161921 Introduction Smoking remains a major risk factor for chronic diseases . Health advice is considered one of the most cost-effective interventions ; however , changes produced by counseling tend not to persist over time , it is necessary to implement enforcement mechanisms . Methods R and omized clinical trial to evaluate the effectiveness of a combined program that includes health advice and text messaging to mobile phone ( SMSalud ® ) . Patients were r and omized to one of two interventions : health advice ( control group ) or health advice and text messaging (  intervention group ) . We included 320 smoker patients who met the inclusion criteria : being motivated , aged over 18 years , having a mobile phone , being able to read and send messages . Patients were excluded if they had a history of mental or behavioral disorders , or depression . The primary endpoint was the percentage of patients who had stopped smoking by 6 months and confirmed by CO breath test . Results By 6 months after the start of the program , 24.4 % ( 39/160 ) of patients in the intervention group and 11.9 % ( 19/160 ) of controls had stopped smoking ( OR : 2.3 ; 95 % CI : 1.3 - 4.3 , p = .007 ) . Patients with no dependence or mild dependence were more likely to stop ( 28.3 % , 36/127 vs. 11.4 % , 22/193 ; OR : 3.0 , 95 % CI : 1.7 - 5.5 , p < .001 ) . The rate of continuous abstinence at 12 months was 16.3 % ( 26/160 ) in intervention group patients and 5.6 % ( 9/160 ) in controls ( OR : 3.2 ; 95 % CI : 1.3 - 5.9 ) . ] . Conclusions The combined program is effective for smoking cessation . Patients with less tobacco dependence have a higher probability of success . Implication s Health advice is effective for promoting changes in lifestyle but these changes do not persist over time , so we have to use strengthening mechanisms , as e-health , and specifically , mobile phone based interventions . SMSalud ® is an innovate program that includes text messaging and health advice , and it 's effective for smoking cessation . The only feature that seems to affect the probability of smoking cessation is the degree of tobacco dependence Background : Supporting lifestyle change is an effective way of preventing recurrent events in people with cardiovascular disease ( CVD ) . However , there is a need to develop innovative strategies that increase access to programmes for individuals at high risk of CVD . This study aim ed to develop a bank of text messages design ed to provide advice , motivation , and support for decreasing cardiovascular risk . Design : Iterative development process with mixed methods Methods : An initial bank of 120 text messages was drafted based on behaviour change techniques , guidelines , and input from clinicians and public health experts . A question naire was then administered to participants ( n = 53 ) for evaluation of message content , usefulness , and language . To test the process of delivery , a pilot study was conducted using a specifically design ed computer programme that delivered messages to multiple mobile phones according to a pre-specified schedule . Data were collected regarding message timing , delivery , and usefulness . Results : In the qualitative question naire , 92 % of participants found the messages easy to underst and and 86 % found the messages contained useful information . Positive feedback was also obtained from the pilot study . Based on these results , together with suggestions provided , several messages were reworded and an additional 44 were written . The need for semi-personalization was also identified and a r and om set of 103 individualized messages was created . Conclusions : A final bank of 137 mobile telephone text messages design ed to support behaviour change and decrease cardiovascular risk have been developed through a multistep iterative process . This provides a scientific approach for future developers of health-related text messages Background Mobile health ( mHealth ) has huge potential to deliver preventative health services . However , there is paucity of literature on theoretical constructs , technical , practical , and regulatory considerations that enable delivery of such services . Objectives The objective of this study was to outline the key considerations in the development of a text message-based mHealth program ; thus providing broad recommendations and guidance to future research ers design ing similar programs . Methods We describe the key considerations in design ing the intervention with respect to functionality , technical infrastructure , data management , software components , regulatory requirements , and operationalization . We also illustrate some of the potential issues and decision points utilizing our experience of developing text message ( short message service , SMS ) management systems to support 2 large r and omized controlled trials : TEXT messages to improve MEDication adherence & Secondary prevention ( TEXTMEDS ) and Tobacco , EXercise and dieT MEssages ( TEXT ME  ) . Results The steps identified in the development process were : ( 1 ) background research and development of the text message bank based on scientific evidence and disease-specific guidelines , ( 2 ) pilot testing with target audience and incorporating feedback , ( 3 ) software-hardware customization to enable delivery of complex personalized programs using prespecified algorithms , and ( 4 ) legal and regulatory considerations . Additional considerations in developing text message management systems include : balancing the use of customized versus preexisting software systems , the level of automation versus need for human inputs , monitoring , ensuring data security , interface flexibility , and the ability for upscaling . Conclusions A merging of expertise in clinical and behavioral sciences , health and research data management systems , software engineering , and mobile phone regulatory requirements is essential to develop a platform to deliver and manage support programs to hundreds of participants simultaneously as in TEXT ME and TEXTMEDS trials . This research provides broad principles that may assist other research ers in developing mHealth programs BACKGROUND This paper describes the development of an urban adolescent text messaging tobacco cessation intervention and preliminary findings from a r and omized , controlled trial . The authors successfully adapted a face-to-face intervention into a personalized , automated , and interactive 5-day texting protocol . METHODS Respondent-driven sampling was used beginning at a community substance abuse facility . Seventy-two tobacco-dependent adolescents were r and omized into an automated computer texting program that delivered either the experimental condition of 30 motivational interviewing- and social network counseling-based personalized messages or the attention control condition consisting of a texting program covering general ( non-smoking-related ) health habits . All teens were provided smartphones for the study and were assessed at baseline and at 1 , 3 , and 6 months post intervention . Analyses examined condition × time interactions . RESULTS At 6 months , the experimental condition decreased the number of cigarettes smoked in the past 30 days , increased intentions not to smoke in the future , and increased peer social support compared with controls . Effect sizes were moderate to large . CONCLUSIONS These findings are unique , as they target urban adolescents with a mobile health format and add to the growing literature on the efficacy of text-delivered interventions BACKGROUND Although physical activity has significant health benefits in the treatment of patients with coronary heart disease , patients often do not follow prescribed physical activity recommendations . Behavioural strategies have been shown to be efficacious in increasing physical activity among those patients with coronary heart disease who are attending structured cardiac rehabilitation programmes . Research has also shown that tailoring consultation according to patients ' needs and sending motivational reminders are successful ways of motivating patients to be physically active . However , there is a lack of evidence for the efficacy of behavioural interventions based on individualised consultation in promoting physical activity among those patients with coronary heart disease who are not attending structured physical activity programmes . OBJECTIVE This paper outlines the study protocol for a trial which is currently underway , to examine the effect of a behavioural change intervention delivered through individualised consultation calls and motivational reminder text messages on the level of physical activity among patients with coronary heart disease . SETTING Two large hospitals in Jordan . PARTICIPANTS Eligible patients aged between 18 and 70 years , who are clinical ly stable , are able to perform physical activity and who have access to a mobile telephone have been r and omly allocated to control or intervention group . DESIGN AND METHODS Two-group r and omised controlled trial . Behavioural intervention will be compared with usual care in increasing  physical activity levels among patients with coronary heart disease . The control group ( n=85 ) will receive advice from their doctors about physical activity as they would in usual practice . The intervention group ( n=71 ) will receive the same advice , but will also receive behavioural change intervention ( goal - setting , feed-back , self-monitoring ) that will be delivered over a period of six months . Intervention will be delivered through individually tailored face-to-face and telephone consultations , supported by motivational SMS text messages to encourage and remind patients to attain these goals . The participants and the research er delivering the intervention are not blinded to group assignment . RESULTS Recruitment started in February 2012 and preliminary findings are expected in November 2012 . CONCLUSION It is hypothesised that behavioural intervention delivered through tailored individualised consultation supported by motivational SMS text message reminders will help CHD patients to increase their level of PA . TRIAL REGISTRATION The study is registered as a clinical trial at IS RCT N register ( IS RCT N48570595 ) Abstract Although adolescent tobacco use has declined in the last 10 years , African American high school seniors ’ past 30-day use has increased by 12 % , and as they age they are more likely to report lifetime use of tobacco . Very few urban youth are enrolled in evidence d-based smoking prevention and cessation programming . Therefore , we tested a text messaging smoking cessation intervention design ed to engage urban youth through an automated texting program utilizing motivational interviewing-based peer network counseling . We recruited 200 adolescents ( 90.5 % African American ) into a r and omized controlled trial that delivered either the experimental intervention of 30 personalized motivational interviewing-based peer network counseling messages , or the attention control intervention , consisting of text messages covering general ( non-smoking related ) health habits . All adolescents were provided smart phones for the study and were assessed at baseline , and at 1 , 3 , and 6 months post intervention . Utilizing repeated measures general linear models we examined the effects of the intervention while controlling for race , gender , age , presence of a smoker in the home , and mental health counseling . At 6 months , participants in the experimental condition significantly decreased the number of days they smoked cigarettes and the number of cigarettes they smoked per day ; they significantly increased their intentions not to smoke in the future ; and significantly increased peer social support among girls . For boys , participants in the experimental condition significantly reduced the number of close friends in their networks who smoke daily compared to those in the control condition . Effect sizes ranged from small to large . These results provide encouraging evidence of the efficacy of text messaging interventions to reduce smoking among adolescents and our intervention holds promise as a large-scale public health preventive intervention platform Background Mobile phone text message interventions are used to support behaviour change including physical activity , but we have less insight into how these interventions work and what factors predict response . Aims To study the effect of TEXT ME ( Tobacco EXercise and dieT Messages ) text message intervention on physical activity domains , consistency of effects across sub-groups and its additive value in patients that received traditional cardiac rehabilitation programme . Methods This is a secondary analysis of the TEXT ME , a r and omized clinical trial of lifestyle-focused text message intervention compared with usual care in patients with coronary heart disease . A quarter of the messages were design ed specifically to encourage physical activity . Sedentary time and physical activity were assessed using the Global Physical Activity Question naire . Results At baseline , 85 % of the 710 participants reported low physical activity levels . At six months , compared with controls , the intervention arm reported higher recreational physical activity ( 471 vs. 307 metabolic equivalent-min/week , p = 0.001 ) and travel physical activity ( 230 vs. 128 MET-min/week , p = 0.002 ) , similar work-related physical activity and lower sedentary times ( 494 vs. 587 min , p < 0.001 ) . Male gender , high baseline physical activity , cardiac rehabilitation participation and text message intervention predicted physically active status at six months . Subjects that received both cardiac rehabilitation and text messaging intervention were more likely to achieve target physical activity levels compared with cardiac rehabilitation alone ( odds ratio 7.07 vs. 1.80 , p < 0.001 ) . Conclusions The TEXT ME intervention improved recreational and travel physical activity , reduced sedentary times but had no effects on work-related physical activity . It had incremental benefits at achieving target physical activity levels even in patients participating in the traditional cardiac rehabilitation programme Background Adequate antenatal care is important to both the health of a pregnant woman and her unborn baby . Given South Africa ’s high rate of cellphone penetration , mobile health interventions have been touted as a potentially powerful means to disseminate health information . This study aim ed to increase antenatal health knowledge and awareness by disseminating text messages about clinic procedures at antenatal visits , and how to be healthy during pregnancy . Methods Participants recruited were pregnant women attending a primary health care facility in Cape Town . A controlled clinical trial was carried out where the intervention group ( n = 102 ) received text messages staggered according to the week of pregnancy at the time of recruitment . The control group ( n = 104 ) received no text messages . These text messages contained antenatal health information , and were delivered in English , Xhosa or Afrikaans , according to the preference of each participant . A baseline knowledge question naire with nine questions was administered prior to the intervention . The same question naire was used with added health-related behaviour questions for the intervention group at exit . A modified intention-to-treat analysis was done . To compare the control and intervention group ’s knowledge , Fisher ’s exact tests and two- sample t-tests tests were carried out for binary and continuous outcomes , respectively . A focus group of seven participants from the intervention group was then conducted to gain more insight into how the text messages were perceived . Results There was substantial loss to follow-up during the study with only 57 % of the participants retained at exit . No statistically significant difference was detected between the control and intervention group in any of the nine knowledge questions at exit ( all p > 0.05 ) . Responses from the focus group indicated that the text messages acted as a welcome reminder and a source of positive motivation , and were perceived as extended care from the health care provider . Conclusions While the intervention failed to improve antenatal health knowledge , evidence from self-reported behaviour and the focus group suggests that text messages have the potential to motivate change in health-seeking behaviour . One should be mindful of loss to follow-up when rolling out mobile health interventions in developing country setting s . Trial registration Pan African Clinical Trials Registry PACTR201406000841188 . Registered 3 June 2014 BACKGROUND Very little is known about the perception of patients with alcohol use disorder ( AUD ) and comorbid depression about the usefulness of supportive text messages . OBJECTIVE To examine the perception of patients with AUD and comorbid depression about the usefulness of supportive text messages . METHODS Participants ( n=26 ) with a DSM IV diagnosis of AUD and depression and completing an in-patient dual diagnosis treatment programme had twice daily supportive text messages delivered to their mobile phones for three months as part of a r and omised trial . Participants were contacted at the end of the third month to obtain their views regarding the usefulness of the supportive text messages using a semi-structured question naire . RESULTS Overall , 24 out of 26 patients were contactable for feedback ( 92 % response rate ) . Eighteen ( 75 % ) patients reported that the text messages always or often reminded them to remain abstinent from alcohol . Again , 20 ( 83 % ) patients reported that the intervention had played a useful role in helping to improve their mental health , in particular , in serving as a motivation for recovery and in preventing relapse . CONCLUSIONS Patients with AUD and depression perceive that supportive text messages help them to remain abstinent from alcohol and also improve upon their mental wellbeing Implementation intentions planning in advance the situation in which one will act , have been proposed to be an effective self-regulatory technique for changing health behaviour . Encouraging people to receive text message reminders of their implementation intentions should enhance their strength and , thus , it was predicted that this combined approach would be particularly effective in increasing exercise .  Participants ( N = 155 ) were r and omly allocated to one of five conditions ( implementation intentions and SMS , implementation intention , SMS or one of two control groups ) then completed self-report measures of exercise behaviour and motivation . Four weeks later , they responded to similar items . Results suggested that the combined intervention increased exercise frequency significantly more than the other strategies including the implementation intention group . It is proposed , therefore , that implementation intention effects can be enhanced via plan reminders Background Addressing the increasing prevalence , and associated disease burden , of diabetes is a priority of health services internationally . Interventions to support patients to effectively self-manage their condition have the potential to reduce the risk of costly and debilitating complications . The utilisation of mobile phones to deliver self-management support allows for patient-centred care at the frequency and intensity that patients desire from outside the clinic environment . Self-Management Support for Blood Glucose ( SMS4BG ) is a novel text message-based intervention for supporting people with diabetes to improve self-management behaviours and achieve better glycaemic control and is tailored to individual patient preferences , demographics , clinical characteristics , and culture . This study aims to assess whether SMS4BG can improve glycaemic control in adults with poorly controlled diabetes . This paper outlines the rationale and methods of the trial . Methods / design A two-arm , parallel , r and omised controlled trial will be conducted across New Zeal and health districts . One thous and participants will be r and omised at a 1:1 ratio to receive SMS4BG , a theoretically based and individually tailored automated text message-based diabetes self-management support programme ( intervention ) in addition to usual care , or usual care alone ( control ) . The primary outcome is change in glycaemic control ( HbA1c ) at 9 months . Secondary outcomes include glycaemic control at 3 and 6 months , self-efficacy , self-care behaviours , diabetes distress , health-related quality of life , perceived social support , and illness perceptions . Cost information and healthcare utilisation will also be collected as well as intervention satisfaction and interaction . Discussion This study will provide information on the effectiveness of a text message-based self-management support tool for people with diabetes . If found to be effective it has the potential to provide individualised support to people with diabetes across New Zeal and ( and internationally ) , thus extending care outside the clinic environment . Trial registration Australian New Zeal and Clinical Trials Registry : ACTRN12614001232628 Background The risk of poor sexual health , including unplanned pregnancy and sexually transmitted infections ( STIs ) , is greatest amongst young people . Innovative and acceptable interventions to improve sexual health are required . Mobile phone text messaging ( short message service , SMS ) interventions have the potential to reach large numbers of people at relatively low cost , but greater underst and ing is needed on how these interventions should be developed and how they work . Objectives The aim of this paper is to explore young people ’s views of and experiences with a mobile phone text messaging intervention to promote safer sex behavior . Methods We undertook qualitative interviews with young people aged 16 to 24 years as part of a pilot trial of a sexual health intervention delivered by text message in the United Kingdom . Study participants received sexual health promotion text messages based on behavior-change techniques . The message content , tailored by gender and STI status , included support for correct STI treatment and promotion of safer sex behaviors . Young people were eligible if they had received a positive chlamydia test or had more than one partner and at least one episode of unprotected sex in the last year . Telephone interviews were conducted 2 to 3 weeks after initiation of the intervention . A semi-structured topic guide was followed to explore participant experiences and a thematic analysis was conducted . Results We conducted 16 telephone interviews with participants who had received the text intervention and an additional four interviews with those in the control group ( 13 women and 7 men ) . Intervention participants found text messages easy to underst and and appearing to come from a friendly and trustworthy source . They considered the frequency and timing of messages to be appropriate , and delivery via mobile phones convenient . Receipt of support by text message allowed recipients to assimilate information at their own pace , and prompted reflection on and sharing of messages with friends , family members , and partners , thus providing opportunities for education and discussion . For some recipients , the messages had increased their knowledge of how to correctly use condoms . Some described how the messages had increased their confidence and reduced stigma , enabling them to disclose infection to a partner and /or to do so sooner and more calmly . Discussing the messages with a partner reportedly enabled some women to negotiate condom use . Conclusion From the perspective of the recipients , the tone , frequency , and content of the text messaging-based sexual health intervention was acceptable and appropriate . Their accounts indicated that the intervention increased knowledge , confidence , and safer sex behaviors . A large-scale r and omized controlled trial ( RCT ) is needed to assess effectiveness Abstract Introduction : SMS text messaging is increasingly used for delivering smoking cessation support and pilot studies suggest this may also be useful in pregnancy . This study explores the views of women who received a tailored text messaging cessation intervention ( MiQuit ) during pregnancy , focusing on acceptability , perceived impact , and suggestions for improvements . Methods : Semi-structured interviews were undertaken with 15 purposively sample d women who had received the MiQuit intervention during pregnancy as part of a r and omized controlled trial . Data were analyzed thematically . Results : Three main themes were identified : “ impact ” , “ approach , ” and “ optimization . ” Participants described an immediate , yet often short-lived , impact from the texts that distracted and delayed them from smoking and they perceived that texts focusing on the development of and risk to the baby generated more enduring emotional impacts . Most women found receiving support by text preferable to face-to-face cessation support , with participants citing the greater regularity , convenience , and non-judgmental style as particular advantages . Participants would have preferred a longer support program with increased tailoring , greater customization of text timings and consideration of cutting down as an alternative/precursor to quitting . Conclusion : Pregnancy-specific cessation support by text message was well received and participants considered the support increased their motivation to stop smoking . The focus on the developing baby , the regularity of contact and the provision of gentle , encouraging messages were highlighted as particularly important elements of the program . Implication s : This study adds further evidence to the acceptability and perceived positive impact of text-messaging programs in aiding smoking cessation in pregnancy . The findings indicate that for some women , this type of support is preferable to face-to-face methods and could be utilized by health professionals , either in addition to current methods or as an alternative . This study is also relevant to research ers developing health-related text programs to consider participants ’ desire for greater tailoring . Further research is required into adapting and continuing text support for women postpartum Text-based interventions are effective for smoking cessation , but have not been tested in rural older adults . The purpose of this study was to compare the feasibility , acceptability and preliminary efficacy of a text-based Scheduled Gradual Reduction ( SGR ) program to a non-SGR text messaging support condition among rural older adults . Adults over 60 years were r and omized to either : ( i ) the SGR program  ( n = 20 ) , a  text-based program to reduce smoking over 4-weeks plus text-based support messages ;  or ( ii ) control  ( n = 20 ) , receipt of text-based support messages only . Participants completed surveys at baseline and end of program to assess feasibility and acceptability of the intervention , and biochemically vali date d 7-day point prevalence cessation was assessed at end of treatment . Most participants ( 81 % ) reported reading all the messages they received . Participants found both interventions useful in quitting smoking ( SGR = 57 % , Control = 63 % ) and would recommend it to a friend ( SGR = 72 % , Control = 79 % ) . Although not statically significant , the SGR group had a higher rate of biochemically vali date d cessation ( SGR = 15 % , Control = 5 % , Cohen d = 0.67 ) . Among those still smoking , the median percent reduction in cigarettes was 33.3 % for both groups . Text-based cessation interventions are feasible , acceptable and can be easily disseminated to rural older adult tobacco users Background Effective use of proven treatments for high blood pressure , a preventable health risk , is challenging for many patients . Prompts via mobile phone SMS-text messaging may improve adherence to clinic visits and treatment , though more research is needed on impact and patient perceptions of such support interventions , especially in low-re source setting s. Method An individually-r and omised controlled trial in a primary care clinic in Cape Town ( 2012–14 ) , tested the effect of an adherence support intervention delivered via SMS-texts , on blood pressure control and adherence to medication , for hypertensive patients . ( Trial registration : Clinical Trials.gov NCT02019823 ) . We report on a qualitative evaluation that explored the trial participants ’ experiences and responses to the SMS-text messages , and identified barriers and facilitators to delivering adherence support via patients ’ own mobile phones . Two focus groups and fifteen individual interviews were conducted . We used comparative and thematic analysis approaches to identify themes and triangulated our analysis amongst three research ers . Results Most participants were comfortable with the technology of using SMS-text messages . Messages were experienced as acceptable , relevant and useful to a broad range of participants . The SMS-content , the respectful tone and the delivery ( timing of reminders and frequency ) and the relational aspect of trial participation ( feeling cared for ) were all highly valued . A subgroup who benefitted the most , were those who had been struggling with adherence due to high levels of personal stress . The intervention appeared to coincide with their readiness for change , and provided practical and emotional support for improving adherence behaviour . Change may have been facilitated through increased acknowledgement of their health status and attitudinal change towards greater self-responsibility . Complex interaction of psycho-social stressors and health service problems were reported as broader challenges to adherence behaviours . Conclusion Adherence support for treatment of raised blood pressure , delivered via SMS-text message on the patient ’s own phone , was found to be acceptable , relevant and helpful , even for those who already had their own reminder systems in place . Our findings begin to identify for whom and what core elements of the SMS-text message intervention appear to work best in a low-re source operational setting , issues that future research should explore in greater depth Introduction Expectant mothers in low-income and middle-income countries often lack access to vital information about pregnancy , preparation for birth and best practice s when caring for their newborn . Innovative solutions are needed to bridge this knowledge gap and dramatically improve maternal and neonatal health in these setting s. This study aims to evaluate the impact of an innovative text messaging intervention on maternal and neonatal health outcomes . Methods and analysis This study offers expectant mothers in rural China a package of free short messages via cell phone regarding pregnancy and childbirth . These messages are tailored to each mother 's gestational week . It is hypothesised that delivering these short advice messages to pregnant women can improve maternal and newborn health . The study uses factorial quasi-r and omisation to compare psychological , behavioural and health outcomes between 4 groups : 2 groups receiving different sets of short message interventions ( ie , good household prenatal practice s and healthcare seeking ) , a group receiving both interventions and a control group . Treatment assignment occurs at the individual level . The primary outcome is newborn health , measured by appropriateness of weight for gestational age . Secondary outcomes include severe neonatal and maternal morbidity as well as psychological and behavioural measures . This study has enrolled pregnant women who attend county maternal and child health centres for their prenatal visits . Discussion This pilot is the first large-scale effort to build a comprehensive evidence base on the impact of prenatal text messages via cell phone on maternal and newborn health outcomes in China . The study has broad implication s for public health policy in China and the implementation of mobile health interventions in low-re source setting s around the world . Ethics This study was approved by the Ethics Committee of the School of Medicine at Xi'an Jiaotong University on 18 January 2013 . Trial registration number NCT02037087 ; Pre- results AIMS To determine whether a smoking cessation service using mobile phone text messaging is as effective for Maori as non-Maori . METHODS A single-blind r and omised controlled trial was undertaken with recruitment targeted to maximise the participation of young Maori . The intervention included regular , personalised text messages providing smoking cessation advice , support , and distraction . Maori text messages related to Maori language , support messages ( in Maori and English ) and information on Maori traditions . Text messaging was free for 1 month . After 6 weeks , the number of messages reduced from 5 per day to 3 per week until the 26-week follow-up . RESULTS Participants included 355 Maori and 1350 non-Maori . Maori in the intervention group were more likely to report quitting ( no smoking in the past week ) at 6 weeks ( 26.1 % ) than those in the control group ( 11.2 % ) RR 2.34 , 95 % CI : 1.44 - 3.79 . There was no significant difference between the RR for Maori and that for non-Maori ( RR : 2.16 , 95%CI : 1.72 - 2.71 ) . CONCLUSIONS A mobile phone-based cessation programme was successful in recruiting young Maori , and was shown to be as effective for Maori as non-Maori at increasing short-term self-reported quit rates . This shows clear potential as a new public health initiative abstract Objective : Mobile health ( mHealth ) approaches have the potential to transform prevention , wellness , and illness management for people with dual diagnosis consisting of co-occurring mental illness and substance use disorders by providing timely and cost-effective interventions in clients ' natural environments . However , little is known about how clients interact with mHealth interventions to manage their illness . This qualitative study explored the content of mobile phone text messages between clients with dual diagnosis and a clinician who engaged them in daily assessment and intervention text exchanges . Methods : Seventeen participants with psychotic disorders and substance use were enrolled in a 12-week single-arm trial of an mHealth intervention focusing on illness management . The clinician ( i.e. , mobile interventionist ) sent daily text messages to participants ' privately owned mobile phones to assess their medication adherence and clinical status . The clinician provided other illness management and wellness suggestions flexibly , in response to participants ' needs and preferences . In this qualitative study we conducted a thematic analysis of the client – clinician text exchanges that occurred over the course of the intervention . Results : Seven major content themes in client – clinician text message exchanges were identified : mental health symptoms ; mental health coping strategies ; mental health treatment and management ; lifestyle behaviors ; social relationships and leisure activities ; motivation and personal goal setting ; and independent living . Participants were interested in discussing strategies for coping with mental health symptoms ( e.g. , cognitive restructuring , social support ) and health behavior change ( e.g. , increased physical activity , dietary changes ) . Conclusions : Our findings suggest that client-centered text messaging has the potential to be an important component of illness management for people with dual diagnosis . This approach is able to offer coping strategies that are tailored to clients ' needs and preferences in real time when help is needed BACKGROUND Mobile text messaging is a potentially powerful tool for behaviour change because it is widely available , inexpensive , and instant . AIMS To evaluate whether mobile Text Messaging Service is a feasible mode of raising knowledge regarding maternal and child health ( MCH ) and to explore issues related to mobile text messages as a mode of health education . METHOD A community-based intervention study was conducted from January to June 2013 in six r and omly selected villages of Vellore district , Tamil Nadu . A multi-stage sampling technique was followed : 120 individuals from 120 households ( 30 clusters in six villages ) were contacted . Data was collected using a pretested question naire by house-to-house visits in three phases : 1 ) baseline assessment of aptitude towards text messages ; 2 ) intervention : sending MCH-related text messages ; and 3 ) end-line assessment to evaluate the increase in knowledge level . Qualitative data regarding mobile text messages as a mode of health education was explored . Quantitative data was analysed using SPSS version 17.0 and qualitative data by Anthropac software . RESULTS Of the individuals surveyed , 69.17 per cent and 52.5 per cent were " able to read " and " type and send " text messages , respectively . Seventy per cent of individuals were willing to receive health information via text messages , and 98.33 per cent believed text messages could effectively spread health messages . A significant increase in knowledge was observed following text messages . Male gender and subjects ' ability to read text messages were significantly associated . Factors related to mobile phone use include minimum economic burden , easy availability , portability , and ease of use . Factors related to mobile text messages as a mode of health message delivery include direct receipt of information , mass reach , the absence of regional language font in many h and sets , and illiterate individuals being unable to read messages . CONCLUSION In rural areas , mobile text messages have the potential to deliver health messages regarding MCH Background Interventions to support people with hypertension in attending clinics and taking their medication have potential to improve outcomes , but delivery on a wide scale and at low cost is challenging . Some trials evaluating clinical interventions using short message service ( SMS ) text-messaging systems have shown important outcomes , although evidence is limited . We have developed a novel SMS system integrated with clinical care for use by people with hypertension in a low-re source setting . We aim to test the efficacy of the system in improving blood pressure control and treatment adherence compared to usual care . Methods / design The SMS Text-message Adherence suppoRt trial ( StAR ) is a pragmatic individually r and omised three-arm parallel group trial in adults treated for hypertension at a single primary care centre in Cape Town , South Africa . The intervention is a structured programme of clinic appointment , medication pick-up reminders , medication adherence support and hypertension-related education delivered remotely using an automated system with either informational or interactive SMS text-messages . Usual care is supplemented by infrequent non-hypertension related SMS text-messages . Participants are 1:1:1 individually r and omised , to usual care or to one of the two active interventions using minimisation to dynamically adjust for gender , age , baseline systolic blood pressure , years with hypertension , and previous clinic attendance . The primary outcome is the change in mean systolic blood pressure at 12-month follow-up from baseline measured with research staff blinded to trial allocation . Secondary outcomes include the proportion of patients with 80 % or more of days medication available , proportion of participants achieving a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg , hospital admissions , health status , retention in clinical care , satisfaction with treatment and care , and patient related quality of life . Anonymised demographic data are collected on non- participants . Discussion The StAR trial uses a novel , low cost system based on widely available mobile phone technology to deliver the SMS-based intervention , manage communication with patients , and measure clinical ly relevant outcomes . The results will inform implementation and wider use of mobile phone based interventions for health care delivery in a low-re source setting .Trial registration
The intervention can therefore be considered cost-saving and health-improving .
Neither parameter nor structural uncertainty had a significant impact on the conclusion that TEXT ME is cost-effective .
Conclusions The provision of TEXT ME is predicted to lead to better health outcomes and an overall saving in costs for the health system .
Objective To estimate the cost-effectiveness of Tobacco , Exercise and Diet Messages ( TEXT ME ) , a text message-based intervention that provides advice , motivation , information and support to improve health-related behaviours .