Using photos to develop text messages to promote walking.

AbstractPurpose: Sending text messages (TMs) is a promising global intervention to help adults increase their engagement in walking as a form of physical activity (PA). But, little is known about how effective and acceptable TMs are developed.Design: Our study was designed to (a) determine the acceptability, among low-income adults, of receiving TMs to increase their walking and (b) develop, using photos to prompt discussion, a participant-generated database of TMs to promote walking.Methods: In 2011, three focus groups (low-income, sedentary adults) met at community clinics (one focus group at each of three clinics). To promote dialogue to help develop TMs, we created a discussion guide and a set of 40 photos depicting barriers to increasing PA or showing people walking. A content analysis of TMs developed was done using audiotaped transcripts, photo page notes, flip chart notes, and field notes.Findings: Twelve TM themes emerged, including 172 TMs developed by the 23 study participants (age 50 ± 6.3 years).Conclusions: Using TMs to help achieve walking goals is an acceptable method of promoting PA with adults. Using culturally relevant photos to prompt discussion, focus groups can develop a database of PA-related TMs to promote walking.Clinical Relevance: Physical inactivity is a significant contributor to adult health problems worldwide, and walking is a realistic method of increasing PA. Using focus groups and photos, individuals can generate acceptable, personalized and innovative TMs to promote walking.Key wordsPhysical activity, text messaging, focus groups, photos, adultsMany physical activity (PA) interventions have been tested globally in the past two decades, but translating research findings into increases in everyday activity (i.e., translating efficacy into effectiveness) remains elusive (Foster, Hillsdon, Thorogood, Kaur, & Wedatilake, 2005; Ogilvie et al., 2007). In fact almost one third of adults throughout the world (World Health Organization [WHO], 2013a) are insufficiently physically active (Hallal et al., 2012). Physical inactivity is now ranked fourth as a leading risk factor for mortality worldwide (WHO, 2013b). This is true despite the well-known health benefits of PA, including lower risk for heart disease, diabetes, stroke, and depression, and helping with weight control. Adults should do > 150 min per week of moderate-intensity PA, and one way this can be achieved is with brisk walking (WHO, 2010). Walking is a realistic and inexpensive form of PA for adults. Walking has many advantages; it can be done in a variety of settings and has a low injury rate (U.S. Department of Health and Human Services [USDHHS], 2008). Nevertheless, there are still barriers to walking regularly. These barriers include family issues, motivational concerns, time constraints, health-related issues, and environmental factors such as safety and weather (Centers for Disease Control and Prevention [CDC], 2011; Cerin, Leslie, Sugiyama, &* Owen, 2010; Dunton & Schneider, 2006).One promising intervention to help adults engage in more PA is the use of text messaging (Buchholz, Wilbur, Ingram, & Fogg, 2013). There are 6 billion cell phones worldwide (Central Intelligence Agency, 2011). Specifically, in the United States over 80% of adults own a cell phone and almost three fourths of these cell phone owners engage in text messaging (Smith, 2011a). Text messaging is now being used to promote health in many countries (WHO, 2011). In addition, text messaging to promote PA may be especially effective for low-income adults, since they engage in text messaging more frequently than middle or upper income adults (Smith, 2011a) and are less likely to engage in PA (CDC, 2012).However, little is known about how effective text messages (TMs) are developed. Of 10 PA text messaging intervention studies in adults, only one discussed TM development (Fjeldsoe, Miller, & Marshall, 2010). …