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What Really Works in Using SMS to Improve Health Outcomes
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What Really Works in Using SMS to Improve Health Outcomes



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  • 2009 Systematic ReviewAny evidence to support use of SMS for health behavior changeFindings generally suggest that SMS is usefulFew conclusions on BEST PRACTICES
  • For this PRESENTATION---Went back to literature for updatesHappy to find that there are new studiesUNFORTUNTATELY There are Still no REAL ANSWERSHOWEVER This review is meant to highlight the KEY characteristics of best practices that we can glean from these studies and hopefully this will be informative for practical intervention design and implementation Review CriteriaRCT/Quasi exp- GOLD STANDARDHealth or Behavior as primary outcome (including one-time appointment reminders- which my original review excluded, because it isn’t a continuous behavior)Only focused on those articles with significant findings b/c we want to know WHAT WORKS(since this panel is what really works, limited studies to those that had sig. findings. Although this synthesis of information for those with non-significant findings would be just as interesting) 24 articles, 19 distinct studies dating back to 2005sample size varied INFORMAL REVIEW- the literature in this field is evolving, and new papers pop up every month…so it’s likely that this review is already out of dateBut this is INFORMAL, Just wanted to get an ideaNOW TO THE FINDINGS
  • Here is a summary of the population characteristics bottom line is, SMS works for many different populationADULTS- represented most, but young adults/teens get good representation as wellMakes sense- They are USED to PHONEsTargeted populations range- Healthy people to Diabetic to HIV+Interesting that HIV is represented now because in last review, no studies targeting HIV+ people but here there are 3 HIV studies
  • Also interesting, is that two of HIV studies took place in KenyaIn original review, only 1 was in a developing country but now there is more representation from developing world in research literatureAlso clear that US is well represented in the literatureInteresting because in practice- blogs, development reports, we find that developing world is very advanced when it comes to mHealth, but they are often more interested in practical application so they don’t conduct rigorous Randomized Controlled Trials, and it doesn’t end up in the scientific literature. Therefore, Scientific Literature shouldn’t be ONLY place you look for WHAT WORKS 
  • When we look at what kind of technology is being usedFor every trial that used SMS only, there was one that used SMS Coupled with another TechnologyFor example, SMS and Internet, SMS and EmailSeveral studies also made use of sensor technology that communicates directly with the phone, like Bluetooth enabled pedometers or glucometers
  • These are the references that I used to compile this information. Again the state of the field is nascent, so we still don’t have all the answers to what really works for SMS to improve health outcomes. However, in just 2 years we’ve seen a great increase in studiesWe are clearly on the way to gaining a better understanding for the best approach to improving health outcomes using SMS
  • Thank youPlease feel free to contact me if you have questions in the future


  • 1. What Really Works in Using SMS to Improve Health Outcomes
    Heather Cole-Lewis, MPH
    Yale University
    School of Epidemiology and Public Health
    Mobile Health 2011: What Really Works?
    Stanford University
    May 4, 2011
  • 2. 2009 Review of Literature
    Text Messaging as a Tool for Behavior Change in Disease Prevention and Management
    Cole-Lewis & Kershaw, Epidemiologic Reviews, 2010
    Conclusion: SMS appears effective, but no clear conclusions on What WORKS because field is new
  • 3. 2011 informal Review of Literature
    Review Criteria
    Randomized Controlled Trial/Quasi-experimental Trial
    Health or Behavioral Primary Outcome
    Significant findings in SUPPORT of SMS
    24 Articles representing 19 Studies
    Year of Publication: 2005-2011
    Sample Size: 17-1859
  • 4. Population Characteristics
  • 5. Location
  • 6. It’s not just SMS
  • 7. Health Conditions of Interest
  • 8. Significantly Improved Outcomes
  • 9. Basic Characteristics
  • 10. Message Frequency
  • 11. Message Dose
  • 12. Personalized Adjustment Options
  • 13. Time Outcomes Observed(months)
  • 14. References
    Rodgers A, Corbett T, Bramley D, et al. Do u smoke after txt? Results of a randomized trial of smoking cessation using mobile phone text messaging
    Free C, Whittaker R, Knight R, Abramsky T, Rodgers A, Roberts G 2009 Txt2stop: A pilot randomized controlled trial of mobile phone-based smoking cessation support
    Nguyen HQ, Gill DP, Wolpin S, Steel BG, Benditt JO 2009 Pilot study of a cell phone-based exercise persistence intervention post-rehabilitation for COPD
    HaapalaI, Barengo NC, Biggs S, Surakka L, Manninen P. 2009 Weight loss by mobile phone: a 1-year effectiveness study
    Patrick K, Raab F, Adams M, et al. 2009 A text message-based intervention for weight loss: Randomized controlled trial
    FjeldsoeBS, Miller YD, Marshall AL 2010 MobileMums: A randomized controlled trial of an SMS-based physical activity intervention Leong KC, Leong KW, Mastura I et al. 2006 The use of text messaging to improve attendance in primary care: a randomized controlled trial
    Chen ZW, Fang LZ, Chen LY, Dai HL 2008 Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: A randomized controlled trial
    Franklin VL, Waller A, Pagliari C, Greene SA. 2006 A randomized controlled trial of Sweet Talk, a text messaging system to support young people with diabetes
    Rami B, Popow C, Horn W, Waldhoer T, Schober E 2006 Telemedical support to improve glycemic control in adolescents with type 2 diabetes
    Yoon KH, Kim HS. 2008 A short message service by cellular phone in type 2 diabetic patients for 12 months
    HanauerDA, Wentzell K, Laffel N, Laffel L 2009 Computerized automated reminder diabetes system (CARDS): Email and SMS cell phone text messaging reminders to support diabetes management
    Cho JH, Lee HC, Lim DJ, Kwon HS, Yoon KH 2009 Mobile communication using a mobile phone system with a glucometer for glucose control in type 2 patients with diabetes: As effective as an Internet-based glucose monitoring system
    StrandbygaardU, Thomsen SF, Backer V 2010 A daily SMS mreinder increases adherence to asthma treatment: A three-month follow-up study
    Lim MSC, Hocking JS, Aitken CK, Fairley CK, Jordan L, Lewis JA, Hellard ME 2011 Impact of text and email messaging on the sexual health of young people: a randomised controlled trial
    JuzangI, Fortune T, Black S, Wright E, Bull S 2011 A pilot programme using mobile phones for HIV prevention
    Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, de Walque D, Mackeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR 2011
    Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders
    Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung M, Jack W, Habyarimana, Sadatsafavi M, Najafzadeh M, Marra CA, et al 2010 Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya 1): A randomised trial
    Armstrong AW, Watson AJ, Makredes M, Frangos JE, Kimball AB, Kvedar JC 2009 Text message reminders to improve sunscreen use: a randomized controlled trial using electronic modeling
  • 15. Thank you!
    mHeath student group meet-up during Fun Reception
    7pm @fireplace in the lounge