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Testing the effectiveness of physical activity advice delivered via text messaging vs. human phone advisors in a Latino population: The On The Move randomized controlled trial design and methods.

ABSTRACT: Physical inactivity is a key risk factor for a range of chronic diseases and conditions, yet, approximately 50% of U.S. adults fall below recommended levels of regular aerobic physical activity (PA). This is particularly true for ethnic minority populations such as Latino adults for whom few culturally adapted programs have been developed and tested. Text messaging (SMS) represents a convenient and accessible communication channel for delivering targeted PA information and support, but has not been rigorously evaluated against standard telehealth advising programs. The objective of the On The Move randomized controlled trial is to test the effectiveness of a linguistically and culturally targeted SMS PA intervention (SMS PA Advisor) versus two comparison conditions: a) a standard, staff-delivered phone PA intervention (Telephone PA Advisor) and b) an attention-control arm consisting of a culturally targeted SMS intervention to promote a healthy diet (SMS Nutrition Advisor). The study sample (N = 350) consists of generally healthy, insufficiently active Latino adults ages 35 years and older living in five northern California counties. Study assessments occur at baseline, 6, and 12 months, with a subset of participants completing 18-month assessments. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of PA, assessed via validated self-report measures and supported by accelerometry, and physical function and well-being variables. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. Trial Registration: clinicaltrial.gov Identifier = NCT02385591.

SUBMITTER: King AC

PROVIDER: S-EPMC7351675 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Testing the effectiveness of physical activity advice delivered via text messaging vs. human phone advisors in a Latino population: The On The Move randomized controlled trial design and methods.

King Abby C AC Campero Ines I Sheats Jylana L JL Castro Sweet Cynthia M CM Espinosa Patricia Rodriguez PR Garcia Dulce D Hauser Michelle M Done Monica M Patel Michele L ML Parikh Nina M NM Corral Cecilia C Ahn David K DK

Contemporary clinical trials 20200711

Physical inactivity is a key risk factor for a range of chronic diseases and conditions, yet, approximately 50% of U.S. adults fall below recommended levels of regular aerobic physical activity (PA). This is particularly true for ethnic minority populations such as Latino adults for whom few culturally adapted programs have been developed and tested. Text messaging (SMS) represents a convenient and accessible communication channel for delivering targeted PA information and support, but has not b ...[more]

PMID: 32659437

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Project description:Background:The majority of Latino immigrants have been shown to have a mobile phone. Cellular phones offer a low-cost method of reaching larger populations and have the potential for increased tailoring and interactivity. This supports the development of mHealth interventions to address healthcare disparities in this population. In this study we sought to evaluate the feasibility and acceptability of interactive Spanish-language text messages sent throughout a child's first year of life in a low-income, limited-English proficient (LEP) Latino population to support families in accessing and using pediatric primary care more effectively. Methods:Participants (n=79) received interactive text messages over a period of 12 months as a part of a multi-modal mHealth intervention conducted at an urban academic pediatric primary care practice. Inclusion criteria were: singleton infant <2 months of age, enrollment in public health insurance, parent age >18, parent preferred healthcare language of Spanish, and at least one household cellular phone. Interactive text messages were designed to promote increased healthcare engagement and prompted participant responses through preprogramed algorithms. Text message sequences included clinic appointment reminders, support for obtaining medicine and completing referral appointments, monitoring of illness care needs and use, and parent support program reminders. Descriptive analyses were used to examine text message volume, usability, and participant response to text sequences. Results:Among participants, mean parent age was 30.1 years (SD: 6.1 years); mean years in the US was 7.5 years (SD: 5.1 years). 63.3% of parents had less than a high school education and 84.8% of parents had possible/high likelihood of limited health literacy. Participants completed the majority of sequences with appointment reminder sequences having the quickest response time. The top quartile of responders completed 88.3% of sequences; lower educational attainment was associated with lower text message sequence completion. Participants rated the program positively, especially the appointment reminders. Conclusions:LEP Latino parents successfully engaged with interactive Spanish-language text sequences and parent acceptability was high. This study demonstrates feasibility for interventions employing this technology. Text message interventions may be a feasible approach to reduce healthcare disparities and costs for vulnerable populations.

Project description:BACKGROUND:Mobile phone text messaging (SMS) has the potential to promote adherence to tuberculosis treatment. This systematic review aims to synthesize current evidence on the effectiveness of SMS interventions in improving patients' adherence to tuberculosis treatment. METHODS:We searched electronic databases (PubMed, EMBASE, Science Citation Index), reference lists of relevant articles, conference proceedings, and selected websites for eligible studies available by 15 February 2013; regardless of language or publication status. Two authors independently screened selected eligible studies, and assessed risk of bias in included studies; resolving discrepancies by discussion and consensus. RESULTS:We identified four studies that compared the outcomes of the SMS intervention group with controls. Only one of the four studies was a randomized controlled trial. This was conducted in Argentina and the SMS intervention did not significantly improve adherence to tuberculosis treatment compared to self-administration of tuberculosis treatment (risk ratio [RR] 1.49, 95% confidence intervals [CI] 0.90 to 2.42). One of the non-randomized studies, conducted in South Africa, which compared SMS reminders to directly observed therapy short course (DOTS) reported similar rates of tuberculosis cure (62.35% vs. 66.4%) and treatment success (72.94% vs. 69.4%). A second study from South Africa, utilized SMS reminders when patients delayed in opening their pill bottles and reported increased tuberculosis cure (RR 2.32, 95% CI 1.60 to 3.36) and smear conversion (RR 1.62, 95% CI 1.09 to 2.42) rates compared to DOTS. In the third non-randomized study, conducted in Kenya, use of SMS reminders increased rates of clinic attendance on scheduled days compared to standard care (RR 1.56, 95% CI 1.06 to 2.29). Using the GRADE approach, we rate the quality of the evidence as low, mainly because of the high risk of bias and heterogeneity of effects across studies. CONCLUSIONS:This systematic review indicates that there is a paucity of high-quality data on the effectiveness of SMS interventions for improving patients' adherence to tuberculosis treatment. The low quality of the current evidence implies that further studies (in particular randomized trials) on the subject are needed. In the interim, if the intervention is implemented outside research settings an impact evaluation is warranted.

Project description:IntroductionLow vaccine coverage is a major public health concern, the consequences of which contribute to around 1.5 million child deaths from vaccine-preventable diseases. Thus, innovative strategies to rapidly increase coverage and recall rates for vaccinations are urgently required. Mobile text messaging (or short messaging service, SMS) has the potential to help increase vaccination coverage and therefore we propose to conduct a review of the current best evidence for the use of SMS as an intervention to promote vaccination coverage.Methods and analysisThis article describes the protocol for a systematic review of the effectiveness of SMS in improving the uptake of vaccination. Primary and secondary outcomes of interest are prespecified. We will preferably include randomised controlled trials (RCTs). However, non-randomised studies (NRS) will be considered if there is an inadequate number of RCTs. We will search several bibliographic databases (eg,PubMed, EMBASE, CINAHL, CENTRAL, Science Citation Index, Africa-Wide Information and WHOLIS electronic databases and search sources for grey literature. Following data extraction and assessment of risk of bias, we will meta-analyse studies and conduct subgroup analyses, according to intervention subtypes. We will assess clinical heterogeneity and statistical heterogeneity. For outcomes without quantitative data, a descriptive analysis will be used. This review protocol is registered in the PROSPERO International Prospective Register of systematic reviews, registration number 2014:CRD42014007531 ETHICS AND DISSEMINATION: Ethics is not required for this study, given that this is a protocol for a systematic review, which uses published data. The findings of this study will be disseminated through peer-reviewed publications and conference presentations. We anticipate that the results could be used by researchers and policymakers to help inform them of the efficacy of mobile phone text messaging interventions to promote increased vaccination coverage.Trial registration numberPROSPERO registration number 2014:CRD42014007531.

Project description:BackgroundDevelopment of new peer or lay health-related lifestyle advisor (HRLA) roles is one response to the need to enhance public engagement in, and improve cost-effectiveness of, health improvement interventions. This article synthesises evidence on the cost-effectiveness of HRLA interventions aimed at adults in developed countries, derived from the first systematic review of the effectiveness, cost-effectiveness, equity and acceptability of different types of HRLA role.MethodsThe best available evidence on the cost-effectiveness of HRLA interventions was obtained using systematic searches of 20 electronic databases and key journals, as well as searches of the grey literature and the internet. Interventions were classified according to the primary health behaviour targeted and intervention costs were estimated where necessary. Lifetime health gains were estimated (in quality-adjusted life years, where possible), based on evidence of effectiveness of HRLAs in combination with published estimates of the lifetime health gains resulting from lifestyle changes, and assumptions over relapse. Incremental cost-effectiveness ratios are reported.ResultsEvidence of the cost-effectiveness of HRLAs was identified from 24 trials included in the systematic review. The interventions were grouped into eight areas. We found little evidence of effectiveness of HRLAs for promotion of exercise/improved diets. Where HRLAs were effective cost-effectiveness varied considerably: Incremental Cost effectiveness Ratios were estimated at £6,000 for smoking cessation; £14,000 for a telephone based type 2 diabetes management; and £250,000 or greater for promotion of mammography attendance and for HIV prevention amongst drug users. We lacked sufficient evidence to estimate ICERs for breastfeeding promotion and mental health promotion, or to assess the impact of HRLAs on health inequalities.ConclusionsOverall, there is limited evidence suggesting that HRLAs are cost-effective in terms of changing health-related knowledge, behaviours or health outcomes. The evidence that does exist indicates that HRLAs are only cost-effective when they target behaviours likely to have a large impact on overall health-related quality of life. Further development of HRLA interventions needs to target specific population health needs where potential exists for significant improvement, and include rigorous evaluation to ensure that HRLAs provide sufficient value for money.

Project description:BackgroundType 2 diabetes mellitus (T2DM) is a disease affecting approximately 29.1 million people in the United States, and an additional 86 million adults have prediabetes. Diabetes self-management education, a complex health intervention composed of 7 behaviors, is effective at improving self-care behaviors and glycemic control. Studies have employed text messages for education, reminders, and motivational messaging that can serve as "cues to action," aiming to improve glucose monitoring, self-care behaviors, appointment attendance, and medication adherence.ObjectivesThe Text to Move (TTM) study was a 6-month 2-parallel group randomized controlled trial of individuals with T2DM to increase physical activity, measured by a pedometer. The intervention arm received text messages twice daily for 6 months that were tailored to the participant's stage of behavior change as defined by the transtheoretical model of behavior change.MethodsWe assessed participants' attitudes regarding their experience with text messaging, focusing on perceived barriers and facilitators, through two focus groups and telephone interviews. All interviews were audiorecorded, transcribed verbatim, coded, and analyzed using a grounded theory approach.ResultsThe response rate was 67% (31/46 participants). The average age was 51.4 years and 61% (19/31 participants) were male. The majority of individuals were English speakers and married, had completed at least 12th grade and approximately half of the participants were employed full-time. Overall, participants were satisfied with the TTM program and recalled the text messages as educational, informational, and motivational. Program involvement increased the sense of connection with their health care center. The wearing of pedometers and daily step count information served as motivational reminders and created a sense of accountability through the sentinel effect. However, there was frustration concerning the automation of the text message program, including the repetitiveness, predictability of text time delivery, and lack of customization and interactivity of text message content. Participants recommended personalization of texting frequency as well as more contact time with personnel for a stronger sense of support, including greater surveillance and feedback based on their own results and comparison to other participants.ConclusionsParticipants in a theory-based text messaging intervention identified key facilitators and barriers to program efficacy that should be incorporated into future texting interventions to optimize participant satisfaction and outcomes.Trial registrationClinicaltrials.gov NCT01569243; http://clinicaltrials.gov/ct2/show/NCT01569243 (Archived by Webcite at http://www.webcitation.org/6pfH6yXag).

Dataset Information

Testing the effectiveness of physical activity advice delivered via text messaging vs. human phone advisors in a Latino population: The On The Move randomized controlled trial design and methods.

Publications

Testing the effectiveness of physical activity advice delivered via text messaging vs. human phone advisors in a Latino population: The On The Move randomized controlled trial design and methods.

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