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Research: mHealth Tools Coupled With Texting Messaging Can Impact Health Behaviors

December 29, 2015
by Heather Landi
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There is ongoing interest in and discussion about the use of mobile health (mHealth) solutions, from wearables to fitness trackers and text messaging, to change patients’ behavior and impact health outcomes. In a clinical trial, researchers at John Hopkins University School of Medicine found that an automated mHealth intervention that utilized both activity tracking and text messaging significantly increased physical activity levels of cardiology patients.

In an article published in the Journal of the American Heart Association, medical researchers reported the findings of their mActive clinical trial, an automated mHealth intervention for physical activity promotion.

According to the researchers, the mActive mobile intervention provides the first “mobile, fully automated, physician-designed, integrated tracking-texting intervention.”

“mActive has the potential to modify behavior in real time, while also being potentially reproducible, affordable, and widely scalable,” the researchers wrote.

In the clinical trial, researchers enrolled outpatients at an academic cardiovascular disease prevention center in Baltimore, M.D. who were also smartphone users. During the clinical trial, patients used the Fitbug Orb for digital physical activity tracking along with the smartphone and Web interfaces with the goal of 10,000 steps per day.

According to researchers, to enable real-time activity data to inform smart texts, the application programming interfaces of Fitbug linked with a smart texting system.

“Smart text content was written by the physician investigators and reflected behavioral change theories, particularly of feedback loops and habit formation, integrated with cardiovascular knowledge and clinical experience,” the researchers wrote. “Each participant was a patient of a study physician with texts aiming to leverage the physician-patient relationship, using the physician’s name in texts.”

During the study, smart texts were sent to some participants three times a day. The smart texts offered either positive reinforcement when a participant was on track to attain or had already attained his or her daily step goal, or as a booster message sent to motivate individuals when they were not tracking to surpass their step goal.

The participants were separated into three groups – those who had no access to their activity level data and did not receive smart texts, those who had access to activity level data and did not receive smart texts and those with access to activity level data and received smart texts.

The study found that 44 percent of participants in the two groups that did not receive smart texts met or exceeded the daily 10,000 step goal. In contrast, 81 percent of participants in the group that received smart texts achieved or exceeded the daily 10,000 step target.

“The differential in activity levels was significant; participants receiving texts increased their daily steps over those not receiving texts by 2,534 and over blinded controls by 3,376,” the researchers wrote, highlighting the results of the last two-week phase of the study.

“In mActive, coupling smart texts with activity tracking led to the best physical activity outcomes. Nearly twice as many participants in the text-receiving arm achieved the 10 000 steps/day goal compared with the other groups,” the researchers wrote. “The mActive trial lends support to the notion of new mHealth devices as facilitators, not drivers, of behavior change, because sequential randomization suggested that unblinding to device data did not significantly modify behavior, whereas coupling it with smart texts did.”

And, researchers concluded that “if sustained, the change in physical activity from the mActive tracking-texting intervention may be clinically significant.”

“However, the influence of behavioral counseling may be limited in the current health care delivery model wherein clinicians tend to see patients for brief visits every several months or annually. Aimed to fill the gap, the mActive system is physician designed and intended to leverage the clinician-patient relationship while functioning automatically without day-to-day involvement of the physician.

The medical researchers also concluded that the mActive model could be applied the activity tracking apps already built into smartphones.

“Our technique might also enhance the development of cardiac rehabilitation programs using

mHealth. Overall, our resource-efficient strategy may facilitate more continuous monitoring and feedback between the health system and patients,” the researchers wrote.



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