A theory-based video messaging mobile phone intervention for smoking cessation: randomized controlled trial

Health Motivation in the Influencer Era: Analyzing Entertainment, Personal, and Social Media Role Models

This research explored how personal and entertainment role models motivate an individual's health goals, and how following a role model on social media affects this process. A survey of 404 adults revealed that identifying a personal role model, such as a family member, friend, or healthcare professional, had a stronger influence on health motivation in comparison to identifying an entertainment role model. Additionally, our findings indicated that following any role model on social media, whether a personal acquaintance or a celebrity, enhanced motivation. Role model attributes that mediated these relationships included perceived similarity, and in some instances, positive and negative norm deviance. This study highlights the importance of leveraging role model relationships in health communication campaigns and developing authentic influencer-driven health initiatives that feature relatable entertainment figures. Additionally, this research supports the need for further examination of how a role model's perceived positive or negative norm deviance influences motivational capability. We discuss implications for the motivational theory of role modeling, health promotion, and entertainment education.

Learning by observing: a systematic exploration of modulatory factors and the impact of observationally induced placebo and nocebo effects on treatment outcomes

Introduction

Observational learning (OL) refers to learning through observing other people's behavior. OL has been suggested as an effective and simple tool to evoke treatment expectations and corresponding placebo and nocebo effects. However, the exact mechanisms by which OL shapes treatment outcomes, its moderating factors and possible areas of application remain unclear. We thus reviewed the existing literature with two different literature searches to answer the following questions: Which influencing factors contribute to OL-induced placebo and nocebo effects (in healthy volunteers and patients) and how large are these effects (search 1)? In which medical fields has OL been used so far to modulate treatment expectancy and treatment outcomes in patients, their caregivers, and at-risk groups (search 2)? We also aimed to explore whether and how the assessment of treatment expectations has been incorporated.

Methods

We conducted two independent and comprehensive systematic literature searches, both carried out on September 20, 2022.

Results

We identified 21 studies that investigated OL-mediated placebo and nocebo effects for pain and itch, the (placebo) efficacy of sham treatment on anxiety, and the (nocebo) induction of medication side effects (search 1). Studies showed that OL can efficiently induce placebo and nocebo effects across different presentation modes, with medium effect sizes on average: placebo effects, d = 0.79 (range: d = -0.36-1.58), nocebo effects, d = 0.61 (range: d = 0.04-1.5). Although several moderating factors have been investigated, their contribution to OL-induced effects remains unclear because of inconsistent results. Treatment expectation was assessed in only four studies. Regarding medical applications of OL (search 2), we found 12 studies. They showed that OL was effectively applied in preventive, therapeutic and rehabilitative interventions and that it was mainly used in the field of psychosomatics.

Discussion

OL effects on treatment outcomes can be both positive and negative. Future research should investigate which individuals would benefit most from OL and how OL can be implemented most effectively to induce placebo and avoid nocebo effects in clinical settings.

Systematic review registration

This work was preregistered at the Center for Open Science as open-ended registration (doi: 10.17605/OSF.IO/FVHKE). The protocol can be found here: https://archive.org/details/osf-registrations-fvhke-v1.

Internet use, exposure to digital family planning messages, and sexual agency among partnered women in Northern Nigeria: implications for digital family planning intervention

Digital health interventions are gaining ground in conflict-affected countries, but studies on their reproductive health benefits for women are scanty. Focusing on conflict-affected northern Nigeria, this study examined the relationships between Internet use, exposure to digital family planning messages via text messages or social media, and sexual agency - measured as the ability to refuse sex and ask a male partner to use a condom - among partnered women including the rural-urban differentials. Partnered women's data (n= 18,205) from the 2018 Nigeria Demographic and Health Survey were analysed using descriptive and multinomial logistic regression analyses. 44.6% of women are able to refuse sex, and 31.4% to ask a male partner to use a condom. Internet use was positively associated with women's ability to refuse sex in the northern region and urban areas, and across the region to ask a male partner to use a condom. It was also positively associated with women's uncertainty about asking a male partner to use a condom. Exposure to digital family planning messages was positively associated with women's ability to ask a male partner to use a condom across the region, in both urban and rural areas. However, exposure to digital family planning messages was negatively associated with women's uncertainty in urban areas about their ability to refuse sex. Implications of these findings for digital family planning interventions are discussed.

Examining the Persuasive Effects of Health Communication in Short Videos: Systematic Review

BACKGROUND

The ubiquity of short videos has demonstrated vast potential for health communication. An expansion of research has examined the persuasive effect of health communication in short videos, yet a synthesis of the research is lacking.

OBJECTIVE

This paper aims to provide an overview of the literature by examining the persuasive effect of health communication in short videos, offering guidance for researchers and practitioners. In particular, it seeks to address 4 key research questions: What are the characteristics of short videos, samples, and research designs in short video-based health communication literature? What theories underpin the short video-based health communication literature? What are the persuasive effects of health communication in short videos? and What directions should future research in this area take?

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 10 databases up to March 10, 2023, generated 4118 results. After the full-text screening, 18 articles met the eligibility criteria.

RESULTS

The current research lacks a uniform definition of short videos, demonstrates sample biases in location and education, and adopts limited methodologies. Most studies in this synthesis are theoretically grounded or use theoretical concepts, which are predominantly well examined in persuasion research. Moreover, relevant topics and suitable themes are effective in persuasive health communication outcomes, whereas the impact of diverse narrative techniques remains ambiguous.

CONCLUSIONS

We recommend that future research extends the definition of short videos beyond time constraints and explores non-Western and less-educated populations. In addition, researchers should consider diverse methods to provide a more comprehensive examination and investigate the impact of audience targeting and narrative techniques in short video health communication. Finally, investigating how the unique aspects of short videos interact with or challenge traditional persuasion theories is essential.

Feasibility of generating structured motivational messages for tailored physical activity coaching

Tailored motivational messages are helpful to motivate people in eHealth applications for increasing physical activity, but it is not sufficiently clear how such messages can be effectively generated in advance. We, therefore, put forward a theory-driven approach to generating tailored motivational messages for eHealth applications for behavior change, and we examine its feasibility by assessing how motivating the resulting messages are perceived. For this, we designed motivational messages with a specific structure that was based on an adaptation of an existing ontology for tailoring motivational messages in the context of physical activity. To obtain tailored messages, experts in health psychology and coaching successfully wrote messages with this structure for personas in scenarios that differed with regard to the persona's mood, self-efficacy, and progress. Based on an experiment in which 60 participants each rated the perceived motivational impact of six generic and six tailored messages based on scenarios, we found credible support for our hypothesis that messages tailored to mood, self-efficacy, and progress are perceived as more motivating. A thematic analysis of people's free-text responses about what they found motivating and demotivating about motivational messages further supports the use of tailored messages, as well as messages that are encouraging and empathetic, give feedback about people's progress, and mention the benefits of physical activity. To aid future work on motivational messages, we make our motivational messages and corresponding scenarios publicly available.

Using a Hybrid Neural Network and a Regularized Extreme Learning Machine for Human Activity Recognition with Smartphone and Smartwatch

Mobile health (mHealth) utilizes mobile devices, mobile communication techniques, and the Internet of Things (IoT) to improve not only traditional telemedicine and monitoring and alerting systems, but also fitness and medical information awareness in daily life. In the last decade, human activity recognition (HAR) has been extensively studied because of the strong correlation between people's activities and their physical and mental health. HAR can also be used to care for elderly people in their daily lives. This study proposes an HAR system for classifying 18 types of physical activity using data from sensors embedded in smartphones and smartwatches. The recognition process consists of two parts: feature extraction and HAR. To extract features, a hybrid structure consisting of a convolutional neural network (CNN) and a bidirectional gated recurrent unit GRU (BiGRU) was used. For activity recognition, a single-hidden-layer feedforward neural network (SLFN) with a regularized extreme machine learning (RELM) algorithm was used. The experimental results show an average precision of 98.3%, recall of 98.4%, an F₁-score of 98.4%, and accuracy of 98.3%, which results are superior to those of existing schemes.

Social cognitive theory-based health promotion in primary care practice: A scoping review

Background

Using a theoretical perspective to guide research design and implementation can result in a coherent preventative intervention model. Among theoretical frameworks, Bandura's Social Cognitive Theory (SCT) is particularly useful for studies focused on behavior change in health promotion research.

Objective

This scoping review explored and summarized the current evidence on health promotion interventions that integrated constructs of Social Cognitive Theory and the outcome of those interventions in primary care settings.

Method

ology: We conducted this scoping review using the PRISMA scoping review guidelines; we reviewed articles from five electronic databases and additional sources that were peer-reviewed journal articles reporting interventions applying SCT constructs and synthesized the outcomes following the interventions.

Results

Among 849 retrieved from multiple sources, 39 articles met our eligibility criteria. Most studies (n = 19) were conducted in the United States. Twenty-six studies followed a randomized control trial design. Most studies (n = 26) recruited participants utilizing the primary care network. All 39 studies mentioned "self-efficacy" as the most utilized construct of SCT to determine how behavior change operates, followed by "observational learning" through role models. Twenty-three studies integrated individual (face-to-face) or peered group-based counseling-training programs; eight interventions used telephonic health coaching by a specialist; eight studies used audio-visual mediums. All included studies reported positive health outcomes following the intervention, including increased self-reported moderate-to-vigorous physical activity, increased Knowledge of dietary intake, high-risk behaviors such as STIs transmission, adapting to a healthy lifestyle, and adherence to post-transplant medication.

Conclusion

Current evidence suggests that SCT-based interventions positively impact health outcomes and intervention effectiveness. The results of this study indicate the importance of incorporating and assessing several conceptual structures of behavioral theories when planning any primary care health promotion practice.

Digital interventions for smoking abstinence: a systematic review and meta-analysis of randomized control trials

OBJECTIVES

Technological advancements have improved patients' health and clinical care through digital interventions. This study investigated the effects of digital interventions on smoking abstinence.

METHODS

PubMed, the Cochrane Library, and Scopus were systematically searched from inception until December 2021. Meta-analysis was carried out using a random-effects model. The degree of heterogeneity, quality, and publication bias of the selected studies was further evaluated.

RESULTS

A total of 43 randomized control trial studies were eligible for this study. 38,814 participants from 18 countries were included in the analysis. Digital interventions on seven-day point prevalence abstinence (1 month) showed increased smoking abstinence. The odds ratio was 2.02 and confidence interval (CI) was 1.67-2.43; p < 0.001; I² = 55.1%) . The result for a 30-day point prevalence abstinence (1 month) was 1.63 (CI 1.09-2.46; p = 0.018; I² = 0%). Digital intervention also had a significant effect on continuous abstinence (odds ratio = 1.68; CI 1.29-2.18; p < 0.001; I² = 70.1%) and prolonged abstinence (odds ratio = 1.60; CI 1.19-2.15; p = 0.002; I² = 53.6%). There was evidence of heterogeneity and publication bias.

CONCLUSIONS

Digital interventions led to increased smoking abstinence and can be a valuable tool in smoking cessation. Further research is required to evaluate the long-term impact of digital interventions on outcomes related to smoking cessation.

Addressing people's current and future states in a reinforcement learning algorithm for persuading to quit smoking and to be physically active

Behavior change applications often assign their users activities such as tracking the number of smoked cigarettes or planning a running route. To help a user complete these activities, an application can persuade them in many ways. For example, it may help the user create a plan or mention the experience of peers. Intuitively, the application should thereby pick the message that is most likely to be motivating. In the simplest case, this could be the message that has been most effective in the past. However, one could consider several other elements in an algorithm to choose a message. Possible elements include the user's current state (e.g., self-efficacy), the user's future state after reading a message, and the user's similarity to the users on which data has been gathered. To test the added value of subsequently incorporating these elements into an algorithm that selects persuasive messages, we conducted an experiment in which more than 500 people in four conditions interacted with a text-based virtual coach. The experiment consisted of five sessions, in each of which participants were suggested a preparatory activity for quitting smoking or increasing physical activity together with a persuasive message. Our findings suggest that adding more elements to the algorithm is effective, especially in later sessions and for people who thought the activities were useful. Moreover, while we found some support for transferring knowledge between the two activity types, there was rather low agreement between the optimal policies computed separately for the two activity types. This suggests limited policy generalizability between activities for quitting smoking and those for increasing physical activity. We see our results as supporting the idea of constructing more complex persuasion algorithms. Our dataset on 2,366 persuasive messages sent to 671 people is published together with this article for researchers to build on our algorithm.

Automated Digital Interventions and Smoking Cessation: Systematic Review and Meta-analysis Relating Efficiency to a Psychological Theory of Intervention Perspective

Background

Smoking remains a highly significant preventable global public health problem. In this context, digital interventions offer great advantages in terms of a lack of biological side effects, possibility of automatic delivery, and consequent human resource savings relative to traditional interventions. Such interventions have been studied in randomized controlled trials (RCTs) but have not been systematically reviewed with the inclusion of text-based and multiplatform-based interventions. In addition, this area has not been evaluated from the perspective of the psychological theoretical basis of intervention.

Objective

The aim of this paper is to assess the efficiency of digital interventions in RCT studies of smoking cessation and to evaluate the effectiveness of the strategies used for digital interventions.

Methods

An electronic search of RCTs was conducted using PubMed, Embase, and the Cochrane Library by June 30, 2021. Eligible studies had to compare automated digital intervention (ADI) to the use of a self-help guideline or no intervention. Participants were current smokers (aged 16 years or older). As the main outcome, abstinence after endpoint was extracted from the studies. Systematic review and meta-analysis were conducted to assess the efficiency of ADIs. Metaregressions were conducted to assess the relationship between intervention theory and effectiveness.

Results

A total of 19 trials (15,472 participants) were included in the analysis. The overall abstinence rate (95% CI) at the endpoint was 17.8% (17.0-18.7). The overall risk ratio of the intervention group compared to the controls at the endpoint was 17.8% (17.0-18.7). Cochrane risk-of-bias tool for randomized trials (ROB 2) suggested that most of the studies had a low risk of bias (56.3%). Psychological theory–related constructs or predictors, which refer to other theory-based concepts (rather than only behavioral theory) such as craving or anxiety, are associated with effectiveness.

Conclusions

This study found that ADI had a clear positive effect compared to self-help guidelines or to no intervention, and effectiveness was associated with theory-related constructs or predictors. ADIs should be promoted by policy makers and clinical practitioners to address the huge gap between the need for smoking cessation and availability of traditional treatment resources. Possible increases in ADI efficiency may be achieved by optimally integrating psychotherapeutic theories and techniques.

Trial Registration

PROSPERO CRD42021256593; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256593

Evaluation of Dietary Management Using Artificial Intelligence and Human Interventions: Nonrandomized Controlled Trial

Background

There has been an increase in personal health records with the increased use of wearable devices and smartphone apps to improve health. Traditional health promotion programs by human professionals have limitations in terms of cost and reach. Due to labor shortages and to save costs, there has been a growing emphasis in the medical field on building health guidance systems using artificial intelligence (AI). AI will replace advanced human tasks to some extent in the future. However, it is difficult to sustain behavioral change through technology alone at present.

Objective

This study investigates whether AI alone can effectively encourage healthy behaviors or whether human interventions are needed to achieve and sustain health-related behavioral change. We examined the effectiveness of AI and human interventions to encourage dietary management behaviors. In addition, we elucidated the conditions for maximizing the effect of AI on health improvement. We hypothesized that the combination of AI and human interventions will maximize their effectiveness.

Methods

We conducted a 3-month experiment by recruiting participants who were users of a smartphone diet management app. We recruited 102 participants and divided them into 3 groups. Treatment group I received text messages using the standard features of the app (AI-based text message intervention). Treatment group II received video messages from a companion, in addition to the text messages (combined text message and human video message intervention by AI). The control group used the app to keep a dietary record, but no feedback was provided (no intervention). We examine the participants’ continuity and the effects on physical indicators.

Results

Combined AI and video messaging (treatment group II) led to a lower dropout rate from the program compared to the control group, and the Cox proportional-hazards model estimate showed a hazard ratio (HR) of 0.078, which was statistically significant at the 5% level. Further, human intervention with AI and video messaging significantly reduced the body fat percentage (BFP) of participants after 3 months compared to the control group, and the rate of reduction was greater in the group with more individualized intervention. The AI-based text messages affected the BMI but had no significant effect on the BFP.

Conclusions

This experiment shows that it is challenging to sustain participants' healthy behavior with AI intervention alone. The results also suggest that even if the health information conveyed is the same, the information conveyed by humans and AI is more effective in improving health than the information sent by AI alone. The support received from the companion in the form of video messages may have promoted voluntary health behaviors. It is noteworthy that companions were competent, even though they were nonexperts. This means that person-to-person communication is crucial for health interventions.

"OMG, Yes!": Feasibility, Acceptability, and Preliminary Efficacy of an Online Intervention for Female Sexual Pleasure

The purpose of this study was to evaluate the acceptability, feasibility, and preliminary efficacy of using an online educational resource that presents research-informed strategies for women's pleasure, OMGyes.com, as a resource to empower women to broaden the ways in which they understand, advocate for, and enjoy sexual pleasure. A cohort of 870 adult women was given access to OMGyes.com and asked to explore the resource over a four-week period and complete online pre/post questionnaires. Participants reported a high level of satisfaction with the relatability, usefulness, and functionality of OMGyes.com. We observed statistically significant, large effect size increases in participants' knowledge about their own pleasure preferences, their confidence and positivity about that knowledge, as well as how pleasurable their sexual experiences were during both masturbation and partner sex. Many participants reported that after using OMGyes.com they felt more motivated to explore their preferences and more confident to explain their preferences to their partners. Our data suggest that OMGyes.com may be useful for positively impacting how women think about sexual pleasure, how they understand their own specific preferences, how they advocate for what they enjoy with partners, and how they actually experience pleasure.

Improving Palliative Care Knowledge among Hospitalized Hispanic Patients: A Pilot Study

Background: Lack of knowledge of palliative care has been identified as a primary barrier to access to care, with a recent survey reporting that Hispanics have the lowest rate of palliative care knowledge compared with other racial/ethnic groups. The purpose of this pilot study was to determine if there were trends toward improved palliative care knowledge after viewing four-minute video of a palliative care patient. Methods: We conducted a pre- and posttest pilot study among 50 Spanish-speaking, hospitalized Hispanic patients 40 years old and older in a large public hospital. We used the Palliative Care Knowledge Scale (PaCKS) to assess palliative care knowledge. Two questions measured intention to enroll in palliative care. Paired sample t-tests were conducted to investigate change in PaCKS scores. McNemar's test was used to compare differences in intentions to enroll in palliative care from pretest to posttest. We conducted linear regression analysis to determine factors associated with improved knowledge at posttest. Results: PaCKS scores revealed significant improvement in palliative care knowledge following viewing of the video, with scores increasing from an average of 6.4-11.4 at posttest. Intentions to enroll a family member in palliative care increased from 64% at pretest to 64%-98% at posttest. Intentions to enroll oneself increased from 72% to 92%. Conclusions: Brief exposure to a relatable role model may be effective in improving knowledge and intentions to enroll in palliative care services. More research is needed to determine if these videos are effective in increasing enrollment in palliative care.

Factors influencing healthy role models in medical school to conduct healthy behavior: a qualitative study

OBJECTIVES

This study aimed to identify the factors that support or inhibit medical teachers as healthy role models in medical school to conduct healthy behavior.

METHODS

This qualitative study involved semi-structured in-depth interviews with medical teachers categorized as healthy role models in a medical school from a previous survey. Ten medical teachers were selected using purposive sampling. Three medical teachers were interviewed by direct meetings, and the remaining were phone interviewed, with one interview facilitated by chat using WhatsApp. Transcribed interviews were coded openly. Themes were finalized through discussion and debate to reach a consensus.

RESULTS

Two themes were identified: perceived facilitators and perceived barriers, which were classified into four categories and 13 subcategories: intrinsic facilitators (motivation, conscious awareness, having physical limitations, knowledge, and economic reasons); extrinsic facilitators (the impact on doing a particular job, feedback, time, and environment); intrinsic barriers (the lack of self-motivation and having physical limitations); and extrinsic barriers (the burden of responsibilities for being medical teachers and environment).

CONCLUSIONS

Factors that support and inhibit medical teachers as healthy role models in medical school are influenced by intrinsic and extrinsic factors. This result could be used by medical schools to design appropriate interventions to help medical teachers as healthy role models in conducting healthy behavior. More studies are needed to explore other factors that influence medical teachers to conduct healthy behavior. During the COVID-19 pandemic, healthy role models in medical schools are vitally important and significantly contribute to the overall health of a nation.

mHealth for Integrated People-Centred Health Services in the Western Pacific: A Systematic Review

OBJECTIVE

This review aimed to examine how mobile health (mHealth) to support integrated people-centred health services has been implemented and evaluated in the World Health Organization (WHO) Western Pacific Region (WPR).

METHODS

Eight scientific databases were searched. Two independent reviewers screened the literature in title and abstract stages, followed by full-text appraisal, data extraction, and synthesis of eligible studies. Studies were extracted to capture details of the mhealth tools used, the service issues addressed, the study design, and the outcomes evaluated. We then mapped the included studies using the 20 sub-strategies of the WHO Framework on Integrated People-Centred Health Services (IPCHS); as well as with the RE-AIM (Reach, effectiveness, adoption, implementation and maintenance) framework, to understand how studies implemented and evaluated interventions.

RESULTS

We identified 39 studies, predominantly from Australia (n = 16), China (n = 7), Malaysia (n = 4) and New Zealand (n = 4), and little from low income countries. The mHealth modalities included text messaging, voice and video communication, mobile applications and devices (point-of-care, GPS, and Bluetooth). Health issues addressed included: medication adherence, smoking cessation, cardiovascular disease, heart failure, asthma, diabetes, and lifestyle activities respectively. Almost all were community-based and focused on service issues; only half were disease-specific. mHealth facilitated integrated IPCHS by: enabling citizens and communities to bypass gatekeepers and directly access services; increasing affordability and accessibility of services; strengthening governance over the access, use, safety and quality of clinical care; enabling scheduling and navigation of services; transitioning patients and caregivers between care sectors; and enabling the evaluation of safety and quality outcomes for systemic improvement. Evaluations of mHealth interventions did not always report the underlying theories. They predominantly reported cognitive/behavioural changes rather than patient outcomes. The utility of mHealth to support and improve IPCHS was evident. However, IPCHS strategy 2 (participatory governance and accountability) was addressed least frequently. Implementation was evaluated in regard to reach (n = 30), effectiveness (n = 24); adoption (n = 5), implementation (n = 9), and maintenance (n = 1).

CONCLUSIONS

mHealth can transition disease-centred services towards people-centred services. Critical appraisal of studies highlighted methodological issues, raising doubts about validity. The limited evidence for large-scale implementation and international variation in reporting of mHealth practice, modalities used, and health domains addressed requires capacity building. Information-enhanced implementation and evaluation of IPCHS, particularly for participatory governance and accountability, is also important.

Perceived usefulness of receiving a potential smoking cessation intervention via mobile phones among smokers in Indonesia

Background: The use of technology to support healthcare in Indonesia holds new promise in light of decreasing costs of owning mobile devices and ease of access to internet. However, it is necessary to assess end-user perceptions regarding mobile health interventions prior to its implementation. This would throw light on the acceptability of mobile phone communication in bringing about behavioral changes among the target Indonesian population. The aim of this study was to explore the perceived usefulness of receiving a potential smoking cessation intervention via mobile phones. Methods: This is an exploratory cross-sectional study involving current and former adult tobacco smokers residing in Indonesia. Online advertisement and snowballing were used to recruit respondents. Data was collected using a web-based survey over a period of 4 weeks. Those willing to participate signed an online consent and were subsequently directed to the online questionnaire that obtained demographics, tobacco usage patterns, perceived usefulness of a mobile phone smoking cessation application and its design. Results: A total of 161 people who smoked tobacco responded to the online survey. The mean age of the participants was 29.4. Of the 123 respondents, 102 were men. Prior experience with using a mobile phone for health communication (OR 3.6, P=0.014) and those willing to quit smoking (OR 5.1, P=0.043) were likely to perceive a mobile phone smoking cessation intervention as useful. A smartphone application was preferred over text messages, media messages or interactive voice response technology. Content consisting of motivational messages highlighting the methods and benefits of quitting smoking were requested. Conclusion: People who smoke in Indonesia perceived receiving a potential smoking cessation intervention via mobile phones as useful. A multi-component, personalized smartphone application was the desired intervention technique. Such an intervention developed and implemented within a public health program could help address the tobacco epidemic in Indonesia.

Implementation of a Text Message to Improve Adherence to Clinic and Social Service Appointments

Introduction:

Attendance to clinic appointments and compliance with treatment plans are essential components of HIV/AIDS care. Compliance is especially important in young and minority individuals living with HIV/AIDS. We assessed the effectiveness of a text-based reminder system compared with usual care in improving the attendance to clinic and social work appointments at a Ryan White-funded clinic based in an academic institution.

Methods:

Convenience sample looking at 2 periods, 6 months before initiation of text messages and 6 months after initiation of text messages.

Results:

Following a 6-month postintervention period, we found a statistically significant reduction in our no-show rates (individuals failing to keep scheduled appointments) of 24.8% versus 17.7%, P value .05.

Conclusion:

Using an inexpensive online text messaging system, we were able to significantly decrease no-show rates in a primarily younger, low-income, and uninsured population.

Mobile phone text messaging and app-based interventions for smoking cessation

BACKGROUND

Mobile phone-based smoking cessation support (mCessation) offers the opportunity to provide behavioural support to those who cannot or do not want face-to-face support. In addition, mCessation can be automated and therefore provided affordably even in resource-poor settings. This is an update of a Cochrane Review first published in 2006, and previously updated in 2009 and 2012.

OBJECTIVES

To determine whether mobile phone-based smoking cessation interventions increase smoking cessation rates in people who smoke.

SEARCH METHODS

For this update, we searched the Cochrane Tobacco Addiction Group's Specialised Register, along with clinicaltrials.gov and the ICTRP. The date of the most recent searches was 29 October 2018.

SELECTION CRITERIA

Participants were smokers of any age. Eligible interventions were those testing any type of predominantly mobile phone-based programme (such as text messages (or smartphone app) for smoking cessation. We included randomised controlled trials with smoking cessation outcomes reported at at least six-month follow-up.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We performed both study eligibility checks and data extraction in duplicate. We performed meta-analyses of the most stringent measures of abstinence at six months' follow-up or longer, using a Mantel-Haenszel random-effects method, pooling studies with similar interventions and similar comparators to calculate risk ratios (RR) and their corresponding 95% confidence intervals (CI). We conducted analyses including all randomised (with dropouts counted as still smoking) and complete cases only.

MAIN RESULTS

This review includes 26 studies (33,849 participants). Overall, we judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high-income countries. There was moderate-certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I² = 71%; 13 studies, 14,133 participants). There was also moderate-certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I² = 0%, 4 studies, 997 participants). Two studies comparing text messaging with other smoking cessation interventions, and three studies comparing high- and low-intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I² = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I² = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. Five studies compared a smoking cessation smartphone app with lower-intensity smoking cessation support (either a lower-intensity app or non-app minimal support). We pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I² = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so we did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings.

AUTHORS' CONCLUSIONS

There is moderate-certainty evidence that automated text message-based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. There is moderate-certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. The evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions.

Promoting Relational Agent for Health Behavior Change in Low and Middle - Income Countries (LMICs): Issues and Approaches

The use of contemporary technologies in healthcare systems to improve quality of care and to promote behavioral healthcare outcomes are prevalent in high-income countries. However, low and middle-income countries (LMICs) are not receiving the same advantages of technology, which may be due to inadequate technological infrastructure and financial resources, lack of interest among policy makers and healthcare service providers, lack of skills and capacity among healthcare professionals in using technology based interventions, and resistance of the public to the use of technologies for healthcare or health promotion activities. Technology-based interventions offer considerable promise to develop entirely new models of healthcare both within and outside of formal systems of care and offer the opportunity to have a large public health impact. Such technology-based interventions could be used to address targeted global health problems in LMICs, including the chronic non-communicable diseases (NCDs) - a growing health system burden in LMICs. Major preventable behavioral risk factors of chronic NCDs are increasing in LMICs, and innovative interventions are essential to address these risk factors. Computer-based or mobile-based virtual coaches or Relational Agents (RAs) are increasingly being explored for counseling patients to change their health behavior in high-income countries; however, the use of RAs in LMICs has not been studied. In this paper, we summarize the growing application of RA technology in behavior change interventions in high-income countries and describe the potential of its use in LMICs. Finally, we review the potential barriers and challenges in promoting RAs in LMICs.

Perceived usefulness of receiving a potential smoking cessation intervention via mobile phones among smokers in Indonesia

Background: The use of technology to support healthcare in Indonesia holds new promise in light of decreasing costs of owning mobile devices and ease of access to internet. However, it is necessary to assess end-user perceptions regarding mobile health interventions prior to its implementation. This would throw light on the acceptability of mobile phone communication in bringing about behavioural changes among the target Indonesian population. The aim of this study was to explore the perceived usefulness of receiving a potential smoking cessation intervention via mobile phones. Methods: This is an exploratory cross-sectional study involving current and former adult tobacco smokers residing in Indonesia. Online advertisement and snowballing were used to recruit respondents. Data was collected using a web-based survey over a period of 4 weeks. Those willing to participate signed an online consent and were subsequently directed to the online questionnaire that obtained demographics, tobacco usage patterns, perceived usefulness of a mobile phone smoking cessation application and its design. Results: A total of 161 people who smoked tobacco responded to the online survey. The mean age of the participants was 29.4. Of the 123 respondents, 102 were men. Prior experience with using a mobile phone for health communication (OR 3.6, P=0.014) and those willing to quit smoking (OR 5.1, P=0.043) were likely to perceive a mobile phone smoking cessation intervention as useful. A smartphone application was preferred over text messages, media messages or interactive voice response technology. Content comprising of motivational messages highlighting the methods and benefits of quitting smoking were requested. Conclusion: People who smoke in Indonesia perceived receiving a potential smoking cessation intervention via mobile phones as useful. A multi-component, personalized smartphone application was the desired intervention technique. Such an intervention developed and implemented within a public health program could help address the tobacco epidemic in Indonesia.

Combining Real-Time Ratings With Qualitative Interviews to Develop a Smoking Cessation Text Messaging Program for Primary Care Patients

Background

Text messaging (short message service, SMS) interventions show promise as a way to help cigarette smokers quit. Few studies have examined the effectiveness of text messaging (SMS) programs targeting smokers associated with primary care or hospital settings.

Objective

This study aimed to develop a text messaging (SMS) program targeting primary care smokers.

Methods

Adult smokers in primary care were recruited from February 2017 to April 2017. We sent patients 10 to 11 draft text messages (SMS) over 2 days and asked them to rate each message in real time. Patients were interviewed daily by telephone to discuss ratings, message preferences, and previous experiences with nicotine replacement therapy (NRT). Content analysis of interviews was directed by a step-wise text messaging (SMS) intervention development process and the Information-Motivation-Behavioral Skills model of medication adherence.

Results

We sent 149 text messages (SMS) to 15 patients. They replied with ratings for 93% (139/149) of the messages: 134 (96%, 134/139) were rated as clear or useful and 5 (4%, 5/139) as unclear or not useful. Patients’ preferences included the addition of graphics, electronic cigarette (e-cigarette) content, and use of first names. Regarding NRT, patients identified informational gaps around safety and effectiveness, preferred positively framed motivational messages, and needed behavioral skills to dose and dispose of NRT.

Conclusions

Patients recommended text message (SMS) personalization, inclusion of e-cigarette information and graphics, and identified barriers to NRT use.

Combining real-time ratings with telephone interviews is a feasible method for incorporating primary care patients’ preferences into a behavioral text messaging (SMS) program.

The Intervention Effect of SMS Delivery on Chinese Adolescent's Physical Activity

To examine the effects of short messaging service (SMS) frequency and timing on the efficacy of an SMS-intervention for Hong Kong Chinese adolescents, sixty nine students aged between 12 and 16 (mean age 13.75 ± 0.90) were recruited from five schools in Hong Kong. Participants were randomly assigned into one of five groups: high-frequency + self-selected timing (HST), low-frequency + self-selected timing (LST), high-frequency + assigned timing (HAT), low-frequency + assigned timing (LAT) and the control group. The total duration of the intervention was four weeks. No significant intervention effects were detected in adolescent's PA among the five groups (F = 1.14, p = 0.346). No significant differences were observed in the stage movement among the five groups (χ² = 6.18, p = 0.627). No significant differences appeared in the exercise benefits, barriers and benefits/barriers differential scores. However, a growth trend in the exercise benefits score in the LST and HAT groups was found in contrast to the downswing in the control group. The exercise barriers score in the HST group showed the largest reduction after intervention. The benefits/barriers differential score in all the intervention groups increased, whereas it decreased in the control group. Although an increase is demonstrated in the high dosage SMS frequency and timing, no significant intervention effects were found among the five groups in PA behavior, stage of change and exercise benefits and barriers among Hong Kong Chinese adolescents.

Potential sources of cessation support for high smoking prevalence groups: a qualitative study

Objective This study aimed to: i) explore potential sources of cessation support as nominated by disadvantaged smokers; and ii) identify factors influencing decisions to use these sources. Methods Semi-structured interviews were conducted with 84 smokers accessing community service organisations from the alcohol and other drugs, homeless, and mental health sectors. Transcripts were coded and thematically analysed. Results Doctors emerged as the most commonly recognised source of cessation support, followed by Quitline, community service organisation staff; and online resources. The main factors contributing to the possible use of these sources of support were identified as awareness, perceived usefulness and anticipated emotional support. Conclusions The results suggest that doctors are an important group to consider when developing cessation interventions for disadvantaged smokers due to their recognised ability to provide practical and emotional support. However, efforts are needed to ensure doctors are aware of the benefits of cessation for these groups. Community service organisations appear to be another potentially effective source of cessation support for disadvantaged smokers. Implications for public health The results indicate that cessation interventions among high-priority groups should endeavour to provide personalised emotional and practical support. Doctors and community service organisation staff appear to be well-placed to deliver this support.

Study protocol: using a mobile phone-based application to increase awareness and uptake of sexual and reproductive health services among the youth in Uganda. A randomized controlled trial

BACKGROUND

Several cost-effective programs are being implemented around the world that use mobile technology to improve Sexual and Reproductive Health (SRH) uptake and awareness among youth. Mobile phone applications are a viable and effective means of increasing access to SRH services and tools in low and middle-income countries. This paper presents a protocol for a pilot study of a novel program, a mobile phone-based sexual and reproductive health services awareness and delivery application with the objective of increasing the demand for SRH services amongst the youth in Uganda.

METHODS

The study employs rigorous evaluation methods to ascertain the impact of the mobile application. We propose a randomized control trial study to determine the causal effect of the mobile phone app in creating awareness and increasing uptake of sexual and reproductive health services in Uganda. The main outcome of the impact evaluation is the percentage change in the SRH services and tools uptake, SRH knowledge and sexual behavior. We will also conduct a model-based incremental cost-effectiveness analysis (CEA) and budget impact analysis (BIA). The main outcomes of the economic evaluation will be the average cost per app user, cost per app service and tool provided. We will also test the in-app advertising model as a way to generate revenue to sustain the program subsidies and related costs.

DISCUSSION

The study seeks to establish the proof of concept of using a mobile application to increase create awareness and increase uptake of SRH tools and services among youth in Uganda. The study results will lead to the development of a demand-driven, culturally-relevant, and easy-to-use mobile app to enhance the uptake of SRH services among the youth in Uganda and globally.

TRIAL REGISTRATION

MUREC1/7 No. 07/05-18 . Registered 29th June 2018.

A Pilot Randomized Controlled Trial of a Technology-Based Substance Use Intervention for Youth Exiting Foster Care

Youth exiting foster care represent a unique, at-risk population in that they receive supportive health services while under the umbrella of the foster care system, but access to care can drop precipitously upon release from foster custody. Traditional means of substance use treatment may not meet the needs of this vulnerable population. Mobile interventions, however, have demonstrated high acceptability and efficacy across a range of mental and physical health issues. The specific advantages to mobile interventions dovetail well with the barriers faced by youth exiting foster care. This study describes the feasibility, acceptability, and initial efficacy of iHeLP, a computer- and mobile phone-based intervention based in Motivational Interviewing for reducing substance use among youth exiting foster care (n = 33). Participants were randomly assigned to either iHeLP or a contact control, each of which lasted six months. Feasibility was evaluated through eligibility and enrollment rates at baseline, and retention and intervention reach rates 3, 6, 9, and 12 months later. Acceptability was measured through a 5-item satisfaction measure and exit interviews. The two groups were then compared on a monthly measure of substance use. Study enrollment, retention, response rate, engagement, and satisfaction were all very good. Participants receiving iHeLP reported higher percent days abstinent than the control group, with effect sizes ranging from 0.32 to 0.62. Technology-based interventions such as iHeLP may be attractive to this population and support efforts towards reductions in substance use.

Which eHealth interventions are most effective for smoking cessation? A systematic review

PURPOSE

To synthesize evidence of the effects and potential effect modifiers of different electronic health (eHealth) interventions to help people quit smoking.

METHODS

Four databases (MEDLINE, PsycINFO, Embase, and The Cochrane Library) were searched in March 2017 using terms that included "smoking cessation", "eHealth/mHealth" and "electronic technology" to find relevant studies. Meta-analysis and meta-regression analyses were performed using Mantel-Haenszel test for fixed-effect risk ratio (RR) and restricted maximum-likelihood technique, respectively. Protocol Registration Number: CRD42017072560.

RESULTS

The review included 108 studies and 110,372 participants. Compared to nonactive control groups (eg, usual care), smoking cessation interventions using web-based and mobile health (mHealth) platform resulted in significantly greater smoking abstinence, RR 2.03 (95% CI 1.7-2.03), and RR 1.71 (95% CI 1.35-2.16), respectively. Similarly, smoking cessation trials using tailored text messages (RR 1.80, 95% CI 1.54-2.10) and web-based information and conjunctive nicotine replacement therapy (RR 1.29, 95% CI 1.17-1.43) may also increase cessation. In contrast, little or no benefit for smoking abstinence was found for computer-assisted interventions (RR 1.31, 95% CI 1.11-1.53). The magnitude of effect sizes from mHealth smoking cessation interventions was likely to be greater if the trial was conducted in the USA or Europe and when the intervention included individually tailored text messages. In contrast, high frequency of texts (daily) was less effective than weekly texts.

CONCLUSIONS

There was consistent evidence that web-based and mHealth smoking cessation interventions may increase abstinence moderately. Methodologic quality of trials and the intervention characteristics (tailored vs untailored) are critical effect modifiers among eHealth smoking cessation interventions, especially for web-based and text messaging trials. Future smoking cessation intervention should take advantages of web-based and mHealth engagement to improve prolonged abstinence.

Assessment of Health Information Technology Interventions in Evidence-Based Medicine: A Systematic Review by Adopting a Methodological Evaluation Framework

BACKGROUND

The application of Health Information Technologies (HITs) can be an effective way to advance medical research and health services provision. The two-fold objective of this work is to: (i) identify and review state-of-the-art HITs that facilitate the aims of evidence-based medicine and (ii) propose a methodology for HIT assessment.

METHODS

The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Furthermore, we consolidated existing knowledge in the field and proposed a Synthesis Framework for the Assessment of Health Information Technology (SF/HIT) in order to evaluate the joint use of Randomized Controlled Trials (RCTs) along with HITs in the field of evidence-based medicine.

RESULTS

55 articles met the inclusion criteria and refer to 51 (RCTs) published between 2008 and 2016. Significant improvements in healthcare through the use of HITs were observed in the findings of 31 out of 51 trials-60.8%. We also confirmed that RCTs are valuable tools for assessing the effectiveness, acceptability, safety, privacy, appropriateness, satisfaction, performance, usefulness and adherence.

CONCLUSIONS

To improve health service delivery, RCTs apply and exhibit formalization by providing measurable outputs. Towards this direction, we propose the SF/HIT as a framework which may help researchers to carry out appropriate evaluations and extend their studies.

Self-reported quit rates and quit attempts among subscribers of a mobile text messaging-based tobacco cessation programme in India

Introduction

In 2015, as part of the WHO and International Telecommunication Union’s ‘Be Healthy Be Mobile’ initiative using mobile technology to combat non-communicable diseases, the Ministry of Health and Family Welfare and the Ministry of Communication and Information Technology in India developed a short text message-based mobile health programme (the ‘mCessation’ programme) to support tobacco users to quit tobacco use.

Objectives

To evaluate the effectiveness of the mCessation programme by estimating quit rates and quit attempts among registered subscribers of the programme and to understand subscriber perceptions of the programme.

Methods

Subscribers to the mCessation (QuitNow) programme were telephonically interviewed 4–6 months after registration. A total of 12 502 calls were made, and completed responses recorded from 3362 ever tobacco users. A total of 6978 respondents either gave very few responses or refused to participate in the telephonic survey. Never tobacco users (1935) and subscribers to the mDiabetes programme (227) were excluded from the sample.

Results

A large proportion of registrants (1935 out of 12 502 respondents) were found to be never users. The quit rate (estimated as those who stated they had not had any tobacco in the past 30 days at 4–6 months after registering with the programme from the total sample (excluding never smokers and mDiabetes registrants)) was 19%. Sixty-six per cent of registered subscribers who were current tobacco users had made quit attempts in the period between registration and survey. Seventy-seven per cent of respondents reported that the programme was helpful/very helpful to quit tobacco.

Conclusion

The mCessation programme has successfully helped tobacco users in India to quit tobacco by motivating and supporting registered participants through mobile text messages.

Acceptability and Feasibility of a Sexual Health Intervention for Young Adult Black Women

OBJECTIVE

To assess the acceptability and feasibility of S2S, a newly adapted behavior intervention to address high-risk sexual behavior.

DESIGN

Pilot randomized controlled trial.

SETTING

The Internet and text messages with no in-person interactions.

PARTICIPANTS

Eighty-eight Black women, ages 18 to 24 years, were randomly assigned to the intervention or control groups and self-enrolled in the respective text message program.

METHODS

Participants in the intervention group were sent text messages about sexual health, whereas those in the control group were sent text messages about diet and/or exercise. Participants in each group received 24 text messages, including text-only messages, memes, and infopics. Participants in the intervention group also received videos links. All text messages were sent three times per week for 8 weeks. Quantitative methods were used to analyze data from the message and video platform reports. Quantitative and qualitative methods were used to analyze participants' responses to an acceptability and feasibility survey.

RESULTS

Overall, the delivery of health promotion text messages was viewed as acceptable and feasible by participants in both groups. Most of the short answer responses from participants were favorable, and responses to the acceptability and feasibility survey yielded a total mean score of 4.01 on a 5-point scale.

CONCLUSION

Results from this study support the idea that evidence-based interventions can be adapted for delivery by text message. This delivery modality is acceptable to young adult Black women and may help decrease barriers that would otherwise prevent them from receiving health promotion messages.

Rules of engagement in mobile health: what does mobile health bring to research and theory?

BACKGROUND

The effectiveness of mobile health (mHealth) is a controversial issue. For its wide-scale adoption and successful integration to the healthcare system, theoretical, methodological, and practical issues of mHealth should be well understood.

OBJECTIVES

The purpose of the study was to review the essential characteristics of mHealth and discuss what mHealth presents to research and theory.

METHOD

This review synthesized the studies focused on the adoption, design, and implementation of mHealth. The search strategy included reviewing electronic databases, key journals, web-based research and knowledge centers, and manual searching reference lists of the main studies.

RESULTS

mHealth's core characteristics were specified as accessibility, inclusivity, patient's autonomy, customizability, increasing the accuracy of diagnostics and treatment, improvement in service quality, and testability. Opportunities and challenges in regards to theory and research were discussed.

CONCLUSIONS AND IMPLICATIONS

Using an integrated approach, this study identified and summarized the key issues to understand mHealth. Implications and recommendations for research and practice were provided.

Helping cancer patients quit smoking using brief advice based on risk communication: A randomized controlled trial

This randomized controlled trial aimed to examine the effectiveness of a smoking cessation intervention using a risk communication approach. A total of 528 smoking cancer patients were randomly allocated either into an intervention group (n = 268) to receive brief advice based on risk communication by a nurse counselor or a control group (n = 260) to receive standard care. Subjects in both groups received a smoking cessation booklet. Patient follow-ups were at 1 week and at 1, 3, 6, 9 and 12 months. No significant differences were found in self-reported point-prevalence 7-day abstinence between the intervention and control groups at 6 months (15.7% vs 16.5%; OR 0.94, 95% CI 0.59-1.50). The rate of at least 50% self-reported reduction of smoking at 6 months, was higher in the intervention group than in the control group (16.8% vs 12.3%; OR 1.43, 95% CI 0.88-2.35). The biochemically validated quit rate at the 6-month follow-up was higher in the intervention group than in the control group (5.2% vs 3.8%; OR 1.38, 95% CI 0.60-3.16). These data suggest that advice based on risk communication was not effective for quitting but improved the rate of smoking reduction among smoking cancer patients.

Theoretical approaches of online social network interventions and implications for behavioral change: a systematic review

RATIONAL, AIMS AND OBJECTIVES

The aim of this review was to identify general theoretical frameworks used in online social network interventions for behavioral change. To address this research question, a PRISMA-compliant systematic review was conducted.

METHODS

A systematic review (PROSPERO registration number CRD42014007555) was conducted using 3 electronic databases (PsycINFO, Pubmed, and Embase). Four reviewers screened 1788 abstracts.

RESULTS

15 studies were selected according to the eligibility criteria. Randomized controlled trials and controlled studies were assessed using Cochrane Collaboration's "risk-of-bias" tool, and narrative synthesis. Five eligible articles used the social cognitive theory as a framework to develop interventions targeting behavioral change. Other theoretical frameworks were related to the dynamics of social networks, intention models, and community engagement theories. Only one of the studies selected in the review mentioned a well-known theory from the field of health psychology.

CONCLUSION

Conclusions were that guidelines are lacking in the design of online social network interventions for behavioral change. Existing theories and models from health psychology that are traditionally used for in situ behavioral change should be considered when designing online social network interventions in a health care setting.

The effectiveness of smoking cessation, physical activity/diet and alcohol reduction interventions delivered by mobile phones for the prevention of non-communicable diseases: A systematic review of randomised controlled trials

BACKGROUND

We conducted a systematic review to assess the effectiveness of smoking cessation, physical activity (PA), diet, and alcohol reduction interventions delivered by mobile technology to prevent non-communicable diseases (NCDs).

METHODS

We searched for randomised controlled trials (RCTs) of mobile-based NCD prevention interventions using MEDLINE, EMBASE, Global Health, CINAHL (Jan 1990-Jan 2016). Two authors extracted data.

FINDINGS

71 trials were included: smoking cessation (n = 18); PA (n = 15), diet (n = 3), PA and diet (n = 25); PA, diet, and smoking cessation (n = 2); and harmful alcohol consumption (n = 8). 4 trials had low risk of bias. The effect of SMS-based smoking cessation support on biochemically verified continuous abstinence was pooled relative risk [RR] 2.19 [95% CI 1.80-2.68], I2 = 0%) and on verified 7 day point prevalence of smoking cessation was pooled RR 1.51 [95% CI 1.06-2.15], I2 = 0%, with no reported adverse events. There was no difference in peak oxygen intake at 3 months in a trial of an SMS-based PA intervention. The effect of SMS-based diet and PA interventions on: incidence of diabetes was pooled RR 0.67 [95% CI 0.49, 0.90], I2 = 0.0%; end-point weight was pooled MD -0.99Kg [95% CI -3.63, 1.64] I2 = 29.4%; % change in weight was pooled MD -3.1 [95%CI -4.86- -1.3] I2 0.3%; and on triglyceride levels was pooled MD -0.19 mmol/L [95% CI -0.29, -0.08], I2 = 0.0%. The results of other pooled analyses of the effect of SMS-based diet and PA interventions were heterogenous (I2 59-90%). The effects of alcohol reduction interventions were inconclusive.

CONCLUSIONS

Smoking cessation support delivered by SMS increases quitting rates. Trials of PA interventions reporting outcomes ≥3 months showed no benefits. There were at best modest benefits of diet and PA interventions. The effects of the most promising SMS-based smoking, diet and PA interventions on morbidity and mortality in high-risk groups should be established in adequately powered RCTs.

Tobacco cessation interventions for young people

BACKGROUND

Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006.

OBJECTIVES

To evaluate the effectiveness of strategies that help young people to stop smoking tobacco.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO.

SELECTION CRITERIA

We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up.

MAIN RESULTS

Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias.

AUTHORS' CONCLUSIONS

There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.

Using Mobile Health (mHealth) Technology in the Management of Diabetes Mellitus, Physical Inactivity, and Smoking

PURPOSE OF REVIEW

Cardiovascular mortality remains high due to insufficient progress made in managing cardiovascular risk factors such as diabetes mellitus, physical inactivity, and smoking. Healthy lifestyle choices play an important role in the management of these modifiable risk factors. Mobile health or mHealth is defined as the use of mobile computing and communication technologies (i.e., mobile phones, wearable sensors) for the delivery of health services and health-related information. In this review, we examine some recent studies that utilized mHealth tools to improve management of these risk factors, with examples from developing countries where available.

RECENT FINDINGS

The mHealth intervention used depends on the availability of resources. While developing countries are often restricted to text messages, more resourceful settings are shifting towards mobile phone applications and wearable technology. Diabetes mellitus has been extensively studied in different settings, and results have been encouraging. Tools utilized to increase physical activity are expensive, and studies have been limited to resource-abundant areas and have shown mixed results. Smoking cessation has had promising initial results with the use of technology, but mHealth's ability to recruit participants beyond those actively seeking to quit has not been established. mHealth interventions appear to be a potential tool in improving control of cardiovascular risk factors that rely on individuals making healthy lifestyle choices. Data related to clinical impact, if any, of commercially available tools is lacking. More studies are needed to assess interventions that target multiple cardiovascular risk factors and their impact on hard cardiovascular outcomes.

Content Analysis of Smartphone Apps for Smoking Cessation in China: Empirical Study

Background

With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone apps for smoking cessation are increasingly used in China to help smokers quit.

Objective

This study analyzed and evaluated the contents of all smoking cessation apps (iOS and Android) available in China, applying the China Clinical Smoking Cessation Guideline (CCSCG; identical to the US Clinical Practice Guideline for Treating Tobacco Use and Dependence) as a framework for analysis.

Methods

We conducted a content analysis of Chinese Android and iOS smoking cessation apps (N=64) designed to assist users in quitting smoking. Each app was independently coded by two raters for its approach to smoking cessation and adherence to the CCSCG. We also recorded the features of smoking cessation apps (eg, release date, size, frequency of downloads, user ratings, type, quality scores by raters, and designers). Linear regression was used to test predictors of popularity and user-rated quality.

Results

Chinese smoking cessation apps have low levels of adherence to guidelines, with an average score of 11.1 for Android and 14.6 for iOS apps on a scale of 0 to 46. There was no significant association between popularity, user rating, and the characteristics of apps. However, there was a positive relationship between popularity, user rating, and adherence score.

Conclusions

Chinese apps for smoking cessation have low levels of adherence to standard clinical practice guidelines. New apps need be developed and existing apps be revised following evidence-based principles in China.

A Multifaceted Hypnosis Smoking-Cessation Program: Enhancing Motivation and Goal Attainment

Smoking cessation remains a major health priority. Despite public campaigns against smoking and widespread availability of smoking-cessation treatments, many people continue to smoke. The authors argue that the "problem of motivation," that is, suboptimal or fluctuating motivation to resist smoking urges and to comply with the demands of treatment, commonly undermines treatment seeking and adherence, appreciably reducing the success rates of smoking-cessation programs. The authors describe the history of the Winning Edge smoking-cessation program and discuss ways to enhance motivation before, during, and after formal treatment. They illustrate how hypnotic suggestions, administered in the context of their program, can promote cognitive, behavioral, and emotional commitment to treatment and enhance motivation to live a smoke-free life.

Mobile health as a viable strategy to enhance stroke risk factor control: A systematic review and meta-analysis

BACKGROUND

With the rapid growth worldwide in cell-phone use, Internet connectivity, and digital health technology, mobile health (mHealth) technology may offer a promising approach to bridge evidence-treatment gaps in stroke prevention. We aimed to evaluate the effectiveness of mHealth for stroke risk factor control through a systematic review and meta-analysis.

METHODS

We searched PubMed from January 1, 2000 to May 17, 2016 using the following keywords: mobile health, mHealth, short message, cellular phone, mobile phone, stroke prevention and control, diabetes mellitus, hypertension, hyperlipidemia and smoking cessation. We performed a meta-analysis of all eligible randomized control clinical trials that assessed a sustained (at least 6months) effect of mHealth.

RESULTS

Of 78 articles identified, 13 met eligibility criteria (6 for glycemic control and 7 for smoking cessation) and were included for the final meta-analysis. There were no eligible studies for dyslipidemia or hypertension. mHealth resulted in greater Hemoglobin A1c reduction at 6months (6 studies; 663 subjects; SMD: -0.44; 95% CI: [-0.82, -0.06], P=0.02; Mean difference of decrease in HbA1c: -0.39%; 95% CI: [-0.74, -0.04], P=0.03). mHealth also lead to relatively higher smoking abstinence rates at 6months (7 studies; 9514 subjects; OR: 1.54; 95% CI: [1.24, 1.90], P<0.0001).

CONCLUSIONS

Our meta-analysis supports that use of mHealth improves glycemic control and smoking abstinence rates.

Text and Mobile Media Smoking Cessation Service for Young Adults in South Texas: Operation and Cost-Effectiveness Estimation

To realize the promising potential of services delivered via smart phones to help young adults quit smoking at a high level of cost-efficiency, we constructed a texting and mobile media system that was promoted in South Texas via social media advertising and other recruitment channels. During the 6-month service period described here, enrollments were achieved for 798 participants with a mean age of 29.3 years. Seven-month texted follow-up found that 21% (171) of the enrollees reported abstinence at that point. This is consistent with high rates of success found in studies of telephone counseling for young adults and confirms that text and mobile media service specifically designed for young adults provide a feasible and potentially cost-effective approach to promoting cessation.

Effectiveness of problem gambling interventions in a service setting: a protocol for a pragmatic randomised controlled clinical trial

INTRODUCTION

The primary purpose of this study is to evaluate the relative effectiveness of 2 of the best developed and most promising forms of therapy for problem gambling, namely face-to-face motivational interviewing (MI) combined with a self-instruction booklet (W) and follow-up telephone booster sessions (B; MI+W+B) and face-to-face cognitive-behavioural therapy (CBT).

METHODS AND ANALYSIS

This project is a single-blind pragmatic randomised clinical trial of 2 interventions, with and without the addition of relapse-prevention text messages. Trial assessments take place pretreatment, at 3 and 12 months. A total of 300 participants will be recruited through a community treatment agency that provides services across New Zealand and randomised to up to 10 face-to-face sessions of CBT or 1 face-to-face session of MI+W+up to 5 B. Participants will also be randomised to 9 months of postcare text messaging. Eligibility criteria include a self-perception of having a current gambling problem and a willingness to participate in all components of the study (eg, read workbook). The statistical analysis will use an intent-to-treat approach. Primary outcome measures are days spent gambling and amount of money spent per day gambling in the prior month. Secondary outcome measures include problem gambling severity, gambling urges, gambling cognitions, mood, alcohol, drug use, tobacco, psychological distress, quality of life, health status and direct and indirect costs associated with treatment.

ETHICS AND DISSEMINATION

The research methods to be used in this study have been approved by the Ministry of Health, Health and Disability Ethics Committees (HDEC) 15/CEN/99. The investigators will provide annual reports to the HDEC and report any adverse events to this committee. Amendments will also be submitted to this committee. The results of this trial will be submitted for publication in peer-reviewed journals and as a report to the funding body. Additionally, the results will be presented at national and international conferences.

TRIAL REGISTRATION NUMBER

ACTRN12615000637549.

Using Facebook as a Platform to Direct Young Black Men Who Have Sex With Men to a Video-Based HIV Testing Intervention: A Feasibility Study

OBJECTIVE

A randomized control pilot study was conducted with Black men who have sex with men (BMSM; N = 42) aged 18-30 years to examine the feasibility of implementing a video intervention delivered using Facebook to motivate HIV testing.

METHODS

At baseline, participants were unaware of their HIV status and had not tested for HIV in the past 6 months, residing in Los Angeles County. The intervention content included topics such as social influence, HIV knowledge, stigma, HIV positive knowledge, and benefits of knowing one's HIV status.

FINDINGS

Logistic regression revealed that those receiving the video intervention were 7 times more likely to have tested for HIV than those in the control group at 6-week follow-up (odds ratio [OR] = 7.00, 95% confidence interval [1.72, 28.33], p = .006).

CONCLUSION

Data suggest that the intervention was feasible for motivating HIV testing.

Effectiveness of the YourCall™ text message intervention to reduce harmful drinking in patients discharged from trauma wards: protocol for a randomised controlled trial

BACKGROUND

Behavioural brief interventions (BI) can support people to reduce harmful drinking but multiple barriers impede the delivery and equitable access to these. To address this challenge, we developed YourCall™, a novel short message service (SMS) text message intervention incorporating BI principles. This protocol describes a trial evaluating the effectiveness of YourCall™ (compared to usual care) in reducing hazardous drinking and alcohol related harm among injured adults who received in-patient care.

METHODS/DESIGN

Participants recruited to this single-blind randomised controlled trial comprised patients aged 16-69 years in three trauma-admitting hospitals in Auckland, New Zealand. Those who screened positive for moderately hazardous drinking were randomly assigned by computer to usual care (control group) or the intervention. The latter comprised 16 informational and motivational text messages delivered using an automated system over the four weeks following discharge. The primary outcome is the difference in mean AUDIT-C score between the intervention and control groups at 3 months, with the maintenance of the effect examined at 6 and 12 months follow-up. Secondary outcomes comprised the health and social impacts of heavy drinking ascertained through a web-survey at 12 months, and further injuries identified through probabilistic linkage to national databases on accident insurance, hospital discharges, and mortality. Research staff evaluating outcomes were blinded to allocation. Intention-to-treat analyses will include assessment of interactions based on ethnicity (Māori compared with non-Māori).

DISCUSSION

If found to be effective, this mobile health strategy has the potential to overcome current barriers to implementing equitably accessible interventions that can reduce harmful drinking.

TRIAL REGISTRATION

Universal Trial Number (UTN) U1111-1134-0028. ACTRN12612001220853 . Submitted 8 November 2012 (date of enrolment of first participant); Version 1 registration confirmed 19 November 2012. Retrospectively registered.

Psychotherapeutic Applications of Mobile Phone-based Technologies: A Systematic Review of Current Research and Trends

There is a growing interest in using mobile phone technology to offer real-time psychological interventions and support. However, questions remain on the clinical effectiveness and feasibility of such approaches in psychiatric populations. Our aim was to systematically review the published literature on mobile phone apps and other mobile phone-based technology for psychotherapy in mental health disorders. To achieve this, electronic searches of PubMed, ScienceDirect, and Google Scholar were carried out in January 2016. Generated abstracts were systematically screened for eligibility to be included in the review. Studies employing psychotherapy in any form, being delivered through mobile-based technology and reporting core mental health outcomes in mental illness were included in the study. We also included trials in progress with published protocols reporting at least some outcome measures of such interventions. From a total of 1563 search results, 24 eligible articles were identified and reviewed. These included trials in anxiety disorders (8), substance use disorders (5), depression (4), bipolar disorders (3), schizophrenia and psychotic disorders (3), and attempted suicide (1). Of these, eight studies involved the use of smartphone apps and others involved personalized text messages, automated programs, or delivered empirically supported treatments. Trial lengths varied from 6 weeks to 1 year. Good overall retention rates indicated that the treatments were feasible and largely acceptable. Benefits were reported on core outcomes in mental health illness indicating efficacy of such approaches though sample sizes were small. To conclude, mobile phone-based psychotherapies are a feasible and acceptable treatment option for patients with mental disorders. However, there remains a paucity of data on their effectiveness in real-world settings, especially from low- and middle-income countries.

Comparison of Text Messages Versus E-mail When Communicating and Querying With Mothers About Safe Infant Sleep

OBJECTIVE

To assess how mothers' choice of e-mail or text messages (SMS) to receive safe sleep communications is associated with educational video viewing and responses to care practice queries.

METHODS

Seven hundred ninety-two new mothers received safe sleep-related communications for 60 days after newborn hospital discharge as part of a trial of health education interventions on infant care practices. Mothers chose e-mail or SMS for study communications and were sent 22 short safe sleep videos and 41 queries regarding infant care practices.

RESULTS

Study communications via e-mail were elected by 55.7% of participants. The SMS group had a modestly higher overall view rate of videos (59.1% vs 54.4%; adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.07-1.81) and a substantially higher response rate to queries (70.0% vs 45.2%; aOR, 3.48; 95% CI, 2.74-4.43).

CONCLUSIONS

Participants more commonly opted to receive infant care practice videos and queries via e-mail. SMS was associated with higher viewing and response rates, especially for query responses. These results highlight the importance of understanding how specific modalities of communication might vary in reach.

IDEAS (Integrate, Design, Assess, and Share): A Framework and Toolkit of Strategies for the Development of More Effective Digital Interventions to Change Health Behavior

Developing effective digital interventions to change health behavior has been a challenging goal for academics and industry players alike. Guiding intervention design using the best combination of approaches available is necessary if effective technologies are to be developed. Behavioral theory, design thinking, user-centered design, rigorous evaluation, and dissemination each have widely acknowledged merits in their application to digital health interventions. This paper introduces IDEAS, a step-by-step process for integrating these approaches to guide the development and evaluation of more effective digital interventions. IDEAS is comprised of 10 phases (empathize, specify, ground, ideate, prototype, gather, build, pilot, evaluate, and share), grouped into 4 overarching stages: Integrate, Design, Assess, and Share (IDEAS). Each of these phases is described and a summary of theory-based behavioral strategies that may inform intervention design is provided. The IDEAS framework strives to provide sufficient detail without being overly prescriptive so that it may be useful and readily applied by both investigators and industry partners in the development of their own mHealth, eHealth, and other digital health behavior change interventions.

Web-Based Video-Coaching to Assist an Automated Computer-Tailored Physical Activity Intervention for Inactive Adults: A Randomized Controlled Trial

BACKGROUND

Web-based physical activity interventions that apply computer tailoring have shown to improve engagement and behavioral outcomes but provide limited accountability and social support for participants. It is unknown how video calls with a behavioral expert in a Web-based intervention will be received and whether they improve the effectiveness of computer-tailored advice.

OBJECTIVE

The purpose of this study was to determine the feasibility and effectiveness of brief video-based coaching in addition to fully automated computer-tailored advice in a Web-based physical activity intervention for inactive adults.

METHODS

Participants were assigned to one of the three groups: (1) tailoring + video-coaching where participants received an 8-week computer-tailored Web-based physical activity intervention ("My Activity Coach") including 4 10-minute coaching sessions with a behavioral expert using a Web-based video-calling program (eg, Skype; n=52); (2) tailoring-only where participants received the same intervention without the coaching sessions (n=54); and (3) a waitlist control group (n=45). Demographics were measured at baseline, intervention satisfaction at week 9, and physical activity at baseline, week 9, and 6 months by Web-based self-report surveys. Feasibility was analyzed by comparing intervention groups on retention, adherence, engagement, and satisfaction using t tests and chi-square tests. Effectiveness was assessed using linear mixed models to compare physical activity changes between groups.

RESULTS

A total of 23 tailoring + video-coaching participants, 30 tailoring-only participants, and 30 control participants completed the postintervention survey (83/151, 55.0% retention). A low percentage of tailoring + video-coaching completers participated in the coaching calls (11/23, 48%). However, the majority of those who participated in the video calls were satisfied with them (5/8, 71%) and had improved intervention adherence (9/11, 82% completed 3 or 4 modules vs 18/42, 43%, P=.01) and engagement (110 minutes spent on the website vs 78 minutes, P=.02) compared with other participants. There were no overall retention, adherence, engagement, and satisfaction differences between tailoring + video-coaching and tailoring-only participants. At 9 weeks, physical activity increased from baseline to postintervention in all groups (tailoring + video-coaching: +150 minutes/week; tailoring only: +123 minutes/week; waitlist control: +34 minutes/week). The increase was significantly higher in the tailoring + video-coaching group compared with the control group (P=.01). No significant difference was found between intervention groups and no significant between-group differences were found for physical activity change at 6 months.

CONCLUSIONS

Only small improvements were observed when video-coaching was added to computer-tailored advice in a Web-based physical activity intervention. However, combined Web-based video-coaching and computer-tailored advice was effective in comparison with a control group. More research is needed to determine whether Web-based coaching is more effective than stand-alone computer-tailored advice.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN): 12614000339651; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12614000339651+&isBasic=True (Archived by WebCite at http://www.webcitation.org/6jTnOv0Ld).

Prioritizing the mHealth Design Space: A Mixed-Methods Analysis of Smokers' Perspectives

Background

Smoking remains the leading cause of preventable disease and death in the United States. Therefore, researchers are constantly exploring new ways to promote smoking cessation. Mobile health (mHealth) technologies could be effective cessation tools. Despite the availability of commercial quit-smoking apps, little research to date has examined smokers’ preferred treatment intervention components (ie, design features). Honoring these preferences is important for designing programs that are appealing to smokers and may be more likely to be adopted and used.

Objective

The aim of this study was to understand smokers’ preferred design features of mHealth quit-smoking tools.

Methods

We used a mixed-methods approach consisting of focus groups and written surveys to understand the design preferences of adult smokers who were interested in quitting smoking (N=40). Focus groups were stratified by age to allow differing perspectives to emerge between older (>40 years) and younger (<40 years) participants. Focus group discussion included a “blue-sky” brainstorming exercise followed by participant reactions to contrasting design options for communicating with smokers, providing social support, and incentivizing program use. Participants rated the importance of preselected design features on an exit survey. Qualitative analyses examined emergent discussion themes and quantitative analyses compared feature ratings to determine which were perceived as most important.

Results

Participants preferred a highly personalized and adaptive mHealth experience. Their ideal mHealth quit-smoking tool would allow personalized tracking of their progress, adaptively tailored feedback, and real-time peer support to help manage smoking cravings. Based on qualitative analysis of focus group discussion, participants preferred pull messages (ie, delivered upon request) over push messages (ie, sent automatically) and preferred interaction with other smokers through closed social networks. Preferences for entertaining games or other rewarding incentives to encourage program use differed by age group. Based on quantitative analysis of surveys, participants rated the importance of select design features significantly differently (P<.001). Design features rated as most important included personalized content, the ability to track one’s progress, and features designed to help manage nicotine withdrawal and medication side effects. Design features rated least important were quit-smoking videos and posting on social media. Communicating with stop-smoking experts was rated more important than communicating with family and friends about quitting (P=.03). Perceived importance of various design features varied by age, experience with technology, and frequency of smoking.

Conclusions

Future mHealth cessation aids should be designed with an understanding of smokers’ needs and preferences for these tools. Doing so does not guarantee treatment effectiveness, but balancing user preferences with best-practice treatment considerations could enhance program adoption and improve treatment outcomes. Grounded in the perspectives of smokers, we identify several design considerations, which should be prioritized when designing future mHealth cessation tools and which warrant additional empirical validation.