Text messaging interventions increase adherence to antiretroviral therapy and smoking cessation

Abstract

ContextPromoting the uptake of healthier behaviour, either in health promotion or in disease management, presents significant challenges, both at the individual and population levels, and calls for innovative strategies and methods. As mobile technologies have advanced exponentially in recent years, 1 2 there is an increased scope for low-cost health promotion interventions with economy of scale, and for individualised self-management support for healthcare consumers which allows for personal tailored messaging and temporal synchronisation of intervention delivery. Communication technologies have radically changed how individuals access health information and communicate, and this generates a need to examine the effectiveness of mobile technology-based interventions delivered to healthcare consumers for health behaviour change and also for the management of diseases. MethodsThis systematic review by Free and colleagues includes studies in which mobile technology was the primary intervention component under evaluation. The primary outcome was any objective measure of health, or health service delivery or use. Secondary outcomes included self-reported health behaviours, disease management, health service delivery or use and cognitive outcomes. Excluded studies were those in which mixed mobile technologies were adopted, or those evaluating non-mobile technology-based interventions in which the treatment and control group both received the technology-based component or those interventions in which the treatment and control group differed in additional ways besides the use of mobile technology. Two reviewers identified potentially eligible trials and independently extracted data. The authors searched MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, the Cochrane Library and the Health Technology Assessment (HTA) database from 1990 to September 2010. They applied a taxonomy of behaviour change techniques to classify behaviour change interventions 3 and assessed the risk of bias according to the criteria outlined by the Cochrane Collaboration. Risk ratios and standard mean differences were calculated, and the authors used random effects meta-analysis to give pooled estimates when there were two or more trials using the same technology function (eg, short message service (SMS)) and targeting the same disease (eg, diabetes control) or behaviour (eg, physical activity) and reporting the same outcome. Heterogeneity was examined visually and statistically, and funnel plots were included to assess the evidence of publication bias. FindingsThere were 75 controlled trials which met the review criteria: 49 targeted disease management for healthcare consumers (6832 participants, with sample sizes ranging from 17 to 5800) and 26 targeted health behaviour change (10 706 participants with sample sizes ranging from 16 to 273). Almost all the trials were conducted in high-income countries and the majority were of low quality; only two trials of disease management and two trials of health behaviour management had a low risk of ...