Robert Furberg, MBA, Ph.D., BreathEasy Text Messaging Pilot Lead, RTI International
In the past 10 years, there’s been a huge increase in the use of cell phones (particularly smartphones); social media, including Twitter, Facebook and blogs; networking tools; and information sharing systems, including mobile geolocation applications such as Foursquare. These tools may offer new opportunities for enhancing techniques and processes for collecting health data, including participant recruitment; tracing; maintaining contact with participants in longitudinal studies; cognitive interviewing; and passive data collection.
Text messaging is one of the most popular communication methods in the world. The pervasiveness, low cost and convenience of mobile phones make Short Message Service (SMS) texting an ideal tool for disseminating health information to—as well as gathering health information from—consumers. It’s also a direct and immediate route to reach people; I tend to think of it as the most intimate form of high-tech communication.
Despite these advantages, rigorous evaluations of new technologies in health services research applications have been rare. The few SMS interventions that have been well-studied suggest that text messaging systems can effectively increase medication and appointment adherence and sustain health promotion behaviors such as smoking cessation, diabetes, asthma management and depression.
I’ve been so enamored of texting and its potential over the past couple of years that I decided to build an SMS platform for sending and receiving messages for health behavior change interventions. After reflecting on these trends and considering how we can make the BreathEasy smartphone experience more engaging, we hit on the idea of integrating SMS notifications with the application.
So that’s where we are now: devising and testing methods to tie our SQL back end from the BreathEasy application side to the SMS platform in order to generate three kinds of messages. The first type of tailored reminder prompts participants to complete diary entries and/or provide peak flow readings; the second involves health alerts related to air quality, excessive use of rescue inhalers and peak flow readings; the third type of messages are health promotion messages that address general wellness and smoking cessation.
For BreathEasy, rather than focusing on text messaging as a mode of intervention or primary collection of observations of daily living (ODLs), we decided to try using SMS as an adjunctive technology. Our SMS-adjunct (SMS-a), is intended to support the collection of ODLs; SMS-a provides participants interactive, dynamically tailored compliance reminders via a smartphone application. Beyond serving as a technical and process proof of concept, we intend to evaluate the effect of SMS-a on increasing participant satisfaction, retention and data quality.
We’re eager to get started with ODL collection and even more excited to observe how things go with this integration. We’ll be sure to update you about our experience when we go live.