Behavior Change Interventions Delivered by Mobile Telephone Short-Message Service


      The expansion and adoption of new methods of communication provide new opportunities for delivering health behavior change interventions. This paper reviews the current research examining mobile telephone short-message service (SMS) for delivering health behavior change interventions via text messages. This service has wide population reach, can be individually tailored, and allows instant delivery with asynchronous receipt, suggesting potential as a delivery channel for health behavior interventions.

      Evidence acquisition

      An electronic database search was conducted for studies published between January 1990 and March 2008. Studies were included in the review if they (1) evaluated an intervention delivered primarily via SMS, (2) assessed change in health behavior using pre–post assessment, and (3) were published in English in a peer-reviewed scientific journal.

      Evidence synthesis

      Of 33 studies identified, 14 met the inclusion criteria. Four of the 14 studies reviewed targeted preventive health behaviors (e.g., smoking cessation), and ten focused on clinical care (e.g., diabetes self-management). Positive behavior change outcomes were observed in 13 of the 14 reviewed studies. Intervention initiation (researcher or participant), SMS dialogue initiation, tailoring of SMS content, and interactivity were found to be important features of SMS-delivered interventions. Methodologic issues with current SMS research were also identified.


      This review suggests that SMS-delivered interventions have positive short-term behavioral outcomes. Further research is required to evaluate interventions for preventive health behaviors that incorporate features found to affect behavioral outcomes and participant acceptance. The quality of studies in this emerging field of research needs to improve to allow the full potential of this medium to be explored.
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        • Chaudhry S.
        • Phillips C.
        • Stewart S.
        • et al.
        Telemonitoring for patients with chronic heart failure: a systematic review.
        J Card Fail. 2007; 13: 56-62
        • Eakin E.
        • Lawler S.
        • Vandelanotte C.
        • Owen N.
        Telephone interventions for physical activity and dietary behavior change: a systematic review.
        Am J Prev Med. 2007; 32: 419-434
        • Jaana M.
        • Pare G.
        Home telemonitoring of patients with diabetes: a systematic assessment of observed effects.
        J Eval Clin Prac. 2007; 13: 242-253
        • Revere D.
        • Dunbar P.
        Review of computer-generated outpatient health behavior interventions: clinical encounters ‘in absentia.’.
        J Am Med Inform Assoc. 2001; 8: 62-79
        • Evers K.
        • Prochaska J.
        • Driskell M.
        • Cummins C.
        • Velicer W.
        Strengths and weaknesses of health behavior change programs on the internet.
        J Health Psych. 2003; 8: 63-70
        • Marcus B.
        • Nigg C.
        • Reibe D.
        • Forsyth A.
        Interactive communication strategies: implications for population-based physical activity promotion.
        Am J Prev Med. 2000; 19: 121-126
        • Vandelanotte C.
        • Spathonis K.
        • Eakin E.
        • Owen N.
        Website-delivered physical activity interventions: a review of the literature.
        Am J Prev Med. 2007; 33: 54-64
        • Patrick K.
        Information technology and the future of preventive medicine: potential, pitfalls and policy.
        Am J Prev Med. 2000; 19: 132-135
        • Rice R.
        • Katz J.
        Comparing internet and mobile phone usage: digital divides of usage, adoption and dropouts.
        Telecommunications Policy. 2003; 27: 597-623
        • Neuhauser L.
        • Kreps G.
        Rethinking communication in the e-Health era.
        J Health Psychol. 2003; 8: 7-22
        • Atkinson N.L.
        • Gold R.S.
        The promise and challenge of eHealth interventions.
        Am J Health Behav. 2002; 26: 494-503
        • Patrick K.
        • Griswold W.G.
        • Raab F.
        • Intille S.S.
        Health and the mobile phone.
        Am J Prev Med. 2008; 35: 177-181
        • Katz J.
        Machines that become us: the social context of personal communication technology.
        Transaction Publishers, New Brunswick New Jersey2003
        • Hamill L.
        • Lasen A.
        Mobile world: past, present and future.
        USA, Springer2005
        • Ling R.
        The mobile connection: the cell phone's impact on society.
        Morgan Kaufmann Publishers, San Francisco2004
        • Goggin G.
        Cell phone culture: mobile technology in everyday life.
        Routledge, New York2006
        • Cellular Telecommunications & Internet Association
        Semi-Annual Wireless Industry Survey.
        2006 (Washington)
        • Puro J.
        Finland: a mobile culture.
        in: Katz J. Aarkhus M. Perpetual contact. CUP, Cambridge2002: 19-30
        • Atun R.
        • Sittampalam S.
        A review of the characteristics and benefits of SMS in delivering healthcare.
        The Role of Mobile Phones in Increasing Accessibility and Efficiency in Healthcare Report. 2006;
        • Dijkstra A.
        • De Vries H.
        The development of computer-generated tailored interventions.
        Patient Educ Couns. 1999; 36: 193-203
        • Bull F.
        • Holt C.
        • Kreuter M.
        • Clark E.
        • Scharff D.
        Understanding the effects of printed health education materials: which features lead to which outcomes?.
        J Health Commun. 2001; 6: 265-279
        • Suggs L.S.
        A 10-year retrospective of research in new technologies for health communication.
        J Health Commun. 2006; 11: 61-74
        • Trevena L.
        • Davey H.
        • Barratt A.
        • Butow P.
        • Caldwell P.
        A systematic review on communicating with patients about evidence.
        J Eval Clin Pract. 2006; 12: 13-23
        • Ryan P.
        • Lauver D.
        The efficacy of tailored interventions.
        J Nurs Scholarsh. 2002; 34: 331-337
        • Sherry E.
        • Collordi B.
        • Warnke P.
        Short messaging service (SMS): a useful communication tool for surgeons.
        Aust N Z J Surg. 2002; 72: 369
        • Franklin V.
        • Waller A.
        • Pagliari C.
        • Greene S.
        Sweet talk: text messaging support for intensive insulin therapy for young people with diabetes.
        Diabetes Technol Ther. 2003; 5: 991-996
        • Faulkner X.
        • Culwin F.
        When fingers do the talking: a study of text messaging.
        Interacting Comput. 2005; 17: 167-185
        • Koivusilta K.
        • Lintonen T.
        • Rimpela A.
        Orientations in adolescent use of information and communication technology: a digital divide by socio-demographic background, educational career and health.
        Scandinavian J Public Health. 2007; 35: 95-103
        • Lajunen H.
        • Keski-Rahkonen A.
        • Pulkkinen L.
        • Rose R.
        • Rissanen A.
        • Kaprio J.
        Are computer and cell phone use associated with body mass index and overweight? A population study among twin adolescents.
        BMC. 2007; 7: e1-e8
        • Koivusilta K.
        • Lintonen T.
        • Rimpela A.
        Intensity of mobile phone use and health compromising behaviours—how is information and communication technology connected to health-related lifestyle in adolescence?.
        J Adolesc. 2005; 28: 35-47
        • Bos A.
        • Hoogstraten J.
        • Prahl-Andersen B.
        Failed appointments in an orthodontic clinic.
        Am J Orthod Dento Orthop. 2005; 127: 355-357
        • Downer S.R.
        • Meara J.G.
        • DaCosta A.
        Use of SMS text messaging to improve outpatient attendance.
        MJA. 2005; 183: 366-368
        • Milne R.
        • Horne M.
        • Torsney B.
        SMS reminders in the UK National Health Service: an evaluation of its impact on no-shows at hospital out-patient clinics.
        Health Care Manage Rev. 2006; 31: 130-136
        • Vilella A.
        • Bayas J.
        • Diaz M.
        • et al.
        The role of mobile phones in improving vaccination rates in travelers.
        Prev Med. 2004; 38: 503-509
        • Cohen C.
        • Coyne K.
        • Mandalia S.
        • Waters A.
        • Sullivan A.
        Time to use text reminders in genitourinary medicine clinics.
        Int J STD AIDS. 2008; 19: 12-13
        • Pal B.
        The doctor will text you now; is there a role for the mobile telephone in health care?.
        BMJ. 2003; 326: 607
        • Tomnay J.E.
        • Pitts M.K.
        • Fairley C.K.
        New technology and partner notification—why aren't we using them?.
        Int J STD AIDS. 2005; 16: 19-22
        • Menon-Johansson A.S.
        • McNaught F.
        • Mandalia S.
        • Sullivan A.K.
        Texting decreases the time to treatment for genital Chlamydia trachomatis infection.
        STI. 2006; 82: 49-51
        • Weaver A.
        • Young A.
        • Rowntree J.
        • et al.
        Application of mobile phone technology for managing chemotherapy-associated side-effects.
        Annals Oncol. 2007; 18: 1887-1892
        • Dayani A.
        New text scheme for mums-to-be.
        Evening Mail. 2005
        • Neville R.
        • Greene A.
        • McLeod J.
        • Tracy A.
        • Surie J.
        Mobile phone text messaging can help young people manage asthma.
        BM J. 2002; 325: 600
        • Moher D.
        • Cook D.
        • Eastwood S.
        • Olkin I.
        • Rennie D.
        • Stroup D.
        Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement.
        Lancet. 1999; 354: 1896-1900
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2nd ed. Lawrence Erlbaum Associates, New Jersey1988
        • Ferrer-Roca O.
        • Cardenas A.
        • Diaz-Cardama A.
        • Pulido P.
        Mobile phone text messaging in the management of diabetes.
        J Telemedicine Telecare. 2004; 10: 282-286
        • Gammon D.
        • Arsand E.
        • Walseth O.
        • Andersson N.
        • Jenssen M.
        • Taylor T.
        Parent-child interaction using a mobile and wireless system for blood glucose monitoring.
        J Med Internet Res. 2005; 7: e57
        • Wangberg S.
        • Arsand E.
        • Andersson N.
        Diabetes education via mobile text messaging.
        J Telemedicine Telecare. 2006; 12: s55-s56
        • Anjoh J.
        • Moldrup C.
        Feasibility of collecting diary data from asthma patients through mobile phones and SMS (Short Message Service): response rate analysis and focus group evaluation from a pilot study.
        J Med Internet Res. 2004; 6: e42
        • Bellazzi R.
        • Arcelloni M.
        • Ferrari P.
        • et al.
        Management of patients with diabetes through information technology: tools for monitoring and control of the patients' metabolic behavior.
        Diab Tech Therap. 2004; 6: 567-578
        • Hung S.
        • Tseng H.
        • Tsai W.
        • Lin H.
        • Cheng J.
        • Chang Y.
        Care for asthma via mobile phone (CAMP).
        Stud Health Technol Inform. 2007; 126: 137-143
        • Gibson F.
        • Miller M.
        • Kearney N.
        Technology into practice: young people's, parent's and nurses' perceptions of WISECARE+.
        Paed Nurs. 2007; 19: 31-34
        • Pinnock H.
        • Slack R.
        • Pagliari C.
        • Price D.
        • Sheikh A.
        Understanding the potential role of mobile phone-based monitoring on asthma self-management: qualitative study.
        Clin Exper Allergy. 2007; 37: 794-802
        • Cleland J.
        • Cladow J.
        • Ryan D.
        A qualitative study of the attitudes of patients and staff to the use of mobile phone technology for recording and gathering asthma data.
        J Telemed Telecare. 2007; 13: 85-89
        • Carroll A.
        • Marrero D.E.
        • Downs S.
        The HealthPia GlucoPack diabetes phone: a usability study.
        Diab Tech Therap. 2007; 9: 158-164
        • Halifax N.
        • Cafazzo J.
        • Irvine J.
        • Hamill M.
        • Rizo C.
        • McIssac W.
        Telemanagement of hypertension: a qualitative assessment of patient and physician preferences.
        Can J Cardiol. 2007; 23: 591-594
        • Boland P.
        The emerging role of cell phone technology in ambulatory care.
        J Ambulatory Care Manage. 2007; 30: 126-133
        • Trudel M.
        • Cafazzo J.
        • Hamill M.
        • et al.
        A mobile phone based remote patient monitoring system for chronic disease management.
        Medinfo. 2007; 12: 167-171
        • Bauer S.
        • Percevic R.
        • Okon E.
        • Meermann R.
        • Kordy H.
        Use of text messaging in the aftercare of patients with Bulimia Nervosa.
        Eur Eat Disorders Rev. 2003; 11: 279-290
        • Fairley C.K.
        • Levy R.
        • Rayner C.R.
        • et al.
        Randomized trial of an adherence program for clients with HIV.
        Int J STD AIDS. 2003; 14: 805-809
        • Wilkins A.
        • Mak D.
        … Sending out an SMS: an impact and outcome evaluation of the Western Australian Department of Health's 2005 Chlamydia campaign.
        Health Promotion J Aust. 2007; 18: 113-120
        • Vidrine D.
        • Arduino R.
        • Lazev A.
        • Gritz E.
        A randomized trial of a proactive cellular telephone intervention for smokers living with HIV/AIDS.
        AIDS. 2006; 20: 253-260
        • Kubota A.
        • Fujita M.
        • Hatano Y.
        Development and effects of a health promotion program utilizing the mail function of mobile phones.
        Jap J Public Health. 2004; 51: 862-873
        • Yeong S.
        • Siun Lim S.
        The effects of a weight control program with competence.
        Taehan Kanho Hakhoe Chi. 2007; 37: 1177-1183
        • Rodgers A.
        • Corbett T.
        • Riddell T.
        • Wills M.
        • Lin R.
        • Jones M.
        Do u smoke after txt?.
        Tob Control. 2006; 14: 255-261
        • Obermayer J.
        • Riley W.
        • Asif O.
        • Jean-Mary J.
        College smoking-cessation using cell phone text messaging.
        J Am Coll Health. 2004; 53: 71-78
        • Hurling R.
        • Catt M.
        • DeBoni M.
        • et al.
        Using Internet and mobile phone technology to deliver an automated physical activity program: randomized controlled trial.
        J Med Internet Res. 2007; 9: e7
        • Joo N.
        • Kim B.
        Mobile phone short message service messaging for behavior modification in a community-based weight control programme in Korea.
        J Telemedicine Telecare. 2007; 13: 416-420
        • Vahatalo M.A.
        • Virtamo H.E.
        • Viikari J.S.
        • Ronnemaa T.
        Cellular phone transferred self blood glucose monitoring: prerequisites for positive outcome.
        Practical Diab Int. 2004; 21: 192-194
        • Kwon H.
        • Cho J.
        • Kim H.
        • et al.
        Development of web-based diabetic patient management system using short message service (SMS).
        Diabetes Res Clin Pract. 2004; 66: s133-s137
        • Franklin V.
        • Waller A.
        • Pagliari C.
        • Greene S.
        A randomized controlled trial of SweetTalk, a text-messaging system to support young people with diabetes.
        Diabet Med. 2006; 23: 1332-1338
        • Rami B.
        • Popow C.
        • Horn W.
        • Waldhoer T.
        • Schober E.
        Telemedicine support to improve glycemic control in adolescents with Type 1 Diabetes Mellitus.
        Eur J Pediatr. 2006; 165: 701-705
        • Kollman A.
        • Riedl M.
        • Kastner P.
        • Schreier G.
        • Ludcik B.
        Feasibility of a mobile phone-based data service for functional insulin treatment of Type 1 Diabetes Mellitus patients.
        J Med Internet Res. 2007; 9: e36
        • Kim H.
        A randomized controlled trial of a nurse short-message service by cellular phone for people with diabetes.
        Int J Nurs Stud. 2007; 44: 687-692
        • Ostojic V.
        • Cvoriscec B.
        • Ostojic S.B.
        • Reznifoff D.
        • Stripic-Markovic A.
        • Tudjman Z.
        Improving asthma through telemedicine: a study of short-message service.
        Telemed J E Health. 2005; 11: 28-35
        • Marquez Contreras E.
        • Figuera von Wichmann M.
        • Guillen V.
        • Figueras M.
        • Balana M.
        • Naval J.
        Effectiveness of an intervention to provide information to patients with hypertension as short text messages of reminders sent to their mobile phone.
        Atencion Primaria. 2004; 34: 399-405
        • Logan A.
        • McIsaac W.
        • Tisler A.
        • et al.
        Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients.
        Am J Hypertension. 2007; 20: 942-948
        • Robinson S.
        • Perkins S.
        • Bauer S.
        • Hammond N.
        • Treasure J.
        • Schmidt U.
        Aftercare intervention through text messaging in the treatment of Bulimia Nervosa-feasibility study.
        Int J Eat Disord. 2006; 39: 633-638