Issue 37 / 28 September 2015

NEW Australian research showing text messaging can be an effective health promotion tool for patients with coronary heart disease has been welcomed by experts, but they say more sophisticated, individualised approaches could yield even greater health benefits. (1)
Professor Sven-Erik Bursell, professor of telehealth at the NHMRC Clinical Trials Centre, Sydney Medical School, said existing mobile technology could be used to personalise health education for patients, to help them sustain lifestyle modification over longer periods and improve clinical outcomes.
“We can go a long way beyond your generic SMS [short message service] and, if we can do this in a meaningful way, then the clinical outcomes improvement and health impacts can increase significantly”, Professor Bursell told MJA InSight.
Professor Bursell was commenting on the Australian research published in JAMA that found providing lifestyle advice and motivational messages to patients with coronary heart disease (CHD) over a 6-month period improved risk factors compared with usual care.
The single-blind, randomised clinical trial included 710 patients with proven CHD. In addition to usual care, the 352 patients in the intervention group received four text messages each week via an automated messaging service. The messages were sourced from a bank of standard messages, but were targeted according to patients’ baseline characteristics, and were sometimes personally addressed.
The low-cost program led to significant reductions in low-density lipoprotein cholesterol levels, systolic blood pressure and body mass index. Participants receiving the text messages were also more likely to report engaging in regular exercise and being non-smokers.
Professor Bursell said the study added to the evidence gathered over the past decade that text messaging could play a positive role in health promotion. However, he said that to sustain the health benefits in the long term, a more individualised approach was necessary.
“You really have to evolve your text messaging paradigm so it becomes both contextually and temporally relevant to the patient, so you’re providing the right tip at the right time for that patient”, he said. “If you don’t evolve with the patient, then the text messaging to the patient just becomes clutter.”
Professor Bursell said an example was a patient being reminded to make a healthy choice just as they were about to enter a restaurant. Incentives could also be incorporated into programs, delivering small rewards to patients when health goals were attained.
He said gaming technology was already being applied to diabetes education and video streaming could be used to deliver personalised health messages to patients.
Professor Monika Janda, Health Determinants and Health Systems theme leader at the Queensland University of Technology Institute of Health and Biomedical Innovation, said the JAMA findings were exciting, but agreed that the technology was not yet being used to its full capacity. 
“It’s only the beginning of a very exciting kind of intervention”, she told MJA InSight.
Earlier this year, Professor Janda and colleagues showed that text messaging could play a role in skin cancer prevention by encouraging sun safety and skin self-examination in 18–42-year-olds. (2)
Professor Janda said that this project and the program reported in JAMA had investigated only basic uses of the technology and augmenting messages with photos, videos or further personalising the content and delivery frequency could enhance the benefits.
“The evidence is building that this is an exciting way to reach people fairly easily and cheaply and we should keep working on this and make it even more relevant for people”, she said.
An editorial accompanying the JAMA research welcomed the results of the “well-conducted” randomised clinical trial, but highlighted the lack of such evaluation in this rapidly growing field of health care. (3)
“Health care needs to be challenged to make its evaluation as nimble as that of technology”, the editorial authors wrote.
Professor Janda said this was a key challenge in the mobile health sphere, and underlined the difference between apps developed by medical researchers and those developed by commercial enterprises.
She said commercial app developers often relied on market forces, rather than evidence, to determine the success of a product.
“We [medical researchers] always have to go through the slow process of conducting trials to make sure [an intervention] is absolutely watertight before we apply it to the patient”, she said.
UK researchers last week revealed significant variations in the privacy credentials of 79 apps that had been certified as safe and trustworthy by the UK’s NHS Health Apps library. (4)
(Photo: Sergey Nivens / shutterstock)


Should doctors use text messaging and other mobile technologies to actively encourage their patients to improve their health?
  • Yes – this is the future (62%, 34 Votes)
  • Maybe – could help some patients (22%, 12 Votes)
  • No – it’s a public health role (16%, 9 Votes)

Total Voters: 55

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