Text messaging connects people to healthier habits, researchers to urban subjects

Text messaging is a fixture in modern culture. In two separate studies, U-M Family Medicine researchers have shown that in addition to facilitating everyday conversation, texting can help people adopt healthier behaviors, and can make it easier for health researchers to gather information.

Texting could be good for your health

Two studies published in the Journal of Medical Internet Research detailed how U-M researchers used a text messaging program to help individuals decrease their risk for type 2 diabetes.  The customized texting service, called txt4health, was piloted in Detroit, Cincinnati and New Orleans, with results reported for participants in Detroit and Cincinnati.

An overwhelming majority of surveyed people who enrolled in txt4health said the free mobile education program made them more aware of their diabetes risk and more likely to make diet-related behavior changes and lose weight.  While txt4health seemed to work well for those who completed it, only 39 percent stuck with it through the duration of the 14 week program.

“We found that this method of health intervention had potential to significantly influence people’s health habits and have great reach – however, sustained participant engagement across the 14 weeks was lower than desired,” says lead author of both studies Lorraine R. Buis, Ph.D., assistant professor in the Department of Family Medicine at the U-M Medical School.

“It’s clear that a text message program may not be appropriate for everyone; however, for a large subset of people, this may be a feasible, acceptable, and useful strategy to motivate positive behavior changes.”

Most participants reported that after completing the program, they were more likely to replace sugary drinks with water (78 percent), have a piece of fresh fruit instead of dessert (74 percent), substitute a small salad for chips or fries when dining out (76 percent), buy healthier foods when grocery shopping (80 percent), and eat more grilled, baked, or broiled foods instead of fried (76 percent).

The majority of survey respondents also reported that text messages were easy to understand (100 percent), that the program made them knowledgeable of their risk for developing type 2 diabetes (88 percent) and more aware of their dietary and physical activity habits (89 percent). Eighty-eight percent also said they enjoyed participating in the program.

The txt4health initiative is a large, public health focused text message-based program that aims to raise type 2 diabetes risk awareness, as well as facilitate weekly weight and physical activity self-monitoring to lower diabetes risk. Both pilots were supported by the Office of the National Coordinator for Health Information Technology. In Detroit, the program was by the Southeast Michigan Beacon Community and Cincinnati’s program was led by the Greater Cincinnati Beacon Collaborative. The groups launched txt4health as part of each city’s campaign to educate the public about diabetes and prevention.    

Researchers enrolled 1,838 participants in the program who were asked to answer background questions in order to get personalized health tips and recommendations over 14 weeks. Overall, roughly 74 percent of participants completed the diabetes risk assessment, 89 percent tracked their weight and 55 percent reported their physical activity at least once during the program.

“Text message programs may be a useful tool when used as a component in a broad-based public health campaign,” Buis says. “However, sole reliance on this strategy may be cautioned when targeting a general population because the level of individual engagement widely varies. We need to further explore ways to improve retention rates among participants.”

Text messaging may be a key to tapping into urban communities for research

A pilot study of low income African Americans in Detroit suggests researchers looking to learn more about residents of urban communities should replace traditional direct mail surveys with text messaging.

The study, which appeared online in the journal BioMed Central Public Health, was a collaboration among researchers at the U-M Health System, VA Ann Arbor Healthcare System, the Detroit Community-Academic Urban Research Center and non-profit Detroit organization, Friends of Parkside.

Their work suggests that there is a clear preference for text messaging among urban residents – whether it’s by researchers asking questions for a health study or community advocates gauging resource needs. “Our study shows great potential to connect with a population that’s traditionally difficult to reach.  Texting is a simple technology that is already being used for everyday communication- it is something people from all backgrounds are very comfortable with,” says lead author Tammy Chang, M.D., M.P.H., M.S., an assistant professor in the Department of Family Medicine at the University of Michigan Medical School.

“This is a group whose attitudes and perceptions are incredibly important to understand, but who may not necessarily be taking online surveys or attending community meetings. We found that texting is not only acceptable and feasible, but is the preferred method of collecting real time information from low-income community members.   Most importantly, texting may offer an efficient, inexpensive way to give a voice to people who aren’t often heard and whose needs aren’t always met.”

Twenty participants were asked hypothetical questions related to their health to evaluate how they would respond to leading reasons for urgent outpatient medical visits and also common primary care concerns. Examples included what they’d do if they needed a flu shot for a new job, had a four-day-old rash on their leg, or fell down the stairs and thought they’d broken a leg. On average, the response rate was 72 percent.

The answers gave researchers a glimpse into possible health needs in the community. One question, for example, asked people how they would respond if they couldn’t move their right arm or leg and suddenly couldn’t speak. Several participants didn’t realize those were signs of a stroke, answering that they would wait it out. The findings prompted local initiatives to better educate the community on telltale stroke warnings.

Researchers point out that text messaging has become ubiquitous in the country and its brevity and simple wording may potentially reduce the literacy barrier of other types of surveys. Cell phone ownership is also rapidly growing among minorities and low-income Americans. More black Americans own cell phones than white Americans (93 percent compared to 90 percent) and they are also more likely to use text messaging (79 percent compared to 68 percent), according to the Pew Research Center.

“What’s great about text messaging is that it’s not a new technology that anyone has to create or learn how to use,” says Chang, an alumna of the Robert Wood Johnson Foundation Clinical Scholars Program. “Typically we have used cellular phone technology to push out information, not as much to collect opinions from people.

“However, this everyday technology may not only help researchers better understand under-represented perspectives, it can also help organizations quickly tap into their stakeholders thoughts and opinions to get to the heart of significant issues.”

The median income of residents surveyed was between $16,000 and $26,000, with 32-47 percent living below poverty. Most participants said they could answer two text message survey questions a day while others said they could answer up to five.

Learn more about current research underway in the U-M Department of Family Medicine here.

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