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On March 30th, Epidemiologic Reviews published a paper entitled “Text Messaging as a Tool for Behavior Change in Disease Prevention and Management.” Written by Heather Cole-Lewis and Trace Kershaw, the paper reviews previously published data to assess the potential for mobile phones to be used in disease management and prevention.

Comprised of data from 17 articles representing 12 studies (five of which focused on disease prevention and seven of which focused on disease management), the authors draw conclusions on the effectiveness of using mobile phones (and more specifically, text messaging on mobile phones) to change health behaviors. 

The study takes a close look at some of the flaws in previously published research without denying the many ways in which texting can be used in the health field, including disease and symptom monitoring, medication and appointment reminders, test delivery, data collection and remote diagnosis. The report is intended to be both an assessment of the current literature on mHealth and text messaging and also a means of identifying gaps in the literature.

The authors acknowledge the potential of text messaging (eight of the featured studies found evidence supporting text messaging as a tool for positive behavior change) for promoting positive change in health behaviors, but are cautious enough to view it as only part of the solution, writing:

Text messaging should not be considered a stand-alone model for behavior change but rather as a tool by which behavior change methods can be administrated. The tendency to view text messaging as a stand-alone method itself is understandable, because it naturally encompasses concepts that positively influence behavior change; however, we must be careful to understand the mechanisms o change in order to build upon the way that text messaging works for behavior change.

Because the survey draws from other data, the authors review how text messaging influenced treatment and behavior change for a wide variety of diseases including diabetes, tuberculosis, obesity, and anti-smoking initiatives. However, the authors point out that a weakness of the research to date is that all but one of the studies come from developed countries, and thus lack important data on how text messaging for m-health relates to developing countries. The authors conclude that while there is ample evidence that text messaging can have an impact on health behaviors and disease management and prevention, it is important to continue to research in order to fill in the knowledge gaps: 

This review supports the feasibility of using text messaging to effect behavior change. Future studies should ensure rigorous methods and sufficient power in order to contribute to the existing body of literature seeking to determine whether the behavior change observed is sufficient to produce relevant public health and clinical outcomes. More information is also needed on what combinations of text message factors (dose, duration, complimentary technologies, etc) produce the best results, because opportunities exist to adapt successful interventions to new populations and diseases. Additionally, more information is needed on the long-term effects of text message interventions.

This paper is a start for anyone who wants an overview of the literature on text messaging for disease prevention and management, as it both acknowledges the potential of the field while taking a hard look at what's missing.

Anne-Ryan Heatwole is a writer for MobileActive.org. Follow her on Twitter @arheatwole

Image courtesy Flickr user another.point.in.time