Cited by 1,190Mobile Health and mHealth ApplicationsMobile Learning in EducationSocial Media in Health Education

Text messaging as a tool for behavior change in disease prevention and management

Open access
Cole-Lewis, H., Kershaw, T.·2010·Epidemiologic Reviews

Abstract

Mobile phone text messaging is a potentially powerful tool for behavior change because it is widely available, inexpensive, and instant. This systematic review provides an overview of behavior change interventions for disease management and prevention delivered through text messaging. Evidence on behavior change and clinical outcomes was compiled from randomized or quasi-experimental controlled trials of text message interventions published in peer-reviewed journals by June 2009. Only those interventions using text message as the primary mode of communication were included. Study quality was assessed by using a standardized measure. Seventeen articles representing 12 studies (5 disease prevention and 7 disease management) were included. Intervention length ranged from 3 months to 12 months, none had long-term follow-up, and message frequency varied. Of 9 sufficiently powered studies, 8 found evidence to support text messaging as a tool for behavior change. Effects exist across age, minority status, and nationality. Nine countries are represented in this review, but it is problematic that only one is a developing country, given potential benefits of such a widely accessible, relatively inexpensive tool for health behavior change. Methodological issues and gaps in the literature are highlighted, and recommendations for future studies are provided.

Integrity signals

Registry

Crossref · 10.1093/epirev/mxq004

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

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  • Findingown data

    Only two included studies specified a theoretical framework.

    “Only 2 studies specified a theoretical framework (46, 52).”
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      “Few studies in this sample specified a theoretical rationale.”
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  • Findingcitation

    One included study had noticeable nonadherence to the intervention protocol that may have reduced the intervention's effectiveness.

    “One study had noticeable rates of nonadherence to the intervention protocol that may have reduced the effectiveness of the intervention.”
    • Also stated in: § Assessment of risk of bias · hedged
      “Several participants failed to wear pedometers, which was hypothesized to decrease physical activity when used in conjunction with text messaging (47).”
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  • Findingcitation

    Obese adults showed greater weight loss at 4 and 12 months.

    “Significant clinical outcomes observed included greater weight loss in obese adults at 4 and 12 months (46, 48)”
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  • Findingown data

    Retention was above 80% in all but three of the included studies.

    “Retention was above 80% for all but 3 studies (Tables 1 and 2) (23, 27, 46).”
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  • Findingcitation

    Among diabetic adolescents and young adults, text messaging increased the frequency of blood glucose monitoring and reporting compared with e-mail.

    “increase in frequency of blood glucose monitoring and reporting via text message compared with e-mail among diabetic adolescents and young adults (23).”
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    Findingown data

    Across the included studies, intervention duration ranged from 3 to 12 months, and no study followed participants beyond the end of the intervention.

    “Intervention length ranged from 3 months to 12 months, none had long-term follow-up, and message frequency varied.”
    • Also stated in: § Intervention characteristics · plain
      “Intervention length ranged from 3 months to 12 months, and, for all studies, follow-up was conducted at baseline and immediately after the intervention.”
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    Findingcitation

    Vitamin adherence among healthy college students increased in both groups, with no evidence of an effect.

    “adherence to using vitamins by healthy college students (increased in both groups, no evidence of effect) (45)”
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    Findingcitation

    Nine countries were represented in the review, and only one of them was a developing country.

    “Nine countries are represented in this review, but it is problematic that only one is a developing country, given potential benefits of such a widely accessible, relatively inexpensive tool for health behavior change.”
    • Also stated in: § DISCUSSION · plain
      “Nine countries were represented, only one of which is a developing country (53).”
    • Also stated in: § DISCUSSION · plain
      “It is also of note that only one of the studies in this review was conducted in a developing country (53), which is alarming.”
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    Findingown data

    The average study design quality score was 76% for disease prevention studies and 81% for disease management studies.

    “The average study design quality scores were 76% for disease prevention studies and 81% for disease management studies (Table 3).”
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    Findingcitation

    Smokers showed a greater prevalence of current nonsmoking at 6 and 12 weeks, with the same effect in a minority subgroup analysis.

    “Significant behavior change outcomes observed included greater prevalence of current nonsmoking by smokers at 6 and 12 weeks (same effect observed in minority subgroup analysis) (27)”
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    Findingcitation

    Physical activity measured by daily step count decreased unexpectedly in both groups, with no evidence of an effect.

    “physical activity as measured by daily step count (unexpected decrease in both groups, no evidence of effect) (23).”
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    Findingown data

    Text message frequency varied widely across studies, from once per week to five or more times per day.

    “Frequency of text messaging varied greatly, ranging from once weekly to 5 times per day or more.”
    Quote in the paperNot a substantial claim
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    Findingown data

    The review found effects across age groups, minority and nonminority populations, and different nationalities.

    “Effects exist across age, minority status, and nationality.”
    • Also stated in: § DISCUSSION · hedged
      “Effects appeared to exist among adolescents and adults, among minority and nonminority populations, and across nationalities.”
    Quote in the paperSubstantial claim
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    Findingown data

    The review included 17 articles that represented 12 studies, comprising 5 disease prevention studies and 7 disease management studies.

    “Seventeen articles representing 12 studies (5 disease prevention and 7 disease management) were included.”
    • Also stated in: § RESULTS · plain
      “Of 30 articles identified from the comprehensive search, 17 articles representing 12 studies met criteria for inclusion in the study.”
    Quote in the paperNot a substantial claim
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    Findingreasoning

    There is a paucity of data, and the health behavior studies included in the review are heterogeneous.

    “Because of the relative newness of text messaging as a method of delivery for behavior change interventions, there is a paucity of data, and the health behavior studies included in this review are quite heterogeneous.”
    Quote in the paperSubstantial claim
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    Findingnone given

    Other methodological issues include lack of rigor in statistical power and failure to isolate text messaging technology.

    “Other methodological issues include lack of rigor in study design with regard to statistical power to detect a significant difference and, perhaps most importantly, failure to isolate the text messaging technology.”
    Quote in the paperSubstantial claim
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    Findingown data

    Evidence for text messaging in prevention and management was observed for weight loss, smoking cessation, and diabetes management.

    “Evidence for text messaging in disease prevention and management interventions was observed for weight loss, smoking cessation, and diabetes management.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Diabetes management was the most advanced area because it represented all but one of the disease management randomized controlled trials in the review.

    “Currently, the area of diabetes management is most advanced because it represented all but one of the disease management randomized controlled trials in this review.”
    Quote in the paperNot a substantial claim
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    Findingnone given

    No clear differences in intervention outcomes were found based on age, gender, or message length.

    “There were no clear differences in intervention outcomes based on age, gender, or length of messages.”
    Quote in the paperNot a substantial claim
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    Study design and conductreasoning

    Participant blinding was not possible in this type of study, and only two studies blinded research staff during assessment.

    “Blinding of participants to condition is not possible in this type of study, but only 2 studies utilized blinding of research staff during assessment (27, 47).”
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    Study design and conductcitation

    Another included study with low retention did not report whether attrition differed between groups.

    “Another study with a low retention rate did not specify whether attrition was differential (23).”
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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The review is subject to publication bias.

    “Additionally, as with all systematic reviews, the present study is subject to publication bias.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The information on medication reminders, periodic prompts, and mobile phones provides a strong rationale for extending research on text messaging to medication adherence, especially for global diseases such as HIV.

    “This information, coupled with evidence of the benefits of mobile phones as an inexpensive, personal, efficient, and widely accessible way to intervene on health (14, 18, 61), provides a very strong rationale for extending research on text messaging to medication adherence, especially in the context of global diseases such as HIV.”
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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    mHealth is a rapidly growing area of research with potential to promote health equity.

    “This review is important because mHealth is a rapidly growing area of research with the potential to promote health equity (8, 36).”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Mobile phone use grew rapidly, with an estimated 4 billion subscribers worldwide by the end of 2008, up from 1 billion in 2002.

    “By the end of 2008, there were an estimated 4 billion mobile phone subscribers worldwide. Since there were only 1 billion subscribers in 2002, it is apparent that use of this technology is growing rapidly (1).”
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    Premisecitation

    Text messaging is the most widely available and frequently used mobile data service.

    “Text messaging is of particular interest in this review because of the unique promise of mHealth—it is the most widely available and frequently used mobile data service (3, 30).”
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    Study design and conductnone given

    The review's synthesis of randomized controlled trials and quasi-experimental studies is a strength.

    “A strength of this review is that it synthesizes evidence from randomized controlled trials and quasi-experimental studies.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Text messaging is asynchronous and can be accessed at personally convenient times.

    “Text messaging also has the advantage of being asynchronous because it can be accessed at any time that is personally convenient (13, 14).”
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    Premisecitation

    Text messaging is available on almost every mobile phone model, relatively low cost, widespread, requires little technological expertise, and applies to many health behaviors and conditions.

    “Text messaging demonstrates strong potential as a tool for health care improvement for several reasons; it is available on almost every model of mobile phone, the cost is relatively low, its use is widespread, it does not require great technological expertise, and it is widely applicable to a variety of health behaviors and conditions (1, 2, 13, 29).”
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    Premisecitation

    An estimated 98% of cell phones worldwide have text message capabilities.

    “An estimated 98% of cell phones worldwide have text message capabilities, but text messaging usage rates vary by age, culture, and country (3, 28, 30).”
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    Premisecitation

    Total cost of ownership, the share of income needed to connect, decreased 20% between 2005 and 2008.

    “Furthermore, total cost of ownership, the amount of a person’s income necessary to connect, decreased 20% between 2005 and 2008 (65).”
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    Premisecitation

    Mobile phone communication is less expensive than landline telephones or standard Internet.

    “Communication by mobile phone is less expensive than alternative options such as landline telephones or standard Internet (1, 7).”
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    Premisecitation

    Mobile phones have had a considerable impact in developing countries.

    “Mobile phones have had a considerable impact in developing countries (3, 5, 6).”
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    Premisecitation

    People worldwide are gaining Internet access via mobile phones, and for many the mobile phone is the primary mode of Internet access.

    “Additionally, across the world (in both developing and developed countries), people are gaining access to the Internet via mobile phones. For many, the mobile phone is currently the primary mode of accessing the Internet, which the Pew Internet & American Life Project suggests will be the case for the entire world by 2020 (5, 9).”
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    Premisecitation

    Millions of people in Africa and Asia who never had traditional phone communication now use mobile phones regularly.

    “Millions of people across Africa and Asia who never had access to traditional phone communication now use mobile phones on a regular basis (3, 5, 8).”
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    Premisecitation

    Mobile technology is increasingly used to promote health and prevent disease.

    “Mobile technology is also increasingly used to promote health and prevent disease (11, 13–17).”
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    Premisecitation

    Ninety-five percent of countries have mobile phone networks, and most of these have more mobile phone than landline subscriptions.

    “Ninety-five percent of countries in the world have mobile phone networks, and the majority of these countries have more mobile phone than landline subscriptions (2, 3).”
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32 of 32

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In a review of seven intervention studies, including four randomized trials, text messaging showed significant promise for improving adherence rates.

    “In a review of seven intervention studies, including four randomized trials, text messaging showed significant promise for improving adherence rates.”

    From Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here? (2012) · cites this paper as [7]

    The Results report 12 included studies, not seven; the Discussion describes them as randomized controlled trials, not a set including only four randomized trials. The Methods say adherence studies were excluded unless they targeted an ongoing preventive health behavior, so the review does not establish the claimed improvement in adherence rates. (LLM, conf=0.90)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured
  • Few successful mHealth interventions have been described in the developing world.

    “Notwithstanding some successful examples, few successful mHealth interventions have been described in the developing world [10], [11].”

    From Optimizing Network Connectivity for Mobile Health Technologies in sub-Saharan Africa (2012) · cites this paper as [11]

    The Discussion (page not provided) says only one of the 12 reviewed text-messaging trials was conducted in a developing country, supporting the point that published evidence was scarce. The review covers a specific subset of mHealth interventions, however, and does not establish that few successful mHealth interventions of all kinds had been described there. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • Literature reviews indicate that SMS messages and other tools for communicating with patients between medical visits can improve health behaviours and physiological outcomes.

    “Literature reviews indicate that SMS messages and other tools for communicating with patients between medical visits can improve health behaviours and physiological outcomes.”

    From Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here? (2012) · cites this paper as [8]

    The Discussion reports that eight of twelve text-messaging studies found a short-term effect on a behavioral or clinical outcome. But the Methods limit the review to interventions delivered primarily by text message; other communication tools were included only as supplements. The paper therefore does not establish the broader claim about other tools for communicating with patients between visits. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Literature reviews indicate that SMS messages and other tools for communicating with patients between medical visits can improve health behaviours and physiological outcomes.

    “Literature reviews indicate that SMS messages and other tools for communicating with patients between medical visits can improve health behaviours and physiological outcomes.”

    From Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here? (2012) · cites this paper as [7]

    The Results (Effect of text messaging; page unavailable) report improved blood-glucose monitoring and reduced hemoglobin A1c in studies of text-message interventions, supporting the claim about health behaviours and physiological outcomes. The Methods (Inclusion and exclusion criteria; page unavailable) specify that the review included other communication technologies only when they supplemented text messaging; it does not establish that those other tools improve both outcomes. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Patient communication via SMS messages, interactive voice response calls or other modalities is more likely to have an effect if the content is theoretically driven, and culture-specific factors may well influence uptake.

    “Patient communication via SMS messages, interactive voice response calls or other modalities is more likely to have an effect if the content is theoretically driven, and culture-specific factors may well influence uptake.”

    From Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here? (2012) · cites this paper as [8]

    The Discussion says messaging interventions grounded in behavioral theory are more likely to succeed, supporting the claim about theoretically driven content. The Results mention culture-specific tailoring, and the Discussion mentions voice-response systems for people with limited literacy, but the paper does not establish that cultural factors influence uptake or extend the theory finding specifically to interactive voice response calls and other modalities. Page numbers were not available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Quasi-experimental trial citation is absent from the included-study list

    Minor

    The results cite reference 30 as an included quasi-experimental trial, but the exhaustive lists of five prevention and seven management studies do not include reference 30.

  • Trial count excludes a reported quasi-experimental study

    Minor

    The results identify one included trial as quasi-experimental, but the discussion describes all twelve included trials as randomized controlled trials.

2 of 2

Cites

Flagged first, then by citations

1 of the 48 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. 2009, HIV AIDS TREAT PRACT, 137, 2
  2. Bramley, 2005, The New Zealand medical journal, 118, U1494

Cited by

Sorted by citations

Authors
Cole-Lewis, H., & Kershaw, T.
Affiliations
Yale University (US)
Corresponding author
Cole-Lewis, H.
Venue
Epidemiologic Reviews
Published
2010-03-30
Volume
32
Issue
1
Pages
56-69
ISSN
  • 0193-936X (ISSN-L)
  • 1478-6729
OpenAlex
W2108664775
Cited by
1,190
References
48
Citations by year
2026: 12 · 2025: 22 · 2024: 31 · 2023: 35 · 2022: 58 · 2021: 63 · 2020: 83 · 2019: 94 · 2018: 113 · 2017: 108 · 2016: 103 · 2015: 131 · 2014: 111 · 2013: 103 · 2012: 83
FWCI
13.53
Type
journal article
Language
en
Open access
Locations
  • Epidemiologic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • HighWire Press Open Archive (acceptedVersion)
Funders
  • Yale University
  • National Institutes of Health
  • National Institute of Mental Health (T32MH020031)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Physical Sciences › Computer Science › Information Systems › Mobile Learning in Education
  • Social Sciences › Health › Social Media in Health Education
Keywords
text messaging, mobile health, behaviour change interventions, disease prevention, disease management, health behavior change, clinical outcomes, message frequency
MeSH terms
Humans, User-Computer Interface, Disease Management, Risk Reduction Behavior, Cell Phone

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