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Mhealth – the golden rules for SMS texts in Public Health

Professor Karen Pine, talking to the Health Psychology Public Health Network, showed how mHealth – text messaging – can have a significant impact on well-being.

July 17th 2015

What was the last text you received? Was it as mundane as ‘What’s for dinner?’ Or more profound, like ‘I love you’.

In 2014 Ofcom reported that 90% of UK adults had sent or received a text message in the last week. Since 93% of adults have a mobile phone it’s little wonder that text messaging has become the most common form of mobile communication.

But can a text really help people to get healthier?
Our very own Professor of Psychology, Karen Pine, speaking to the Health Psychology Public Health Network at Putteridge Bury in Bedfordshire this week, presented evidence to a packed room of the positive effects of mHealth for lifestyle change, disease prevention and the self-management of long term conditions.

Drawing on research evidence and experience from Do Something Different public health projects, Karen argued that text messaging can be beneficial for a whole range of health conditions, and are suitable for vast populations of people, young and old and from all backgrounds.

Extending the reach of Public Health programmes
Most people only see their health advisor a few times a year. Yet they have their mobile phone with them all day every day. What better method then to deliver health reminders, behavioural prompts and support in real time and in a user-friendly way?

‘To have an impact on health and health behaviours, interventions must be perceived by individual users as both useful and desirable. These applications must be something that an individual would want to use.’ (Bock et al 2015).

The advantages on mHealth interventions
Karen listed the advantages of text-based interventions as providing:

  • Population reach at low cost
  • Overcoming disparities
  • Support and touchpoints between appointments
  • Acceptable mode of communication
  • Every day and in real time
  • Personalised support
  • Overcoming stigma and isolation
  • Disruptive

‘Disrupting people as they go about their every day lives, with a text reminding them to do something different, can be a potent ingredient in these interventions, switching the person from behaving automatically and habitually, to self-management and conscious action.’ (Pine, 2015)


Key ingredients in mHealth effectiveness
Presenting the results of meta-analyses (De Leon et al 2015) and systematic reviews into mHealth, Professor Pine also summarised for the audience the 4 characteristsics associated with text-intervention effectiveness. The research shows the key features are:

  1. Tailoring of messages
  2. Strategies rather than educational content
  3. High frequency
  4. Feedback and support

Do Something Different’s mHealth approach
The latter part of Karen’s talk showed how Do Something Different satisfies these four essential criteria by using digital technology to change health behaviour.

  1. Tailoring of messages
    Everyone is profiled before starting a Do Something Different programme about their habits and dominant behaviours. The system then delivers a programme of content that is tailored to the individual.
  1. Strategies rather than educational content
    Research shows that knowing does not lead to doing. Each Do Something Different text, or Do, is activity-based. It focuses on the person ‘doing’ rather than ‘knowing’, bringing about behaviour change rather than simply offering information.
  1. High frequency
    Do Something Different prompts are sent regularly, usually once or twice daily several times per week over a number of weeks. A typical programme is about 6 weeks long and more texts can be sent around times of vulnerability e.g. a smoker’s Quit Day.
  1. Feedback and support
    Participants access the Do Zone: an online community where they can share what they are doing, get inspiration and support from others and receive coaching.

The future of mHealth
The future of mHealth lies in technology becoming more and more responsive to the individual, a direction in which Do Something Different is heading with its Do Change project.

Currently Do Something Different offers responsive support for people struggling with cravings. By simply texting a number provided they receive a disruptor text, that’s a simple action to carry out that will last for 90 seconds. Enough time for the craving to pass while the person is pleasurably distracted.

The importance of engagement
Karen concluded that Do Something Different’s experience of mHealth intervention, which has covered a wide range of programmes with thousands of participants in over 40 countries, is that any mHealth programme that you instigate must be engaging for the user. That means being relevant, timely, do-able (involving small steps) and above all ‘light-touch’. The moment anyone feels there is a sense of nagging or preaching, they will turn off.

Get it right and we have found that mHealth can have positive role to play:

  • Delivering positive changes in a range of physical and mental health outcomes
  • Helping to increase self-management of long-term conditions
  • Reaching vulnerable groups, people in remote areas and the elderly or less mobile.


Health programme in Coventry
Smoking cessation in Brighton
Medical device integration, EU