Abstract
BackgroundDespite widespread popularity, text messaging has rarely been used for data collection in clinical research. This paper reports on the development, feasibility, acceptability, validity, and discriminant utility of a single item depression rating scale, delivered weekly via an automated SMS system, as part of a large randomised controlled trial.Methods755 depressed patients (BDI-II score ≥20) were recruited from primary care into a randomised trial of acupuncture versus counselling or usual care, and invited to opt into a repeated-measures text messaging sub-study. Two weeks following random allocation, trial participants were sent a weekly text message for 15 weeks. Texts were a single question asking, on a scale from 1 to 9, the extent to which they felt depressed. Feasibility and acceptability of the automated SMS system were evaluated according to cost, ease of implementation, proportion consenting, response rates, and qualitative feedback. Concurrent validity was estimated by correlating SMS responses with the Patient Health Questionnaire (PHQ-9). SMS responses were compared between groups over time to explore treatment effects.Results527 (69.8%) trial participants consented to the texting sub-study, of whom 498 (94.5%) responded to at least one message. Participants provided a valid response to an average of 12.5 messages. Invalid responses accounted for 1.1% of texts. The automated SMS system was quick to set-up, inexpensive, and well received. Comparison of PHQ-9 and SMS responses at 3 months demonstrated a moderate to high degree of agreement (Kendall’s tau-b = 0.57, p < 0.0001, n = 220). SMS depression scores over the 15 weeks differed significantly between trial arms (p = 0.007), with participants allocated to the acupuncture and counselling arms reporting improved depression outcomes compared to usual GP care alone, which reached statistical significance ten weeks after randomisation. Overall, the single item SMS scale also appeared more responsive to changes in depression, resulting from treatment, than the PHQ-9.ConclusionsAutomated SMS systems offer a feasible and acceptable means of monitoring depression within clinical research. This study provides clear evidence to support the regular use of a simple SMS scale as a sensitive and valid outcome measure of depression within future randomised controlled trials.Trial registrationCurrent Controlled Trials - ISRCTN63787732 http://www.controlled-trials.com/ISRCTN63787732/ACUDEP Date of registration: 15/12/2009
Highlights
Despite widespread popularity, text messaging has rarely been used for data collection in clinical research
Levels of depression were comparable in terms of their Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire 9 (PHQ-9) and EQ-5D anxiety/depression scores
Principal findings The results of this study demonstrate that use of an automated short message service’ (SMS) system offered a feasible, acceptable, inexpensive and valid method of measuring change in depression, for the purposes of clinical research
Summary
Text messaging has rarely been used for data collection in clinical research. Despite the popularity of text messaging as a quick and affordable method of communication, and the extensive use of automated SMS systems, there has been very limited research to explore the potential applications and benefits of automated text messaging for clinical research purposes We distinguish such applications from the paradigm of ecological momentary assessment, which involves far more intensive real time data capture [3]. Research on the use of text messaging for the collection of clinical data appears to have focused largely on monitoring lower back pain [4,5,6,7,8,9] In these studies participants were asked to reply to text messages, sent out on a weekly basis, by reporting on either the number of days they had been bothered by back pain, time taken off work, or by providing a single symptom score for their back pain on that particular day. One recent study employed a two way SMS system in which participants with rheumatoid arthritis completed the EQ-5D quality of life measure, by responding to multiple text messages, each corresponding to a different item, sent at one minute intervals [16]
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