Text Messages Research Articles

Using Brain Waves and Computer Interface Technology as a Communication System

ABSTRACT Introduction The existing methods for individual emergency alert systems often rely on physical or voice-based human intervention, which may not be practical or safe in certain emergency situations or for people with certain rare medical conditions or disabilities. Popular voice command programs such as Siri and Alexa can be loud, drawing unwanted attention. Additionally, existing devices are limited to indoor usage, lack portability, involve multiple wires, have low noise tolerance, and offer limited customization options. This study introduces a novel method for emergency alert using brain waves. Method An electroencephalography (EEG) headset device was used to capture the user’s brain waves. After calibration, the device identifies peak brain signals and stores them for future use. When a command is triggered, the device’s Bluetooth functionality communicates with a dedicated application installed on any digital device. The user can use their thoughts to select a predefined command within the application, which is then transmitted to any local WiFi network or internet connection. Results Overall, this pilot study achieved a success rate of 96–98% for receiving the brain-computer interface (BCI) commands and sending the appropriate SMS text messages. Conclusion By leveraging these technologies, disabled individuals may access and use new technologies, starting with the ability to text message using their mind.

Understanding patterns of use and preferences for technology among people who use opioids in Colombia: implications for mHealth interventions

ABSTRACT Background Colombia has seen an increase in heroin use, leading to higher HIV rates and challenges in accessing treatment for people who use opioids (PWUO). With widespread mobile phone ownership, technology-based interventions show promise in Colombia. This study aims to understand technology use patterns among PWUO in Colombia, aiding the development of targeted mHealth interventions for better treatment outcomes. Methods A cross-sectional study was conducted among adults with Opioid Use Disorder (OUD) from harm reduction centers, inpatient detoxification units, and methadone maintenance treatment programs in three Colombian cities with high OUD prevalence. The survey covered sociodemographic characteristics, OUD treatment receipt, technology ownership and use patterns, and preferences for technology-based interventions. Results Among 247 participants, the majority were men, single, with a mean age of 29.9 years, and mainly had high school education. Smartphone ownership was reported by 43.6%, with preferences for social networking apps, internet browsers, and text messaging. Bivariate analysis showed associations between technology ownership and factors such as age, education, sex, and household stability. Conclusion These findings provide insights into the technology use patterns and preferences among PWUO in Colombia, highlighting implications for designing and implementing effective technology-based interventions to enhance OUD treatment outcomes.

Intention to use short messaging services for promoting drug adherence among individuals with diabetes in Addis Ababa, Ethiopia

Background Suboptimal medication adherence among individuals with diabetes presents a significant challenge in low-income nations. Growing evidence demonstrates the effectiveness of text messaging interventions to enhance medication adherence. This study assesses the intention to use Short Messaging Service (SMS) based reminder services in promoting drug adherence among diabetic patients and associated factors in Addis Ababa, Ethiopia. Methods An institution-based cross-sectional study was conducted from February 06, 2023, to March 27, 2023, in Addis Ababa, Ethiopia. A sample of 351 patients was selected using systematic random sampling. Structured questionnaires were used for data collection. Binary and multivariable logistic regression models were used to analyze the association between intention to use SMS reminders to promote drug adherence among individuals with diabetes and related factors. Results A total of 333 respondents, with a 94.87% response rate, were interviewed for this study. The majority of respondents, 66.4 % (95% CI [61.9–71.2]), expressed an intention to use SMS-based reminder services to promote their drug adherence. Age < 45 years (AOR = 5.73, 95% CI [2.07–15.73]), higher educational level (AOR = 3.03, 95% CI [1.16–7.90]), type of diabetes (AOR = 3.71, 95% CI [1.16–7.90]), oral medication users (AOR = 2.99, 95% CI [1.42–6.32]), SMS as a preferred medium for communication (AOR = 2.86, 95% CI [1.17–7.00]) were deemed to be important variables linked to intention to use SMS reminders to promote drug adherence among individuals with diabetes. Conclusion The findings suggest the majority of individuals with diabetes have intention to use SMS reminders to enhance adherence. This result indicates the potential for utilization of SMS reminders to enhance adherence to diabetic medications. Furthermore, the findings highlight the importance of tailored interventions that take into account patient characteristics and preferences as factors that influence intention when designing such an intervention.

Elite sense-making in the core executive: the case of Denmark’s 2020 Minkgate Scandal

Abstract This article analyzes the Danish Mink Scandal of 2020 using Karl Weick’s sense-making theory. It zooms in on the 72-hour decision-making process that led to the culling of Denmark’s entire 17 million farmed-for-fur mink population in response to the perceived threat of coronavirus disease 2019 (COVID-19) forming a new mutation. Since there was insufficient legal justification for the culling, the prime minister was forced to call a snap general election, leading to a change of government. We exploit detailed data material containing text messages, e-mail correspondence, documentary material, and specific inquiries. The article demonstrates the strength of Weick’s social–psychological perspective on sense-making for public management research. It shows how time pressure can cut across heavily institutionalized standard operating procedures. It can increase the centralization of the decision-making power at the apex and decouple the formal legal responsibilities, which remain institutionalized with the line ministries. The study argues that sense-making offers learning points that cannot be obtained from formal legal perspectives, which are used to assign responsibilities. Indeed, ex-post thinking may be too convenient—traditional solutions like punishing leaders or agencies may obscure the discovery of more systemic vulnerabilities when crises unfold.

Abstract 4147618: Modality of Research Engagement Among Postpartum Women with Hypertension and High Health-Related Social Needs

Introduction: People of color and non-English speakers are underrepresented in research and disproportionately affected by health-related social needs (HRSNs). Research engagement can be particularly challenging after pregnancy as postpartum care attendance is low. We describe our experience with remote recruitment modalities in a such a population. Methods: The study population included all patients affected by hypertension during a pregnancy who delivered at a large safety-net hospital 1/2022-6/2023. These patients also engaged in 6 weeks of remote blood pressure monitoring postpartum. Patients were contacted between 6 weeks and 12 months post-delivery to complete an online survey regarding HRSNs and provide consent to link survey data to clinical data. The recruitment protocol included initial outreach via the electronic medical record (EMR) patient portal, if available, or else a hard copy letter via mail, followed by a series of text messages then phone calls. All communication was conducted in the patient’s primary language (English, Spanish, or Haitian Creole). Results: We recruited 148 (9.4%) of 1571 patients contacted. Respondents were 51% Black, 39% Latina, 26% White. Table illustrates the comparable rate of recruitment across languages, dominance of EMR as mode of engagement and an illustration of the high rate of complex HRSN among our participants. The most effective recruitment method was EMR communication (57% of total recruitment) followed by text messages (28%). Our Haitian Creole-speaking respondents had the highest rates of HRSN - possibly representing the Haitian migrant crisis affecting Boston in this time period - as well as the highest rate of engaging via EMR messaging. Other domains of HRSN were high among all language groups including trouble affording medication (11-23%) and heating/electric access (21-34%). Conclusions: A diverse postpartum population with a high prevalence of HRSNs is hard to engage in research. Despite presumed digital barriers, EMR and secure text were effective and secure methods of online survey recruitment. Future studies seeking to understand the intersection of health outcomes and HRSNs should consider adding recruitment with EMR to common texting strategies.

Telemedicine technologies in combat settings: efficiency and prospects (literature review)

Relevance. Large-scale military conflicts involving a technically well-equipped peer enemy are associated with a higher risk of delayed evacuation of the wounded which therefore requires extended medical care at advanced medical evacuation stages, especially amid absence or shortage of skillful medical professionals. Telehealth can offer solutions to overcome the difficulties in medical care provision amid combat settings. The objective is to study the prospects and efficiency of telemedicine technologies in enhancing availability of medical care during modern military operations.Methods. The PubMed database and the Scientific Electronic Library (eLIBRARY.ru) were used to collect research papers published from 2014 to 2024 studying the development and implementation of telemedicine technologies to backup combat operations.Results and discussion. Consultations by phone together with transfer of photos and text messaging remain the most common technology to provide telehealth assistance in combat settings. Teleconference connection allowing for two-way audio and video communication involving real-time data transfer is a most promising telecommunication format. Telehealth capacities can be expanded by augmented and mixed reality technologies, AI, drones, or robotic surgery. In combat environments, however, using telemedicine is limited by cybersecurity concerns and the signal bandwidth of modern communications systems. An efficient military telemedicine requires an integral centralized system involving multidisciplinary teams of experienced medical consultants providing round-the-clock emergency and routine telemedicine care to military units, including those engaged in combat operations.Conclusion. In combat settings telemedicine technologies have great untapped potential and can contribute largely in terms of evidence-based decision-making in process of medical triage and evacuation, thus optimizing the distribution of medical capacities and resources and improving the results of injury treatment. Although unfit to replace advanced combat medicine training, telemedicine can reinforce existing capacities by providing specialized medical advice to combat medics.

Abstract 4122840: Patient activation improves with a multi-component personalized mHealth intervention in older adults at risk of cardiovascular disease

Background: Patient activation, a person’s level of confidence, comprehension, and autonomy toward their health, is an essential goal of cardiovascular disease therapy. Previous research has shown a link between high levels of patient activation and better patient outcomes and experiences. However, whether individualized interventions such as a text-based mobile health (mHealth), improve patient activation is unclear. Research on patient activation in people at risk for cardiovascular disease and influential factors is minimal. Aims: This study aimed to 1) determine the effect of a multi-component mHealth intervention on patient activation and 2) examine its predictors among older adults at risk for cardiovascular disease. Methods: In this pilot randomized controlled trial, community-dwelling older adults with poor eating behaviors and reduced physical activity (n=54) were randomly assigned to the GetFIT (control) or GetFIT+ (intervention) groups, with three- and six-month follow-up periods. The GetFIT group received healthy lifestyle counseling from a licensed health coach, a free commercial mHealth app with push alerts on physical activity, and an activity tracker for physical activity monitoring. The GetFIT + group received the same components but had personalized text messages instead of push alerts. The 13-item Patient Activation Measure assessed patient activation; higher scores indicate better activation. Linear mixed-effects models were used to investigate between-group changes in outcomes across time. Results: The mean age was 65.4 ± 6.0 years; 61% were females and 61% were married. Baseline characteristics were comparable between groups. Significant improvements were observed in the GetFIT+ group at three months (mean 3.53, 95% CI 0.11, 6.96; p=0.043) and six months (mean 4.37, 95% CI 0.91, 7.83; p=0.014), whereas improvements in the GetFIT group were non-significant. Adjusting for age, gender, education, employment, marital status, social support, smartphone confidence, and self-perceived health did not alter the results. Nevertheless, only social support was associated with higher patient activation overall (B=5.14, 95% CI 1.00, 9.27; p=0.015). Conclusions: People at risk for cardiovascular disease can improve their self-management abilities, knowledge, and confidence through personalized text messaging. Possessing social support is critical for maximizing the benefits of mHealth interventions.

Image Spam Detection through Pattern Recognition with IP Tracing Technique

Image spam is a kind of E-mail spam where the message text of the spam is presented as a picture in an image file. The basic rationale behind image spam is difficult to detect using text spam filtering methods which is designed to detect patterns in text in the plain-text E-mail body or attachments. A new trend in email spam is the emergence of image spam. The most previous works of image spam detection focused on filtering the image spam on the client side. This proposed system considered more desirable comprehensive solution which embraces the both server side filtering and client side detection methods. The spectral clustering algorithm is introduced to similarity measure for cluster analysis of spam images to filter the attack activities of spammers and fast trace back the spam sources. The active learning algorithm is limited where the learner guides the users to label as few images as possible while maximizing the classification accuracy.

Young mothers and eHealth: a scoping review.

Young mothers, defined as those age 25 and under, are at an increased risk of experiencing mental health problems. Despite this increased risk, very few mental health and parenting interventions that target the unique needs of this group are available. This scoping review summarized extant research on mental health and parenting eHealth interventions aimed at young mothers. CINAHL, MEDLINE, PsycINFO, PsycARTICLES, and PubMed databases were used for searches, and articles were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Arksey and O'Malley's five-stage method for scoping reviews. The eligibility criteria included being peer-reviewed, written in English, published between January 1, 2000, and May 9, 2024, and being an eHealth program targeting mental health and/or parenting skills for women-identifying mothers under the age of 26. After duplicate removal, 3,431 titles and abstracts were screened, and 112 articles moved to full-text review. Four studies were included, each assessing intervention components, targeting mental health and parenting, and outlining participant feedback on the treatment. Each study evaluated a different type of intervention, with depression being the most studied mental health outcome and coping skills being the most studied parenting outcome. Preliminary findings suggest that eHealth features such as flexibility, text messaging, and peer support are appreciated among young mothers. Further research on mental health and parenting eHealth interventions aimed at addressing the needs of young mothers is needed.

Adult sibling relationships and media multiplexity theory

Sibling relationships are among the longest-lasting relationships in people’s lives. Information and Communication Technologies (ICTs), including voice calls, texting, and social media, help adult siblings keep in touch. The present study tests media multiplexity theory (MMT) in the context of adult sibling relationships. In the first study, a quota sample of American adults completed several name listing tasks to identify their most important relationship partners, ranging from 0 to 16 people, and 29% of participants listed at least one sibling. Multilevel modeling (MLM) results found that emotional closeness between siblings was positively associated with the frequency of phone calls and emails and negatively associated with the frequency of person-to-person media sharing. Showing mixed support for MMT, the number of ICTs used was negatively associated with emotional closeness, but the overall frequency of ICT use was positively associated with closeness. In the second study, a quota sample of American adults identified six of their closest friendships, and siblings constituted 2.9% of friends listed. MLM results found that the frequency of phone calls and text messages between siblings was positively associated with emotional closeness. The number of ICTs used was unrelated to emotional closeness, but the overall frequency of ICT use was positively associated with closeness, showing partial support for MMT. Both studies suggested that the frequency of communicating across ICTs was associated with greater life satisfaction, accounting for sibling closeness.

A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study.

Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. The result of this study is a modular intervention web application named RØST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users' motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design.

Therapy for Therapists: Design Opportunities to Support the Psychological Well-being of Mental Health Workers

On-demand mental health services-including counseling, crisis hotlines, and peer support programs-are vital to the healthcare system, providing acute and ongoing support through telephone, online chats, and text messaging. Although such services have proven effective at reducing hopelessness, psychological pain, and suicidality, they put the providers of these services at high risk of burnout, secondary traumatic stress, and compassion fatigue. Our interviews with professionals from four mental health organizations revealed that while these workers have a strong motivation to help clients with mental health care needs, they face various challenges themselves, particularly regarding heavy caseloads, difficult crisis clients, and coping with repeated exposure to abuse and harassment. To overcome challenges, participants identify the need to be self-reliant and engage in self-care practices ranging from socializing with coworkers to yoga and meditation. Although organizations spend significant time training workers prior to their involvement with clients, the training typically lacks components on self-compassion and self-care. Designers might see technology as an opportunity to promote such practices; however, while technology is an integral part of their work routine, participants, irrespective of age, had misapprehensions regarding technology use in the mental health care space, including for managing their psychological well-being. We recommend design guidelines for HCI researchers, including developing contextualized just-in-time adaptive interventions to promote self-compassion and educating workers regarding the use of various technologies to manage their well-being.

Design and development of a mobile health intervention for rehabilitation support after knee arthroplasty: TeleRehabilitation after knee ArThroplasty (TReAT) project

BackgroundThe steep increase in knee arthroplasties in lower- and middle-income countries has increased demand for personalised rehabilitation care. Technology-based rehabilitation programs offer potential to replace or augment conventional face-to-face rehabilitation for providing continuum of care. We aimed to systematically develop a theory, evidence-driven, contextualised, and user-centred mobile health platform for people undergoing knee arthroplasty to facilitate monitoring progress during rehabilitation.MethodsWe followed the UK Medical Research Council’s framework and adopted a behaviour design thinking approach, consisting of five steps; (1) conduct multiple literature reviews and cross-sectional surveys to determine the needs and problems experienced during the rehabilitation phase by healthcare professionals and individuals with replaced knees, (2) identify target behaviours along with barriers and facilitators, integrated within the Capability, Opportunity, Motivation-Behaviour (COM-B) framework, (3) identify intervention functions and components, behaviour change techniques, and features for the mobile application, selected after discussions with orthopaedic surgeons, physiotherapists and behavioural experts, (4) develop a prototype application for end-users, and a web-based platform for healthcare professionals, and (5) pilot test the intervention for end-users’ feedback on usability of the application and to identify possible strategies for implementing the intervention package.ResultsUsing the COM-B model, education, training, persuasion, enablement, and modelling were chosen as intervention functions for improving adherence to exercise protocol during early-phase of rehabilitation. The application featured five interlinked components; education, training, goal setting and self-management, communication, and a personalized therapy plan utilising 13 behaviour change techniques. An education booklet, exercise videos, text messaging, video consultation, and a digital tool for measuring range of motion were incorporated into the application. Feedback on the interactive prototype and education material was sought from ten patient volunteers and a physiotherapist. Pilot testing in a convenient sample with broad eligibility criteria (n = 30) indicated importance of digital literacy and dedicated time for remote consultation by healthcare provider within the existing clinical work. Overall, the intervention was well received and valued by the end users.ConclusionThis paper demonstrates the development of a contextualised digital behavioural intervention grounded in behavioural theory and evidence from literature to improve end-user’s engagement with rehabilitation protocols after knee arthroplasty in lower- and middle-income country context.Trial registrationStudy registered prospectively (on 16 February 2023) at Clinical Trials Registry of India (CTRI/2023/02/049792).

Efficacy of an mHealth intervention to support pain self-management and improve analgesia in patients with rib fractures: protocol for a randomised controlled trial

IntroductionIn light of the risks of over-reliance on opioid analgesia during recovery from rib fractures, there is increased interest in the efficacy of non-pharmacological approaches to pain management. This paper...

Special Section on Patient-Reported Outcomes and Informatics: Collection of Patient-Reported Outcome Measures in Rural and Underserved Populations.

The NIH Pragmatic Trials Collaboratory supports the design and conduct of 31 embedded pragmatic clinical trials, and many of these trials use patient-reported outcome measures (PROMs) to provide valuable information about their patients' health and wellness. Often these trials enroll medically underserved patients, including people with incomes below the federal poverty threshold, racial or ethnically minoritized groups, or rural or frontier communities. In this series of trial case reports, we provide lessons learned about collecting PROMs in these populations. The unbiased collection of PROM data is critical to increase the generalizability of trial outcomes and to address health inequities. Use of electronic health records (EHRs) and other digital modes of PROM administration have gained traction. However, engagement with these modes is often low among disparities prone populations due to lessened digital proficiency, device access, and uptake of EHR portals and web interfaces. To maximize the completeness and representativeness of their trial outcome data, study teams tested a range of strategies to improve PROM response rates with emphasis on disparities prone and underserved patient groups. This manuscript describes the approaches, their implementation, and the targeted populations. Optimized PROM collection required hybrid approaches with multiple outreach modes, high-touch methods, creativity in promoting digital uptake, multi-modal participant engagement, and text messaging.

Out of sight but in mind: Experimentally activating partner representations in daily life buffers against common stressors.

Lab experiments have shown that reminders of romantic partners buffer against stressors. Yet, tightly controlled experiments do not mimic what transpires in people's actual lives. Thus, an important question is as follows: To what extent do reminders of romantic partners confer affective benefits when they occur "in the wild" as people experience their daily activities? To capture people's emotional experience in real time, two studies, each spanning 3 months, used event-contingent ecological momentary assessments with a within-subject experimental manipulation. Prior to encountering a stressful event (taking an exam), participants received either a supportive text message from their partner or no message (Studies 1 and 2), or a supportive text message from the research team (Study 2). Receiving supportive partner messages, compared to no messages or messages from the research team, led to less negative affect and greater positive affect, and to less negative affect and greater positive affect about the exam itself. Receiving supportive partner messages had no statistically significant effects on subjective stress. Interestingly, the quality of the partner messages, as coded by independent raters, did not significantly predict the magnitude of the affective benefits. These findings suggest that receiving any supportive partner message, and not necessarily more subtle differences in the quality of the message, may be the key ingredient for these benefits to occur. The present work advances understanding of how the symbolic presence of partners confers affective regulatory benefits in everyday life. Implications for emotion regulation and the utility of integrating perspectives from adult attachment are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Implementation of a Mobile Health Approach to a Long-Lasting Insecticidal Net Uptake Intervention for Malaria Prevention Among Pregnant Women in Tanzania: Process Evaluation of the Hati Salama (HASA) Randomized Controlled Trial Study.

Malaria infection is associated with many adverse outcomes for pregnant women and neonates, yet pregnant women in East and Southern Africa remain frequently exposed to malaria. Long-lasting insecticidal nets (LLINs) can help prevent malarial infections and the associated adverse events. The Hati Salama (HASA) study was a cluster-randomized controlled trial implemented in 100 antenatal health facilities in urban and rural settings of Tanzania that provided pregnant women in both intervention and control groups with e-vouchers to redeem for LLINs for malaria prevention. The intervention group received behavior change communication mobile messages across a 14-day period while the e-voucher was active, and no significant difference between the rates of e-voucher redemption was found across the two groups. This study was a process evaluation of the HASA randomized controlled trial to determine barriers and facilitators to e-voucher reception and LLIN acquisition for pregnant women enrolled in the trial, as well as challenges and lessons learned by nurses who worked at the antenatal health facilities supporting the trial. Following the e-voucher's expiration at 14 days, voluntary phone follow-up surveys were conducted for nurses who supported the trial, as well as participants in both intervention and control groups of the trial who did not redeem their e-vouchers. Survey questions asked nurses about workflow, training sessions, network connectivity, proxy phone use, and more. Surveys asked participants about reasons for not redeeming e-vouchers. Both surveys provided lists of preset answers to questions, as well as the option to provide open-ended responses. Nurses and trial participants were contacted between January and June 2016 on up to three occasions. While nurses who supported the HASA trial seemed to recognize the value of the program in their communities, some barriers identified by nurses included network connectivity, workload increase, inadequate training and on-the-ground support, and difficulty following the workflow. Several barriers identified by trial participants included personal obligations preventing them from redeeming the e-voucher on time, network connectivity issues, losing the e-voucher number, no stock of LLINs at retailers when attended, inadequate explanation of where or how to redeem the e-voucher, or not receiving an SMS text message with the e-voucher number promptly or at all. Large-scale e-voucher platforms for health-related commodity interventions, such as LLIN distribution in sub-Saharan Africa, are feasible, but challenges, including network connectivity, must be addressed. Nurses identified issues to be considered in a future scale-up, such that the number of nurses trained should be increased and the e-voucher issuance workflow should be simplified. To address some of the key barriers impacting e-voucher redemption for trial participants, the network of retailers could be expanded and the e-voucher expiration period should be extended. ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624.

Behaviorally Informed Text Message Nudges to Schedule COVID-19 Vaccinations: A Randomized Controlled Trial.

Vaccine hesitancy, especially related to COVID-19 vaccinations among Veterans, may limit uptake. Behaviorally informed text-based messages have the potential to improve uptake of COVID-19 vaccinations. To evaluate the impact of two different behaviorally informed text message nudges on COVID-19 vaccine scheduling and completion, compared to standard control message. Prospective, three-arm patient-level randomized quality improvement trial. Between March and May 2021, 20,523 Veterans were eligible for the initial series of COVID-19 vaccination, enrolled at two large Veterans Health Administration sites. Arm 1 (Control): standard scheduling message; Arm 2 (Social Good): standard message plus behaviorally informed text message "When you get a vaccine now, you help protect yourself, your family, and your community"; and Arm 3 (Scarcity): standard plus behaviorally informed text message "Only a limited number of vaccine appointments are available." Outcomes were vaccine scheduling and/or completion rate within 7 days of receipt of text message (primary), and within 14 days and 30 days after receipt of text message (secondary). Veterans had an overall rate of 19% of scheduling or receiving a vaccination in 7 days. In our adjusted intention-to-treat analysis, we found no difference between intervention social good or scarcity (aOR 0.98, 95% CI, 0.88-1.09, for both arms) compared to standard scheduling message. We found no statistical differences in our secondary outcomes. During the initial phases of vaccine roll-out, two behaviorally informed text messages did not increase COVID-19 vaccination rates among Veterans compared to a standard scheduling message.

A Digital Health Behavior Intervention to Prevent Childhood Obesity

Infant growth predicts long-term obesity and cardiovascular disease. Previous interventions designed to prevent obesity in the first 2 years of life have been largely unsuccessful. Obesity prevalence is high among traditional racial and ethnic minority groups. To compare the effectiveness of adding a digital childhood obesity prevention intervention to health behavior counseling delivered by pediatric primary care clinicians. Individually randomized, parallel-group trial conducted at 6 US medical centers and enrolling patients shortly after birth. To be eligible, parents spoke English or Spanish, and children were born after 34 weeks' gestational age. Study enrollment occurred between October 2019 and January 2022, with follow-up through January 2024. In the clinic-based health behavior counseling (clinic-only) group, pediatric clinicians used health literacy-informed booklets at well-child visits to promote healthy behaviors (n = 451). In the clinic + digital intervention group, families also received health literacy-informed, individually tailored, responsive text messages to support health behavior goals and a web-based dashboard (n = 449). The primary outcome was child weight-for-length trajectory over 24 months. Secondary outcomes included weight-for-length z score, body mass index (BMI) z score, and the percentage of children with overweight or obesity. Of 900 randomized children, 86.3% had primary outcome data at the 24-month follow-up time point; 143 (15.9%) were Black, non-Hispanic; 405 (45.0%) were Hispanic; 185 (20.6%) were White, non-Hispanic; and 165 (18.3%) identified as other or multiple races and ethnicities. Children in the clinic + digital intervention group had a lower mean weight-for-length trajectory, with an estimated reduction of 0.33 kg/m (95% CI, 0.09 to 0.57) at 24 months. There was also an adjusted mean difference of -0.19 (95% CI, -0.37 to -0.02) for weight-for-length z score and -0.19 (95% CI, -0.36 to -0.01) for BMI z score. At age 24 months, 23.2% of the clinic + digital intervention group compared with 24.5% of the clinic-only group had overweight or obesity (adjusted risk ratio, 0.91 [95% CI, 0.70 to 1.17]) based on the Centers for Disease Control and Prevention criteria of BMI 85th percentile or greater. At that age, 7.4% of the clinic + digital intervention group compared with 12.7% of the clinic-only group had obesity (adjusted risk ratio, 0.56 [95% CI, 0.36 to 0.88]). A health literacy-informed digital intervention improved child weight-for-length trajectory across the first 24 months of life and reduced childhood obesity at 24 months. The intervention was effective in a racially and ethnically diverse population that included groups at elevated risk for childhood obesity. ClinicalTrials.gov Identifier: NCT04042467.

A Randomized Controlled Trial of Gamification to Increase Physical Activity Among Black and Hispanic Breast and Prostate Cancer Survivors: Rationale and Design of the ALLSTAR Clinical Trial

Survivors of breast and prostate cancer, especially those that are Black and/or Hispanic, are at high risk for cardiovascular events. Physical activity can reduce the risk of cardiovascular events in cancer survivors, but Black and Hispanic people are less likely to engage in routine physical activity. Concepts from behavioral economics have been used to design scalable, low-touch, gamification interventions that increase physical activity in individuals at high risk for cardiovascular events, but the effectiveness of these strategies in Black and Hispanic survivors of breast and prostate cancer is uncertain. ALLSTAR (NCT05176756) is a pragmatic, virtual, randomized controlled trial designed to evaluate the effectiveness of a gamification intervention informed by behavioral economic concepts to increase daily physical activity in Black and Hispanic breast and prostate cancer survivors who received cardiotoxic therapies and have additional risk factors for cardiovascular disease. Patients were either referred by their cancer care team or identified by electronic health record searches; contacted by letter, email, text message and/or phone; and complete enrollment and informed consent on the Penn Way to Health online platform. Patients are then provided with a wearable fitness tracker, establish a baseline daily step count, set a goal to increase daily step count by 1500-3000 steps from baseline, and are randomized 1:1 to control or gamification. Interventions continue for 6 months, with follow-up for an additional 3 months to evaluate the durability of behavior change. The trial has met its enrollment goal of 150 participants, with a primary endpoint of change from baseline in daily steps over the 6-month intervention period. Key secondary endpoints include change from baseline in daily steps over the 3-month post-intervention follow-up period, change in moderate to vigorous physical activity over the intervention and follow-up periods, and change in patient-reported measures of physical function, fatigue, and overall quality of life. ALLSTAR is a virtual, pragmatic randomized clinical trial powered to demonstrate whether gamification is superior to control in increasing physical activity in Black and Hispanic breast and prostate cancer survivors. Its results will have important implications for strategies to promote physical activity in survivors of breast and prostate cancer, specifically among minority populations. clinicaltrials.gov; https://clinicaltrials.gov/study/NCT05176756.