Two-way Text Messaging Research Articles

A Depression Prevention Intervention for Adolescents in the Emergency Department

PurposeTo evaluate acceptability and feasibility of a theoretically based two-part (brief in-person + 8-week automated text message) depression prevention program, “intervention for DepressiOn and Violence prevention in the Emergency department” (iDOVE), for high-risk adolescents. MethodsEnglish-speaking emergency department (ED) patients (age 13–17, any chief complaint) were sequentially approached for consent on a convenience sample of shifts and screened for inclusion based on current depressive symptoms and past-year violence. After consent, baseline assessments were obtained; all participants were enrolled in the two-part intervention (brief in-ED + 8-week two-way text messaging). At 8 weeks, quantitative and qualitative follow-up assessments were obtained. Measures included feasibility, acceptability, and preliminary data on efficacy. Qualitative data were transcribed verbatim, double coded, and interpreted using thematic analysis. Quantitative results were analyzed descriptively and with paired t tests. ResultsAs planned, 16 participants (eight each gender) were recruited (75% of those who were eligible; 66% nonwhite, 63% low income, mean age 15.4). The intervention had high feasibility and acceptability: 93.8% completed 8-week follow-up; 80% of daily text messages received responses; 31% of participants requested ≥1 “on-demand” text message. In-person and text message portions were rated as good/excellent by 87%. Qualitatively, participants articulated: (1) iDOVE was welcome and helpful, if unexpected in the ED; (2) the daily text message mood assessment was “most important”; (3) content was “uplifting”; and (4) balancing intervention “relatability” and automation was challenging. Participants' mean ΔBDI-2 (Beck Depression Inventory) from baseline to 8-week follow-up was −4.9, (p = .02). ConclusionsThis automated preventive text message intervention is acceptable and feasible. Qualitative data emphasize the importance of creating positive, relevant, and interactive digital health tools for adolescents.

Alcohol-antiretroviral therapy interactive toxicity beliefs and daily medication adherence and alcohol use among people living with HIV

ABSTRACTAlcohol-antiretroviral therapy (ART) interactive toxicity beliefs reflect perceived adverse outcomes of mixing alcohol and ART. Previous research has shown a significant relationship between alcohol-ART interactive toxicity beliefs and ART non-adherence, over and above other correlates of non-adherence such as human immunodeficiency virus (HIV)symptoms and frequency of alcohol use. Most past studies have collected data over extended periods and have not determined if alcohol use and missed medications occur at the day-level among people holding interactive toxicity beliefs. Previous daily analyses, however, have been limited by self-reported adherence and relatively short periods of observation. To address these gaps in the literature, men and women living with HIV in Atlanta, GA, were enrolled in a 45-day observational cohort study. Daily alcohol use was collected using two-way interactive text message surveys and daily adherence was collected via the Wisepill device. Fifty-seven participants completed a measure of alcohol-ART interactive toxicity beliefs and contributed 2565 days of daily data. Participants who endorsed high levels of interactive toxicity beliefs had significantly more days when they missed doses of medication. Alcohol-antiretroviral toxicity beliefs predicted missing doses of medication on days when participants were drinking and on days when they were not drinking. Multilevel multivariate regressions showed that these toxicity beliefs predicted daily missed doses of medication over and above quantity of alcohol consumed, depression and general medication concerns. This study replicates and extends previous literature and indicates the necessity of addressing alcohol-ART toxicity beliefs within adherence interventions.

The Cedar Project WelTel mHealth intervention for HIV prevention in young Indigenous people who use illicit drugs: study protocol for a randomized controlled trial.

BackgroundDespite successes in preventing and treating HIV, Indigenous people in Canada continue to face disproportionately high rates of HIV infection. Programs that support healing from lifetime trauma, support connection to culture, and reduce drug-related harms are critical to preventing HIV among young Indigenous people who use drugs. The Cedar Project WelTel mHealth intervention proposed here is a structured mobile-phone initiative to connect young Indigenous people who use drugs with Cedar Case Managers in a community-based setting. The intervention consists of a package of supports, including a mobile phone and cellular plan, weekly two-way text messaging, and support from Cedar Case Managers.MethodsThe Cedar Project WelTel mHealth study is a multi-site Zelen pre-randomized trial to measure the effect of a two-way supportive text-message intervention to reduce HIV vulnerability among young Indigenous people who use illicit drugs in two Canadian cities. The trial is nested within the Cedar Project, an ongoing cohort study addressing HIV and hepatitis C vulnerability among young Indigenous people who use drugs in Vancouver and Prince George, British Columbia. The Cedar Project Partnership, an independent body of Indigenous Elders, leaders, and health/social service experts, governs all aspects of the study. Two hundred participants will be followed over a 16-month period, with HIV propensity score at 6 months as the primary outcome. Secondary outcomes include HIV propensity at 1 year, HIV risk, resilience, psychological distress, access to drug-related services, and connection to culture measured at 6 months and 1 year. Primary analysis is by intention to treat.DiscussionCulturally safe interventions that address barriers to HIV prevention while supporting the strength of young Indigenous people who use drugs are urgently needed. Despite presenting a tremendous opportunity to connect young, highly transient Indigenous people who use drugs to prevention services, supportive two-way mHealth programs have yet to be tested for HIV prevention in a community-based setting with this population.Trial registrationClinicalTrials.gov NCT02437123 https://clinicaltrials.gov/show/NCT02437123 (registered 4 May 2015). Protocol version: 24 July 2015.

Two-way text messaging: an interactive mobile learning environment in higher education

Short messaging service (SMS) is perhaps the most popular mobile technology prevalent among students in higher education due to its ubiquitous nature and the capability of two-way communication. However, a major limitation in two-way text messaging is sending back a part of received data with the reply message. This limitation results in users of a mobile learning environment being unable to reply back to the correct destination. This article presents a two-way text messaging system that can be integrated into a learning management system (LMS) to provide an interactive learning experience to the user community. Initially, a database is integrated into the LMS that holds message information such as recipient’s phone number, message body and user data header. A specific port associated with the SMS is used to conceal and exchange data of a particular course unit. Subsequently, software in the student’s mobile device captures this message and sends back the reply message to the appropriate course unit allowing both teachers and students to view messages sent and replies received pertaining to a particular course. Results indicate the educational impact of the proposed system in improving the learning environment and benefits it offers to the community in a campus-wide implementation. Keywords: SMS; UDH; PDU; LMS; concealed data (Published: 10 November 2016) Citation: Research in Learning Technology 2016, 24 : 31818 - http://dx.doi.org/10.3402/rlt.v24.31818

Influence of perceived interactivity of a sexual health text message service on young people's attitudes, satisfaction and repeat use.

Sexual health text message services are becoming an increasingly popular way to reach young people with sexual health information. A variety of service types exist: some send automated messages on a set schedule; others provide personalized responses to individual questions. Young people's perceptions of interactivity, which is often based on system responsiveness, may vary. This study examines perceptions of interactivity for users of a two-way text message service that connects young people directly with a health educator and examines the relationship between perceived interactivity and attitudes toward the service, service satisfaction, and repeated service use. Data from 131 users in the southeastern U.S.A. were analysed. Perceived interactivity was associated with positive attitudes, user satisfaction and repeat use. Data suggest that for sexual health information seeking, young people may view a program as more useful if they perceive it is interactive. Services that provide a back-and-forth dialog between health educators and users may be perceived as interactive, and those perceptions of interactivity can influence attitudes toward the service as well as behaviors, such as using the service repeatedly. Since such services offer accurate and timely health information, repeated use allows for the additional exchange of health information and educational opportunities.

One-way Versus Two-way Text Messaging on Improving Medication Adherence: Meta-analysis of Randomized Trials

BackgroundMobile telephone text messaging is a simple potential solution to the failure to take medications as directed. There is uncertainty over the effectiveness of 1-way text messaging (sending text message reminders only) compared with 2-way text messaging (sending reminders and receiving replies confirming whether medication has been taken) as a means of improving medication adherence. MethodsA meta-analysis of 8 randomized trials (1994 patients) that tested the effectiveness of text messaging on medication adherence was performed. The trials were divided into 2 groups: trials using 1-way text messaging versus no text messaging and trials using 2-way text messaging versus no text messaging. The summary estimates of the effect of the 2 methods of text messaging (1-way or 2-way) were compared. ResultsThe summary relative risk estimate was 1.04 (95% confidence interval, 0.97-1.11) for 1-way text messaging and 1.23 (95% confidence interval, 1.13-1.35) for 2-way text messaging. The difference in effect between the 2 methods was statistically significant (P = .007). ConclusionsTwo-way text messaging is associated with substantially improved medication adherence compared with 1-way text messaging. This has important implications in the provision of mobile-based messaging in the management of patients taking medication for the prevention of chronic disease.

Going mobile with diabetes support: a randomized study of a text message-based personalized behavioral intervention for type 2 diabetes self-care.

Objective. Patients with type 2 diabetes often fail to achieve self-management goals. This study tested the impact on glycemic control of a two-way text messaging program that provided behavioral coaching, education, and testing reminders to enrolled individuals with type 2 diabetes in the context of a clinic-based quality improvement initiative. The secondary aim examined patient interaction and satisfaction with the program.Methods. Ninety-three adult patients with poorly controlled type 2 diabetes (A1C >8%) were recruited from 18 primary care clinics in three counties for a 6-month study. Patients were randomized by a computer to one of two arms. Patients in both groups continued with their usual care; patients assigned to the intervention arm also received from one to seven diabetes-related text messages per day depending on the choices they made at enrollment. At 90 and 180 days, A1C data were obtained from the electronic health record and analyzed to determine changes from baseline for both groups. An exit survey was used to assess satisfaction. Enrollment behavior and interaction data were pulled from a Web-based administrative portal maintained by the technology vendor.Results. Patients used the program in a variety of ways. Twenty-nine percent of program users demonstrated frequent engagement (texting responses at least three times per week) for a period of ≥90 days. Survey results indicate very high satisfaction with the program. Both groups’ average A1C decreased from baseline, possibly reflecting a broader quality improvement effort underway in participating clinics. At 90 and 180 days, there was no statistically significant difference between the intervention and control groups in terms of change in A1C (P >0.05).Conclusions. This study demonstrated a practical approach to implementing and monitoring a mobile health intervention for self-management support across a wide range of independent clinic practices.

Assessing Technologies for Information-Seeking on Prostate Cancer Screening by Low-Income Men

Purpose: This paper presents a multipart investigation of the benefits and challenges in deploying automated question-answering as an alternative to web-based searching to provide information about prostate cancer screening for low-income men age 40 years and older. Methods: The study comprised: 1) a survey assessing current use of the Internet, mobile phones and texting; 2) a controlled observational study of both web-based searching and automated question-answering for information about prostate cancer; and 3) a formative field study in which subjects interacted with a health department nurse using text messages. Results: Survey results suggest the target population has greater access to, and familiarity with, cell phones and text messaging compared to the Internet and web-based searching. Participants were significantly more confident using a cell phone and preferred to get health information through text messaging. Participants in the controlled observational study accepted the text messaging system, with most indicating it answered their questions, was easy to use and was a favorable tool for information-seeking. The field study also demonstrated potential for automated question-answering and text messaging to help the target population access health information. Conclusion: A two-way text messaging system has great potential to promote health communication and health information distribution. Participant interest in this system was high and did not seem to be specific to prostate cancer screening, suggesting that information about other topics, such as high blood pressure screening, could be provided similarly. We believe more investigations should be focused on this area, especially on benefits for the low-income community. (J Patient-Centered Res Rev. 2014;1:188-196.)

Development of a personalized bidirectional text messaging tool for HIV adherence assessment and intervention among substance abusers

We describe the development of a two-way text messaging intervention tool for substance users who are non-adherent with HIV medications, and examine message flow data for feasibility and acceptability. The assessment and intervention tool, TxText, is fully automated, sending participants mood, substance use, and medication adherence queries by text message. Participants respond, the tool recognizes the category of response, and sends the personalized intervention message that participants designed in return. In 10months, the tool sent 16,547 messages (half initial, half follow-up) to 31 participants assigned to the TxText condition, who sent 6711 messages in response to the initial messages. Response rates to substance use (n=2370), medication (n=2918) and mood (n=4639) queries were 67, 69, and 64%, respectively. Responses indicating medication adherence, abstinence from substances, and good moods were more common than negative responses. The TxText tool can send messages daily over a 3month period, receive responses, and decode them to deliver personalized affirming or intervention messages. While we await the outcomes of a pilot randomized trial, the process analysis shows that TxText is acceptable and feasible for substance abusers with HIV, and may serve as a complement to HIV medical care.

A two-way text-messaging system answering health questions for low-income pregnant women

ObjectiveThe purpose of the study was to gauge the effectiveness of a low-cost, automated, two-way text-messaging system to distribute pregnancy and health-related information to low-income expectant women. MethodsIn total, 20 participants were recruited for a one-month intervention involving the use of cell phones to text pregnancy-related questions to the system. Participants received either a direct answer or encouragement to seek answers from health care providers. Pre- and post-tests as well as a focus group at the end of the intervention were conducted. ResultsParticipants uniformly found the system easy to use and accessible. Using the system increased levels of perceived pregnancy-related knowledge and facilitated patient-provider communication. Moreover, participants reported significant reductions in stress and depression and improved mental health after using the system. The system responded to most known questions quickly and accurately, and also encountered many new topics and linguistic expressions. ConclusionOverall, the data indicated that the text messaging system offered psychological benefits and promoted health communication by providing health information and encouraging patient-provider communication. Practice implicationsAn automated, two-way text messaging system is an efficient, cost-effective, and acceptable method for providing health information to low-income pregnant women.

Opening communication channels with people living with HIV using mobile phone text messaging: insights from the CAMPS trial

BackgroundUsing two-way mobile phone text messages to improve adherence to antiretroviral medication enhances communication between patients and health workers. We describe the implications of participants’ responses to text messages in the Cameroon Mobile Phone SMS (CAMPS) trial.FindingsThis is a cross-sectional analysis of data from the intervention arm of the CAMPS trial. CAMPS was a randomized controlled trial of motivational text messaging versus usual care to improve adherence to antiretroviral medication among people living with HIV in Yaounde, Cameroon (n = 200) over a 6 month period. Participants in the intervention arm (n = 101) were given a contact phone number, but were not required to respond to their reminder messages. If they did, their responses were noted and reported as counts and percentages. We received 99 phone calls and 55 text messages (154 responses) from 48 participants during the study period. The median number of responses was 1 (first quartile [Q1]: 1; third quartile [Q3]: 3). Half (n = 79, 51.1%) of them were expressions of gratitude. The rest included requests for logistical (n = 21, 13.6%), medical (n = 20, 12.9%) and financial (n = 11, 7.1%) support.ConclusionInitiating two-way mobile communication opens more channels for people living with HIV to express unmet needs. Researchers, policy makers and clinicians should be ready to respond to the needs expressed by patients who respond to text messages.Trial registrationPan-African Clinical Trials Registry: PACTR201011000261458; Clinicaltrials.gov: NCT01247181

Tailored text messaging intervention for HIV adherence: A proof-of-concept study.

This study sought to determine if dynamically tailored medication messages delivered to people living with HIV (PLWH) via text messaging would be well received and enhance adherence and clinical outcomes. A preexperimental proof-of-concept study with 52 men who have sex with men (MSM) recruited from a health clinic focused on promoting the well-being of gay, lesbian, bisexual, and transgender people. Inclusion criteria were being an English speaking HIV-positive MSM, aged 25 or older. Participants also had to agree to allow access to their medical records, have a cell phone, and be able to receive text messages over the 3-month intervention period. Participants completed baseline surveys that assessed various demographic, social, and health questions; received text messages over 3 months; answered weekly adherence questions via two-way messaging; and completed a follow-up survey at the end of the intervention period. Clinical outcomes were abstracted from participants' medical records at baseline and follow-up. Self-reported medication adherence and clinical outcomes, including CD4 counts and viral load. Participants were receptive to the text messaging intervention, and reported reading and liking the messages. Self-reported medication adherence significantly improved among participants who began the study as nonadherent and received tailored medication reminders. Overall viral load significantly decreased and CD4 count significantly increased from baseline to follow-up. The results demonstrate that using two-way text messaging to dynamically tailor adherence messages may enhance adherence and improve important clinical outcomes for PLWH.

Enhancing behavioral health treatment and crisis management through mobile ecological momentary assessment and SMS messaging

Many veterans returning from service in Afghanistan or Iraq suffer from post-traumatic stress disorder or mild traumatic brain injury. Treating these conditions can be challenging because of high rates of relapse and associated memory impairments. We report on a pilot study that assessed the utility of mobile health (mHealth) technologies, including personal digital assistant-based ecological momentary assessment and two-way interactive text (SMS) messaging, for providing treatment feedback to clinicians, encouraging and motivating veterans throughout treatment, and monitoring participants for relapse after treatment discharge. The results of the pilot suggest that mHealth technologies are feasible adjuncts to traditional mental treatment in the veteran population. Additional work is needed to establish the degree of clinical and economic value.

SickleREMOTE: A Two-Way Text Messaging System for Pediatric Sickle Cell Disease Patients.

Sickle cell disease, the most common hemoglobinopathy in the world, affects patient lives from early childhood. Effective care of sickle cell disease requires frequent medical monitoring, such as tracking the frequency, severity, and duration of painful events. Conventional monitoring includes paper- or web-based reporting diaries. These systems require that patients carry forms, which are easily lost, or laptop computers, which are impractical to scale to large populations. Both are prone to sporadic use by older adolescents due to lack of reminders. In this paper, we design and prototype a Sickle cell disease REporting and MOnitoring TElemedicine system (SickleREMOTE), aiming to resolve limitations of conventional monitoring diaries. This monitoring system is configured as automated short message service text (SMS-text) messages that arrive at a mobile phone anywhere on a cellular network. The messages may be reminders to encourage treatment adherence or questionnaires to collect self-assessed clinical data relating to treatment adjustments. Patients respond to the messages using pre-determined templates and a cloud database parses and stores messages automatically. Providers use a web-based interface to view, analyze, and download collected data. SickleREMOTE is developed by Georgia Institute of Technology in conjunction with Children's Healthcare of Atlanta (CHOA). System effectiveness will be evaluated using a trial of 30 adolescents with sickle cell disease and measured by response rate, time to response, error rate, and correspondence with data collected by telephone calls.

Two-Way Text Messaging for Health Behavior Change Among Human Immunodeficiency Virus–Positive Individuals

text-messaging systems have been used to promote a range of health behaviors, including medication adherence among human immunodeficiency virus-positive individuals. However, little is currently known about the specific characteristics of messaging systems that promote user engagement. using data from a randomized controlled trial involving a pager-based text messaging system, this study sought to examine the overall usability of the system, user evaluation of the system, demographic and psychosocial correlates of usability, and its performance as an adherence assessment tool. the messaging system consisted of an alphanumeric pager capable of sending and receiving individualized text messages and the software necessary to program and track communication. The system was evaluated using behavioral outcomes (pager message response rate), self-report survey responses, focus group discussions, and data from electronic medication monitoring pill bottles. Although the majority of participants reported that the system was effective in reminding them to take medication doses, the overall response rate to system messages was relatively low (42.8%) and dropped significantly over the course of the 3-month intervention period. In addition, user engagement did not differ significantly by most demographic and psychosocial variables. the pager-based text messaging system was received well by participants and appears to be applicable to a broad population; however, the system did not actively engage all participants over the course of the trial. Future research should determine whether systems customized to personal preference in notification style, frequency, and user device can increase use and provide further assistance to achieve optimal medication adherence.

Looking across the Hearing Line?: Exploring Young Deaf People’s Use of Web 2.0

Looking across the Hearing Line?: Exploring Young Deaf People’s Use of Web 2.0

An Investigation of Two-Way Text Messaging Use With Deaf Students at the Secondary Level

Deaf and hard-of-hearing students are often delayed in developing their independent living skills because of parental restrictions on activities outside the home due to worries about their child's inability to communicate, their whereabouts, and their general safety. Recent accounts of the use of two-way text messagers suggests that, like electronic mail, distance communication problems that have long plagued deaf people may be ameliorated--by the use of such technology (M. R. Power & D. Power, 2004; S. S. Rhone & Cox News Service, 2002). This project was designed as an initial foray into investigating the use of two-way text messaging technology as a way of increasing the independence of deaf adolescents and reducing their parents' anxiety about their safety and responsibility. All the deaf and hard-of-hearing students in the deaf and hard-of-hearing programs at two urban high schools (ages 13-19), the staff of the deaf departments at these two schools, and the parents/guardians of the students participated in this study. Preuse surveys, postuse surveys, and monthly statistics on the number of times each pager was used enabled us to chart how often the participants used the technology. The data were used to identify concerns that parents have about student independence and safety, the extent to which deaf students engage in independent activities, and expectations surrounding how two-way text messaging use might increase independence and literacy skills. The data collected on this project to date confirm that two-way text messaging technology is indeed useful for deaf adolescents and helps alleviate some of the concerns that have kept them from developing independence as quickly or readily as their hearing peers. The potential policy implications for this research are discussed.

Satellite Communications Services for "Remote" Mobile and Fixed Site Users in the Oil and Gas Community

What is "Remote?" The community of users referred to as "Oil and Gas," along with many other resource-based industries in North America, have urgent requirements for cost-effective, reliable, and easy-to-use telecommunications in "remote" areas. Depending on the telecommunication service being considered, "remote" can mean several hundred kilometres from an urban area in the case of analog cellphone or two-way radio services. But in the case of two-way text messaging over digital cellphone networks, "remote" can mean 30–50 kms from large urban areas. Until very recently, companies and individuals operating in remote areas seldom considered satellite telecommunications as an affordable, reliable, and easy-to-use alternative to terrestrial-based cellular and two-way radio networks. However, regional mobile satellite service operators in several countries have demonstrated over the last seven years that satellite networks are an excellent complement to the limited coverage available from terrestrial networks. Some former terrestrial users have in fact switched to satellite networks because the satellite network provides better coverage and greater availability (i.e., reliability of service) at lower operating costs. Another important reason for the increasing usage of satellite networks is that the services and applications available over satellite are comparable to those available over traditional terrestrial networks. Satellite Coverage and Services Mobile Satellite Ventures (MSV) owns and operates the MSAT geostationary satellite network which provides a comprehensive range of telecommunications services throughout Canada, U.S.A., Mexico, Central America, the Caribbean, and most of Colombia and Venezuela. The MSAT-1 and MSAT-2 satellites also provide coverage 200 nautical miles off the east and west coasts of North America and throughout the Caribbean. MSV has pioneered the development of a broad range of services including phone, fax, circuit-switched data, dispatch radio, and packet-switched services. Other services, such as asset tracking, flight following, and differential GPS are also offered over the MSV network by independent operators. MSV Satellite Applications All of the MSV network services are utilized in the oil and gas industry. Mobile and fixed-site phone service and fax services are used extensively. Circuit-switched data operating at 2,400 or 4,800 bps provides access to Internet or Intranet e-mail using POP3 connections from ISPs. MSV circuit-switched data service supports continuous data transfer at 4,800 bps for parameters such as pump pressure, rotary speed, and pump load. Dispatch Radio Service provides half-duplex push-to-talk group-oriented communications services. The service replicates many elements of terrestrial "two-way radio" service and features up to 15 talk groups per mobile, private mode for one-on-one communications, priority one interrupt, and the flexibility to assign one of three different priorities to each talk group being monitored. One application of the push-to-talk dispatch radio service is in pipeline patrol where the dispatcher communicates with a fleet of vehicles in push-to-talk operation over the entire length of the pipeline. Proprietary local area networks are interfaced with the satellite network. Two major oil field service companies in the southern U.S. use Dispatch Radio as well as a company in northern B.C. that has service trucks setting up and tearing down rigs.

Best Practices for Online Facilitation

Imagine you are helping a 20-something year-old student logging on to his/her first online course. Then, imagine you are helping a 40- or 50-something year-old student logging on to his/her first online course. What are the differences? The first obvious difference may be the degree of computer skills and experience. Most young adults have had experience with computers, electronic games, and other digital devices in their K-12 classrooms, friends' homes, the mall, and even workplaces. Computers are a way of life for them. But for older learners, computers often cause anxiety; technological proficiency may be a newly acquired skill, limited perhaps only to their television remotes. Those of us older than 35 did not grow up with computer technology, so may have had to adapt to it in our workplaces. Technological proficiency and comfort are also accompanied by very different expectations learners bring to online learning. Younger adults also bring expertise with a variety of different types of communication: IM (instant messaging), interactive video games, online chats, electronic bulletin boards, blogs (Web-based journaling sites) and cell phones that take and send photos and text messages. It is important to take these audience factors into consideration when facilitating online learning. In addition to matching the learner preparation and abilities to the course level and content, other factors that contribute to facilitating of online learning best practices include understanding the technologies, effective course design, the multiple roles of the facilitator, developing your own online style, and effective group interaction. Understanding the Technologies There are many different technologies that add to the complexity of distance learning. The first online courses provided content and communication in one direction, such as documents from a static Web site, video to view, or information pushed from the instructor to the learner by e-mail. Today, the designer of an online course has many more ways to deliver information and create interactive communication. The technologies that make these different course delivery methods possible often are called information communication technologies (ICT). Today these technologies enable delivering course materials and one-way and two-way communication over the Internet, via satellite as well as traditional landline telephone and cable networks. Any of these ICT enable both synchronous (same-time or real-time) communication and asynchronous (at different times) delivery and communication. Examples of synchronous delivery include two-way audio (via computer, telephone or radio) or two-way video, IM, text messages and online chat. Examples of asynchronous delivery include e-mail, listservs, online bulletin boards, Hogs, videotapes, CD-ROMS or archived audio and video streams. ICT delivery modes are converging with the development of high-speed, wide-bandwidth Internet capacity (what the techies call big pipes) to carry content. The early forms of ICT delivery often used static Web sites as information repositories, with e-mail being the primary interactive medium. Then listservs, discussion forums, and chat technologies developed and were attached to Web sites. Soon these technologies were integrated with course management systems (often abbreviated as CMS or LMS--learning management systems). Examples of CMS are Blackboard, WebCT, angel, and eCollege. These course management systems (CMS) integrate features such as pages for announcements, the syllabus, course documents, and calendars along with interactive features such as discussion forums, e-mail, chats, white boards, drop boxes and group workspaces. Instructional management features include grade books, test construction and delivery, and tools to connect digital library resources, other Web resources such as research databases, audio and video streams, etc. …