Elsevier

Social Science & Medicine

Volume 97, November 2013, Pages 41-48
Social Science & Medicine

Review
Efficacy of text messaging-based interventions for health promotion: A meta-analysis

https://doi.org/10.1016/j.socscimed.2013.08.003Get rights and content

Highlights

  • Meta-analysis of 19 interventions; mean effect size d = .329.

  • Smoking cessation and physical activity interventions were most efficacious.

  • Interventions with message tailoring and targeting were most efficacious.

  • Varying message frequency was more efficacious than fixed message frequency.

  • Adding components to text-only interventions did not improve their efficacy.

Abstract

This meta-analysis investigated the efficacy of text messaging-based health promotion interventions. Nineteen randomized controlled trials conducted in 13 countries met inclusion criteria and were coded on a variety of participant, intervention, and methodological moderators. Meta-analytic procedures were used to compute and aggregate effect sizes. The overall weighted mean effect size representing the impact of these interventions on health outcomes was d = .329 (95% CI = .274, .385; p < .001). This effect size was statistically heterogeneous (Q18 = 55.60, p < .001, I2 = 67.62), and several variables significantly moderated the effects of interventions. Smoking cessation and physical activity interventions were more successful than interventions targeting other health outcomes. Message tailoring and personalization were significantly associated with greater intervention efficacy. No significant differences were found between text-only interventions and interventions that included texting plus other components. Interventions that used an individualized or decreasing frequency of messages over the course of the intervention were more successful than interventions that used a fixed message frequency. We discuss implications of these results for health promotion interventions that use text messaging.

Section snippets

Text message-based health promotion interventions

The use of text messaging in health interventions is a relatively new practice. In fact, the first formal evaluation of a health intervention using text messaging only appeared in 2002 (Neville, Greene, McLeod, Tracey, & Surie, 2002). The first randomized controlled trial (RCT) of a health promotion intervention appeared three years later (Rodgers et al., 2005). Recently, scholars have summarized the proliferation of text messaging health interventions in several systematic review articles and

The current study

Text messaging boasts mass public reach, accessibility, and low cost. Past reviews suggest text messaging-based interventions have the potential to be effective in changing health behavior. This new area of research, however, is still experiencing growing pains as researchers and public health practitioners work to determine the most efficient use of text messaging in health-related interventions. Also, as of yet, there has been no quantitative synthesis of outcomes of text messaging

Search strategy

We used a comprehensive search strategy to locate studies relevant to this meta-analysis. We did not set a date limit on the search, and we considered all applicable studies located by October 1, 2011 for inclusion.

The search strategy involved three steps. First, we conducted comprehensive searches of CINAHL, Communication & Mass Media Complete, PsycINFO, and Medline computerized databases using various keywords applicable to this topic, including text messag*, cell* phone, prevent*, short

Results

Characteristics of the individual studies are reported in Table 2 in the Appendix. The k = 19 studies took place in 13 countries (Australia, Canada, Finland, France, Germany, Israel, Malaysia, New Zealand, Norway, Scotland, Thailand, United Kingdom, United States) and had a cumulative N = 5958 (median N per study = 174, ranging from n = 58 to n = 1705). Studies were published between 2005 and 2011, with a median publication year of 2009. With the exception of one study directed toward children (

Discussion

The purpose of this meta-analysis was to examine the efficacy of text messaging-based interventions to improve health behaviors and health-related outcomes. We also sought to examine potentially important moderators of text messaging-based interventions to begin to advance our understanding of what may make such interventions efficacious. It is interesting to observe that 13 countries were represented across the studies in this meta-analysis. Such geographic and cultural diversity is highly

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    References marked with an asterisk indicate studies included in the meta-analysis.

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