• By Laura Whybra
  • Posted on Friday 18th December, 2015

Text messages: an emerging tool for interventions

strong>Millions of teenagers and young adults in the US smoke and drink – far too many to be reached by human-delivered interventions. And, given the stigma of treatment, many of those who want to curb their tobacco or alcohol use would not choose to see a provider even if one was available. Could text messages fill the unmet need?A recent meta-analysis looked at 14 text-based interventions designed to reduce substance use among 12- to 29-year-olds. Several had small but positive effects. On average, about a third of participants reduced their tobacco or alcohol use compared to control group participants. Importantly, because text-based programs can reach large numbers of people at low cost, even a small effect could have important public health benefits. Small but valuable effectsA team of Virginia-based researchers synthesized the quantitative results from 14 intervention studies focusing on tobacco and alcohol prevention, reduction, or cessation among adolescents and young adults aged 12 to 29 years. The interventions varied in the content and number of texts (from one to 278), the approach and duration (from a day to a year), and the characteristics of the participants. The effect of each intervention was compared to no treatment.Some programs showed larger effects than others. Five of the 14 studies reported statistically significant differences between the treatment and comparison groups on substance use behaviors. Only three small studies, with a combined total of about 80 participants, focused on alcohol use. The remaining 11, with more than 10,000 total participants, targeted tobacco use. Overall, there was a small effect of such interventions. This is meaningful as the interventions are low-cost and can reach a large number of people. Furthermore, text-based interventions address critical gaps in human-delivered interventions.Why text-based interventions?As opposed to provider-delivered interventions, individuals do not have to be at a particular location to receive the intervention. This deals with the issue of transportation cost and convenience, as well as the stigma attached to such treatment. Thus, text-based interventions provide a mechanism to increase access to interventions for substance use prevention. Additionally, text-based messages can easily be tailored based on certain characteristics. For example, the number of texts can vary by need. Another advantage is that they can be delivered with 100% fidelity, which is a challenge in face-to-face interventions. Mobile interventions are an easily available option due to the widespread use of text messaging, especially among adolescents and young adults. Tapping into this provides a promising avenue to scale up interventions to meet the need. An emerging toolThis study is exploratory. Few of the studies in the meta-analysis provided detail about the content, length, frequency, or technical delivery of messages. Without such information, it is difficult for researchers to replicate or build on each others’ findings. Interestingly, the studies with the most substantial effects were those that sent the largest number of texts to each participant. But there is no information about what messages are most useful for which needs. The authors call for reports about future studies to include enough detail to build a body of knowledge about this approach. Text messaging could be used as stand-alone interventions, supplements to traditional interventions or methods to improve treatment adherence. Mobile health interventions are more dynamic than traditional interventions and more adaptive theoretical models of behavior change may be needed. Unpacking the theory behind the approach and testing out different methods of using this tool will enhance the development of this promising avenue. ************Reference:Mason, M., Ola, B., Zaharakis, N., & Zhang, J. (2014). Text Messaging Interventions for Adolescent and Young Adult Substance Use: a Meta-Analysis. Prevention Science, DOI 10.1007/s11121-014-0498-7

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