Txt4Health: Using Mobile Technology in Public Health Communications and Education Campaigns

Transcription

1 Txt4Health: Using Mobile Technology in Public Health Communications and Education Campaigns Paul Meyer, J.D. and Pamela Johnson, Ph.D. August 2013

2 Disclosure Commercial Interest What was received? (Salary, honorarium, stocks, etc.) For what role? (Employee, management position, consultant, board member, etc.) Voxiva Salary, stock Board member, management position

3 Why Mobile?

4 Why Text Messaging Engagement & Immediacy Almost All Americans Are Texting 56% Smart Phone 91% Own Cell Phone 44% Other Cell Phone 80% of Cell Phone Users Text Source: Pew Research Center Internet & American Life Project, May 2013 Texts Get Read Immediately! Text is Used by Every Segment Source: Singlepoint 99% Texts Get Read 90% Read Within 3 Min 43% Medicare 63% No Insurance 65% Individual Policy 68% Employer Sponsored 74% Tricare 79% Medicaid Source: PricewaterhouseCoopers HRI Consumer Survey

5 Why Text Messaging Growing Evidence Base Illustrative trials: Smoking cessation (Free 2011, Whitaker 2013) Child immunization (Stockwell 2012) Medication adherence ((Cole-Lewis 2010) Diabetes self-management (Liang 2012)

6 How We Do It Consumer Health Engagement Content Partnerships + + Evidence Based Behavioral Health Methods Interactive Channels = Better Health 6

7 The Science behind mhealth and behavior change Education alone does not lead to sustained behavior change We all know we should eat more fruits and vegetables To change behavior, we need to address other factors such as barriers, motivations, environment Use behavior change theories, proven in science, to develop a program of interrelated messages, motivations and interactions Social cognitive theory (click here for article) Theory of reasoned action/ planned behavior (click here for article) Transtheoretical model/ Stages of change theory (click here for article) Health belief models (click here for article) Personalizing messages to the individual works Noar et al. (2005) shows that tailoring messages is effective in changing behavior (click here for article) Personalization can come in the form of relevance to personal circumstances, timing of content delivery, feedback from data captured, reminders about motivations 7

8 Health Behavior Change Preparation While motivations are highest at the start of the process (e.g. newly diagnosed with diabetes), the individual needs to prepare for behavior change. Starting out with a rigorous exercise regimen will likely be temporary Transtheoretical model: Precontemplation > contemplation > preparation > action > maintenance Text2Quit. Don't give up! Quitting is hard but you can do it, and we can help. Take a step forward when you are ready. Reply DATE to set your quit date. Text2Quit. Tell yourself right now that you will never have another drag of a cigarette. Throw away all the cigs in your pocket. It s time to change lets go! Help the individual define the reasons for change (e.g. for my family) and then regularly remind the participant of these reasons particularly during a slip Theory of Reasoned Action: Text2Quit. Think of the reasons that you want to quit. E.g. For your family, for your health, for sport. We ll check back later and ask you what they are. 8

9 Health Behavior Change Goals Setting goals and tracking progress is popular among users and based in science: People who weigh themselves regularly lose more weight than those who don t (view article here) People who reduce cigarette intake and monitor themselves are more likely to quit Goals need to be personal not imposed on the individual Care4Life. Are you ready to set an exercise goal? How many days a week do you plan to do some exercise? Reply with a number between 1 and 7 Care4Life. You should try to exercise 150 minutes each week and exercise more days than not. Quit Smoking Example (text and web): Text2Quit. Aim to cut out at least 25% of your daily cigs before your QuitDate. Reply with the number of cigs you're cutting down to (e.g. 15). Text2Quit. Time for a pre-quit check-in. Reply with the number of cigarettes you smoked yesterday (e.g. 11). Or Reply TRACK anytime during the day. Text2Quit. Great! You reached your goal of cutting down to XX cigs. Visit text2quit.com to see your progress. Text GOALS to change goals Day 01 Day 02 Pre-Quit Goal: Reduce Smoking Intake Day 03 Day 04 Day 05 Day 06 Day 07 Day 08 Day 09 Day 10 Day 11 Day 12 Day 13 Day 14 Smokes Goal Smokes Achieved 9

10 Health Behavior Change Goals People of different BMI have different views on weight loss Studies show that obese people have higher, and often unrealistic, weight goal expectations (view article here) Allow users to set own weight goals, except for obese BMI. Text4HEALTH: By my calculations you're over a healthy weight range, but I'm here to help. Let's take it slow; lose 2lbs over the next two weeks. You can do this! Being active (exercise) each day is an important first step Studies show that even 15 minutes of exercise/day can significantly reduce mortality (view article here) Ideally get everyone to 30 mins/day 5 days/wk standard Start obese BMI out slowly 30 mins/day, 3 days/wk 10

11 Evidence base CDC & ADA CDC Diabetes Prevention Program e.g. BMI calculations done in line with CDC model Reviewed and approved messages and protocols ADA risk guidelines Risk categories developed based on ADA model Risks weighted accordingly Reviewed and approved messages and protocols 11

12 Ongoing Improvement of txt4health: Lessons Learned Enrollment Person to person Health plans Quit lines Other Cost of text messages TracFone Next generation of txt4health Health & wellness Reminders Additional personalization and choices 30 day challenges Quizzes Mobile website for more information

13 TXT4HEALTH: CONSUMER ENGAGEMENT THROUGH MOBILE HEALTH TECHNOLOGY Nebeyou Abebe, MA, PMP Txt4Health Project Director Associate Director, Health Systems Louisiana Public Health Institute August 2013

14 What is Txt4Health? A SMS-based consumer engagement tool designed to help people understand their personal risk for type 2 diabetes and provide high risk individuals with the support they need to maintain a healthy lifestyle and prevent the onset of diabetes.

15 State of Diabetes in Louisiana 1.1 million pre-diabetics 60% of adult residents in New Orleans have at least one risk factor for diabetes Highest diabetes mortality rate in the U.S. (35.5/100,000 persons) In 2007, total cost of diabetes was $2.4B

16 Program Objectives Raise awareness about personal risk for type 2 diabetes Motivate participants to set weight loss and physical activity goals to support healthy living Link individuals to local care and resources

17 Target Population Adults between 18-44, emphasis on African Americans Undiagnosed, though at-risk for type 2 diabetes Live in Greater New Orleans

18 Ownership & Usage Overall Texting Capabilities in Household Don t Have, No One Does Don't Have but, Someone Does Have, Don't Use 58 Have, Use Source: Pre-Campaign Survey 0 A. Total (N=701) G (N=103) H (N=72) I (N=126) J. 45 and Older (N=393)

19 MEAN Avg. Text Messages Per Week A. Total (701) G (103) H (72) I (126) J. 45 and Older (393)

20 Logic Model Goal Raise awareness of personal risk of diabetes and actions that can be taken to address those risks Objectives Engage people in determining their risk of diabetes Assess and communicate their personal risk of diabetes Connect underserved individuals with care and other resources Support risk reduction activities, i.e. diet, exercise, smoking cessation. Activities Promote enrollment of individuals in txt4health Assess individual s risk of diabetes Provide education about lifestyle changes to address risks Provide information about care and resources to help address risk Set and track exercise and weight goals Process Measures # Enrollees # Participants assessing their personal risks # Participants provided information about local resources & care # Participants setting and tracking goals to reduce risk, i.e. exercise, weight tracking Outcomes Increased knowledge about personal risk of diabetes Increased awareness of how to address risks Increased number of at risk people connected to appropriate care (with a particular focus on the underserved population) Increased number of individuals engaged in riskreducing activities

21 Overview

22 Engagement Strategy 360 Surround Sound Approach Community Advisory Group Public and Private Partnerships TV and Radio PSAs Outdoor billboards Co-branded posters Outreach at community events, neighborhood associations, conferences, universities, and faith based organizations Outreach with providers, including promotion through providers Outreach at businesses and through employee events Contests and incentive programs

23 Working Together

24 Data Generated 1. Programmatic data Risk assessment questions Demographic information Physical activity Weight goals 2. Population based surveys Pre and Post campaign surveys 3. Participant satisfaction survey

25 Programmatic Data Age distribution of participants who entered age (N=1060) Reported weight goal (N=1057) Race/Ethnicity of those reporting (N=639) 30% 41% % Reported weight goal 19% 10% African American/Black White 29% 61% Did not report weight goal 71% Other BMI of participants who entered weight and height information (N=1395) BMI < 25 Normal or Underweight 44% 29% 27% BMI Overweight BMI > 30 50% 40% 30% 20% 10% 0% Reported active for at least 30 minutes a day (N=1431) 45% 25% 5% 7% 8% 4% 2% 4% days

26 Impact of Social Marketing (Pre/Post Survey) N=701 Diabetes in Family African American/Black Years Old Pre Post Pre Post Pre Post Awareness of Txt4Health Awareness of Text HEALTH to = significantly greater than comparison group at 95% confidence level

27 Participant Satisfaction Survey N=77 Overall, how satisfied were you with the program? Txt4health made me conscious of my risky behaviors. Strongly Disagree 1% 3% 2% Disagree 16% 4% 7% Agree 32% 34% 24% Strongly Agree 51% 59% 67% Total 100% 100% 100% I will recommend txt4health to my friends and family. Online rolling bi-weekly satisfaction survey prompted by a consent text message followed by entry in the survey via URL

28 Keys to Success Cultivate strategic public/private partnerships early-on Link (or integrate) mobile solutions to/into evidence based programs at the community-level Design a rigorous evaluation plan to support sustainability efforts

29 Next Steps Scaling txt4health across Louisiana Partnering with YMCA s Diabetes Prevention Program Use mobile to identify pre-diabetics (from the community) and link them to Y-DPP (BMI >25) Recruit providers to refer pre-diabetics to Y-DPP Monitor and evaluate process and clinical health outcomes Specific measures: A1c, blood pressure, cholesterol and BMI

30 Contact Information Nebeyou Abebe, M.A., PMP

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47