Positive Technology: Using Mobile Phones for Psychosocial Interventions

Positive Technology: Using Mobile Phones for Psychosocial Interventions

Sara Konrath (Indiana University, USA & University of Michigan, USA & University of Rochester Medical Center, USA)
Copyright: © 2015 |Pages: 27
DOI: 10.4018/978-1-4666-8239-9.ch072


This article reviews the use of mobile phones in psychosocial interventions. Specifically, it reviews research studies that have used text messages (SMS) or smartphone applications (apps) to improve people's mental health, psychological well-being, or social relationships. Psychosocial interventions are emerging from the larger and more established mobile health (mHealth) literature of physical health interventions. The scientific knowledge of psychosocial interventions is currently quite limited, with only a few published large randomized control trials. Most of those are limited to North American or European participant samples. The advantages and disadvantages of mobile interventions are discussed, along with recommendations for best practices. The success of future research is dependent upon more researcher-friendly tools to implement interventions.
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Introduction And Overview

Intellectual History

Mobile phones are ubiquitous: 91% of Americans own one (Center, 2012), and 61% of those are smartphones (Nielsen, 2013b). Smartphones are extremely versatile, functioning like personal computers, and are an increasingly important part of people’s daily lives. In one study, smartphones were within arm’s reach 50% of the time, and in the same room 90% of the time (Dey et al., 2011). Researchers and clinicians in a variety of fields, including medicine and public health, have taken note of mobile phones as potentially powerful interventions.

Mobile phone interventions, including text messages and smartphone applications, are part of the broader use of electronic tools to improve physical health (also called e-health or mHealth). mHealth is defined as “the use of mobile and wireless technologies to support the achievement of health objectives” (Kay, Santos, & Takane, 2011). These started (and continue) via web-based platforms, and evolved with the rise of widespread mobile phone usage. The first known studies to examine the use of text messaging (or SMS – short message service) were published in 2003, making this a relatively young research discipline. Victoria Franklin of the University of Dundee, UK (Franklin, Waller, Pagliari, & Greene, 2003) and Stephanie Bauer of Heidelberg University, Germany, (Bauer, Percevic, Okon, Meermann, & Kordy, 2003), are among the earliest published authors in the field.

Since these early studies, there have been a large number of intervention studies to improve physical health outcomes, and currently there are a number of published review articles and meta-analyses (Cole-Lewis & Kershaw, 2010; Fiordelli, Diviani, & Schulz, 2013; Fjeldsoe, Marshall, & Miller, 2009; Herbert, Owen, Pascarella, & Streisand, 2013; Krishna, Boren, & Balas, 2009; Liang et al., 2011; Militello, Kelly, & Melnyk, 2012; Park, Howie-Esquivel, & Dracup, 2014; Shaw & Bosworth, 2012; Whittaker et al., 2009). Since text messages are inexpensive, comparatively simple to program, and available to any mobile phone owner, the majority of physical health mobile-based studies have used text messages to deliver interventions, rather than smartphone applications (see Table 1). One recent review concluded that “the potential of smartphones does not seem to have been fully exploited yet” (Fiordelli et al., 2013, p. 7). To date, the vast majority of these studies have taken place in Europe and North America. Studies have only rarely been conducted in developing countries, where the need for such tools is high because of relatively low access to physical health resources. Interventions have ranged from relatively short durations (2 weeks) to relatively long-term (14 months), with the frequency of the interventions ranging from 1 time per month to 6 times per day. The majority of studies (between 60% to 100%) have found positive health change on the outcome measure of interest, although this might be in part due to publication bias. The reviews demonstrate that follow up assessments are rare, making it unclear how long these effects last.

Table 1.
Summary of review articles on mobile based physical health outcomes
CitationNumber of Studies IncludedType of InterventionLocationIntervention Period RangeFollow Up AssessmentsHealth DomainsResults
Cole-Lewis & Kershaw, 2010: review12 studies (RCTs)SMS9 countries (majority European and North America), including 1 developing nation3 to 12 monthsNoneMedication adherence, smoking, obesity / physical activity89% found positive health change. Very high retention rates (9 with 80% plus).
Fiordelli et al, 2013: review117 articles: only 1 from social sciences (RCTs and pilot studies)49% SMS, 6% appsEurope (34%), North America (33%)Not reportedNot reportedDiabetes (21%) and obesity (14%) most commonly studied60% found overall positive impacts across all measures; 35% found mixed results (some positive, some null).
Fjeldsoe et al, 2009: review14 studies
(RCTs or pre post designs)
SMSMajority Europe and North America6 weeks to 12 monthsNoneDiabetes, smoking, obesity / physical activity93% found positive health change.
Herbert et al, 2013: review7 studies (RCTs or quasi experiments)SMSNot reported11 weeks to 12 monthsNoneDiabetes67% found positive health change. Very high retention rates (6 with 80% plus).
Krishna et al, 2009: review25 studies
(20 RCTs and 5 controlled trials)
SMS13 countries (majority in Europe and North America)3 weeks to 12 months (average 6 months)NoneDiabetes, smoking, HIV/AIDS, physical activity84% found positive health change.
Liang et al, 2011: meta-analysis22 studies (11 RCTs, 7 pre-post, 2 quasi-experiments, 2 randomized crossover)SMSNot reported3 months to 12 monthsNoneDiabetes (blood glucose control)Overall, average reduction in blood glucose (declines present in 86% of studies).
Militello et al, 2012: review7 studies of children and adolescents (RCTs)SMSMajority Europe and North America2 weeks to 12 monthsNoneMedication adherence, smoking, physical activity, diabetes71% positive health change.
Park, Howie-Esquivel, & Dracup, 2014: review29 studies
(RCTs and pilot studies)
SMSMajority Europe and North Americaup to 14 months1 study with follow up assessmentsMedication adherence specifically. Most common diseases were HIV/AIDS, diabetes, and asthma62% found positive results.
Shaw & Bosworth, 2012: review14 studies (RCTs and quasi-experiments)SMS7 countries (36% Europe, 36% North America)2 weeks to 12 monthsNoneWeight loss, diet, or exercise79% found positive results.
Whittaker et al, 2009: review4 studies (RCTs and quasi-experiments)SMS4 countries (75% Europe)6 weeks6 months to 12 monthsSmoking cessation100% found short-term self-reported results. Long-term results mixed.

Key Terms in this Chapter

Anxiety: Feelings of worry or unease about future or current situations, especially more uncertain ones.

Well-Being: A complex construct that includes people’s feelings of happiness and also their evaluations of life satisfaction, self-efficacy, and purpose in life.

Depression: A mental illness that is characterized by persistent negative moods, low energy, and feelings of hopelessness, among other symptoms.

Psychosocial Interventions: Programs that are designed to enhance people’s mental health, psychological well-being, or social relationships.

Empathy: A psychological state consisting of affective and cognitive components. It involves feeling with others’ emotions and seeing the world from others’ perspectives.

Social Relationships: Traits and behaviors related to social connection, attachment, and bonding with others.

E-Health or mHealth: The usage of electronic or mobile devices to promote better health and well-being.

Mental Health: The robustness and resilience of people’s internal states, involving psychological and emotional well-being.

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