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
| Citation | Number of Studies Included | Type of Intervention | Location | Intervention Period Range | Follow Up Assessments | Health Domains | Results |
|
Cole-Lewis & Kershaw, 2010: review | 12 studies (RCTs) | SMS | 9 countries (majority European and North America), including 1 developing nation | 3 to 12 months | None | Medication adherence, smoking, obesity / physical activity | 89% found positive health change. Very high retention rates (9 with 80% plus). |
|
Fiordelli et al, 2013: review | 117 articles: only 1 from social sciences (RCTs and pilot studies) | 49% SMS, 6% apps | Europe (34%), North America (33%) | Not reported | Not reported | Diabetes (21%) and obesity (14%) most commonly studied | 60% found overall positive impacts across all measures; 35% found mixed results (some positive, some null). |
|
Fjeldsoe et al, 2009: review | 14 studies
(RCTs or pre post designs) | SMS | Majority Europe and North America | 6 weeks to 12 months | None | Diabetes, smoking, obesity / physical activity | 93% found positive health change. |
|
Herbert et al, 2013: review | 7 studies (RCTs or quasi experiments) | SMS | Not reported | 11 weeks to 12 months | None | Diabetes | 67% found positive health change. Very high retention rates (6 with 80% plus). |
|
Krishna et al, 2009: review | 25 studies
(20 RCTs and 5 controlled trials) | SMS | 13 countries (majority in Europe and North America) | 3 weeks to 12 months (average 6 months) | None | Diabetes, smoking, HIV/AIDS, physical activity | 84% found positive health change. |
|
Liang et al, 2011: meta-analysis | 22 studies (11 RCTs, 7 pre-post, 2 quasi-experiments, 2 randomized crossover) | SMS | Not reported | 3 months to 12 months | None | Diabetes (blood glucose control) | Overall, average reduction in blood glucose (declines present in 86% of studies). |
|
Militello et al, 2012: review | 7 studies of children and adolescents (RCTs) | SMS | Majority Europe and North America | 2 weeks to 12 months | None | Medication adherence, smoking, physical activity, diabetes | 71% positive health change. |
|
Park, Howie-Esquivel, & Dracup, 2014: review | 29 studies
(RCTs and pilot studies) | SMS | Majority Europe and North America | up to 14 months | 1 study with follow up assessments | Medication adherence specifically. Most common diseases were HIV/AIDS, diabetes, and asthma | 62% found positive results. |
|
Shaw & Bosworth, 2012: review | 14 studies (RCTs and quasi-experiments) | SMS | 7 countries (36% Europe, 36% North America) | 2 weeks to 12 months | None | Weight loss, diet, or exercise | 79% found positive results. |
|
Whittaker et al, 2009: review | 4 studies (RCTs and quasi-experiments) | SMS | 4 countries (75% Europe) | 6 weeks | 6 months to 12 months | Smoking cessation | 100% found short-term self-reported results. Long-term results mixed. |