Nudging with mobile phones on behaviour change

One of the important requirements for achieving behaviour change is the salience of behaviour change causing triggers. Information, presented in the most cognitively salient manner and with some close-enough periodicity, can be a powerful trigger to achieving behaviour change.

Mobile phones, thanks to their near universal coverage even in many developing countries and ubiquitousness in daily lives of citizens, have the potential to delivering such information. They are an excellent channel for doctors and health care professionals to maintain a continuous dialogue with the patients.

In recent years there have been numerous studies on experiments that have used mobile phones to both generate optimal treatment response and more effectively manage disease incidence. They have relied on using reminders to people about medication and treatment schedules and management of their eating and lifestyle behaviours.

A randomized control study on adherence to antiretroviral therapy (ART) for AIDS using mobile phone SMS reminders in Kenya among 431 adult patients over 48 weeks found that "weekly text reminders increased antiretroviral drug adherence from 40% to 53% of participants". The authors write,

"In intention-to-treat analysis, 53% of participants receiving weekly SMS reminders achieved adherence of at least 90% during the 48 weeks of the study, compared with 40% of participants in the control group (P = 0.03). Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48 h during the 48-week follow-up period than participants in the control group (81 vs. 90%, P = 0.03)."

In a study about application of sun protection creams to reduce the risk of developing skin cancer, 70 patients in the 18-72 age group were sent cell phone text messages (along with weather report, at 7 AM) reminding them to apply their sunscreen daily for six weeks. The patients’ adherence to daily sunscreen usage was evaluated with a novel electronic monitoring device, which was strapped onto the tube of sunscreen - when the cap of the sunscreen tube was removed, the device sent a text message to researchers that was then recorded as evidence of sunscreen use.

The study found that text reminders increased the proportion of people who applied sun protection from 30% to 56%. Specifically, the 35 subjects who received daily text message reminders to apply sunscreen had a mean daily adherence rate of 56 percent compared to a mean daily adherence rate of only 30 percent by the 35 subjects who did not receive reminders.

A review of 12 RCT studies which examined the use of text messages to promote weight loss, get people to stop smoking and manage diseases like diabetes and asthma, found evidence to support text messaging as a tool for behavior change in eight of nine 'sufficiently powered studies'. The authors write,

"Twelve randomized controlled trials published between 2005 and June 2009 of interventions for disease prevention and management using text messaging were reviewed. Nine countries were represented, only one of which is a developing country. The majority of the studies (8) found evidence of a short-term effect regarding a behavioral or clinical outcome related to disease prevention and management. Of those that found no evidence of effect, only one had sufficient power to detect an effect in the primary outcome. Evidence for text messaging in disease prevention and management interventions was observed for weight loss, smoking cessation, and diabetes management. Effects appeared to exist among adolescents and adults, among minority and non-minority populations, and across nationalities."

The NYT reports of a mobile phone messaging service in the US, text4baby, "that sends free text messages to women who are pregnant or whose babies are less than a year old, providing them with information, and reminders, to improve their health and the health of their babies". Registration can be done from your cell phone by simply texting the word BABY (or BEBE for Spanish) to 511411. The sender will be asked to enter the baby’s due date or baby’s birthday and zip code. Once registered, the sender will start receiving free messages with tips for pregnancy and caring for baby. These messages are timed to the due date or the baby’s birth date.