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To Text or Not to Text: Electronic Message Intervention to Improve Treatment Adherence Versus Matched Historical

Marily A Oppezzo1, Michael V Stanton2, Ariadna Garcia3

  • 1Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States.

JMIR Mhealth and Uhealth
|April 10, 2019
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Electronic messages (e-messages) did not improve treatment adherence in a weight loss trial. Future interventions should explore varied prompts and increased interaction for better user engagement and adherence.

Keywords:
interventionmobile healthpropensity scoreshort message servicetreatment adherence

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Area of Science:

  • Clinical research methodology
  • Behavioral science
  • Health intervention studies

Background:

  • Treatment adherence is crucial for clinical trial validity, especially in interventions with decreasing contact points.
  • Multi-cohort trials offer opportunities to innovate adherence strategies and utilize previous cohorts as historical controls.
  • Electronically delivered nudges present a low-cost method for enhancing treatment adherence.

Purpose of the Study:

  • To assess the effectiveness of electronic messages (e-messages) in improving treatment adherence during the latter half of a year-long parent weight loss intervention.
  • To measure adherence through class attendance and dietary compliance.
  • To evaluate adherence when intervention checkpoint frequency decreases.

Main Methods:

  • A propensity score model was used to match participants receiving e-messages in the final cohort (n=128) with a historical control group (n=31) from earlier cohorts.
  • Comparisons were made on class attendance, dietary adherence (carbohydrate/fat grams), and weight change between 6 and 12 months.
  • The dose-response relationship between message response rate and outcomes was analyzed.

Main Results:

  • E-messages showed no significant effect on class attendance (+4.6%, P=.31), dietary adherence (LC -2.5g carbs, P=.85; LF +6.2g fat, P=.26), or weight change (+0.3kg, P=.68) compared to controls.
  • A significant positive correlation was found between message response rate and class attendance (r=.45, P<.001).

Conclusions:

  • This pilot study's e-message intervention did not improve treatment adherence.
  • Future research should incorporate diverse prompts and interactive elements to enhance user engagement.
  • The study successfully demonstrated the innovative use of propensity score-matched historical controls within a multi-cohort trial.