Predictors of Participation in a Perinatal Text Message Screening Protocol for Maternal Depression and Anxiety: Prospective Cohort Study.

BACKGROUND: Universal screening for depression and anxiety in pregnancy has been recommended by several leading medical organizations, but the implementation of such screening protocols may overburden health care systems lacking relevant resources. Text message screening may provide a low-cost, accessible alternative to in-person screening assessments. However, it is critical to understand who is likely to participate in text message-based screening protocols before such approaches can be implemented at the population level. OBJECTIVE: This study aimed to examine sources of selection bias in a texting-based screening protocol that assessed symptoms of depression and anxiety across pregnancy and into the postpartum period. METHODS: Participants from the Montreal Antenatal Well-Being Study (n=1130) provided detailed sociodemographic information and completed questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (State component of the State-Trait Anxiety Inventory [STAI-S]) at baseline between 8 and 20 weeks of gestation (mean 14.5, SD 3.8 weeks of gestation). Brief screening questionnaires, more suitable for delivery via text message, assessing depression (Whooley Questions) and anxiety symptoms (Generalized Anxiety Disorder 2-Item questionnaire) were also collected at baseline and then via text message at 14-day intervals. Two-tailed t tests and Fisher tests were used to identify maternal characteristics that differed between participants who responded to the text message screening questions and those who did not. Hurdle regression models were used to test if individuals with a greater burden of depression and anxiety at baseline responded to fewer text messages across the study period. RESULTS: Participants who responded to the text messages (n=933) were more likely than nonrespondents (n=114) to self-identify as White (587/907, 64.7% vs 39/96, 40.6%; P<.001), report higher educational attainment (postgraduate: 268/909, 29.5% vs 15/94, 16%; P=.005), and report higher income levels (CAD $150,000 [a currency exchange rate of CAD $1=US $0.76 is applicable] or more: 176/832, 21.2% vs 10/84, 11.9%; P<.001). There were no significant differences in symptoms of depression and anxiety between the 2 groups at baseline or postpartum. However, baseline depression (EPDS) or anxiety (STAI-S) symptoms did predict the total number of text message time points answered by participants, corresponding to a decrease of 1% (eß=0.99; P<.001) and 0.3% (eß=0.997; P<.001) in the number of text message time points answered per point increase in EPDS or STAI-S score, respectively. CONCLUSIONS: Findings from this study highlight the feasibility of text message-based screening protocols with high participation rates. However, our findings also highlight how screening and service delivery via digital technology could exacerbate disparities in mental health between certain patient groups.

"My Mom Would Always Say Pussy Rules the World": A Qualitative Exploration of Southern Black Women's Sexual Messages.

Exploring southern Black women's sexual messaging is important for appropriately contextualizing their sexual experiences. This study advances the literature on southern Black women's sexuality by analyzing the valence, content, and sources of sexual messages using #HotGirlScience. Twenty-five Black women's semi-s tructured interview responses were analyzed using thematic analysis. Thirteen women reported mixed messages, followed by positive messages (n = 10) and negative messages (n = 2). Seven major content themes were constructed: 1) sex is taboo, 2) sex is painful, harmful, and/or violent for Black women, 3) sex prioritizes male partner's pleasure, 4) consent and safety, 5) agency and sexual pleasure, 6) pleasure expansiveness, and 7) sexual communication.

A Digital Sexual Health Intervention for Urban Adolescent and Young Adult Male Emergency Department Patients: User-Centered Design Approach.

BACKGROUND: Adolescents and young adults frequently present to the emergency department (ED) for medical care and continue to have many unmet sexual health needs. Digital interventions show promise to improve adolescent and young adult sexual health; yet, few interventions focus on male ED patients, despite their infrequent use of contraceptives and rising rates of sexually transmitted infections. OBJECTIVE: This paper describes the design and development of Dr. Eric (Emergency Room Interventions to Improve Care), a digital app focused on promoting condom use among sexually active adolescent and young adult male ED patients. METHODS: This study followed 4 phases of app development, which were based on user-centered design and the software development lifecycle. In phase 1, define, we explored our target population and target health problem (infrequent condom use among male ED patients) by collecting key stakeholder input and conducting in-depth interviews with male patients and urban ED medical providers. In phase 2, discover, we partnered with a digital product agency to explore user experience and digital strategy. In phase 3, design, we refined Dr. Eric's content, a 5-part sexual health educational module and a 10-week SMS text messaging program that focuses on condom use and partner communication about effective contraceptives. We conducted semistructured interviews with male adolescent and young adults to gather feedback on the app and perform usability testing, editing the app after each interview. We also interviewed informatics experts to assess the usability of a high-fidelity prototype. Interviews were recorded and analyzed via descriptive thematic analysis; informatic expert feedback was categorized by Nielsen's heuristic principles. In phase 4, develop, we created the technical architecture and built a responsive web app. These findings were gathered leading to the final version of the digital Dr. Eric program. RESULTS: Using data and key stakeholder input from phases 1 and 2, we iteratively created the Dr. Eric prototype for implementation in the ED setting. Interviews with 8 adolescent and young adult male ED patients suggested that users preferred (1) straightforward information, (2) a clear vision of the purpose of Dr. Eric, (3) open-ended opportunities to explore family planning goals, (4) detailed birth control method information, and (5) games presenting novel information with rewards. Five usability experts provided heuristic feedback aiming to improve the ease of use of the app. These findings led to the final version of Dr. Eric. CONCLUSIONS: Following these mobile health development phases, we created a digital sexual health mobile health intervention incorporating the principles of user experience and interface design. Dr. Eric needs further evaluation to assess its efficacy in increasing condom use among adolescent and young adult male ED patients. Researchers can use this framework to form future digital health ED-based digital interventions.

How Other Specialists See Palliative Care Uncovering Their Deep Metaphors to Improve Our Initial Outreach Strategies.

Many patients who could benefit from palliative care (PC) do not access it because of the timing and tenor of the introduction provided by their specialist. A barrier to improving specialists' (from disciplines other than PC) engagement with PC services may be an inadequate understanding of how those specialists view PC. As part of a larger project to develop public messaging for advance care planning, PC, and hospice, we conducted a qualitative market research study aimed at identifying the "deep metaphors" held by specialists about PC to provide an empirical foundation for more effective outreach and messaging. To identify deep metaphors, we used the qualitative Zaltman Metaphor Elicitation Technique to uncover thought patterns from participants' images and interview responses, revealing deeper emotional meanings and unconscious mental orientations. We enrolled 20 provider-level clinicians from a variety of professional disciplines and specialties to participate in a one-hour semi-structured interview that required prework. The interviews were videorecorded and transcribed and were analyzed along with images brought by participants using a variation of the constant comparative method. The themes included: Having to tell patients the "right" information and path; Not allowing myself to make mistakes; Depending on algorithms so I can give my patients the best care; Putting the patient in charge can challenge clinical algorithms; Observing that PC seems to lack an objectively "right" decision; Consulting PC invites subjectivity best contained at the end of the algorithm. These themes can inform strategies for outreach and messaging to other serious illness specialist clinicians to lower reluctance to consult PC, increasing patient access.

Design of a Temporally Augmented Text Messaging Bot to Improve Adolescents' Physical Activity and Engagement: Proof-of-Concept Study.

BACKGROUND: Digital interventions hold promise for improving physical activity in adolescents. However, a lack of empirical decision points (eg, timing of intervention prompts) is an evidence gap in the optimization of digital physical activity interventions. OBJECTIVE: The study examined the feasibility and acceptability, as well as the technical and functional reliability, of and participant engagement with a digital intervention that aligned its decision points to occur during times when adolescents typically exercise. This study also explored the impact of the intervention on adolescents' moderate to vigorous physical activity (MVPA) levels. Consistent with the Obesity-Related Behavioral Interventions Trials (ORBIT) model, the primary goal of the study was to identify opportunities to refine the intervention for preparation for future trials. METHODS: Ten adolescents completed a 7-day baseline monitoring period and Temporally Augmented Goal Setting (TAGS), a 20-day digital physical activity intervention that included a midday self-monitoring message that occurred when adolescents typically start to exercise (3 PM). Participants wore an accelerometer to measure their MVPA during the intervention. Participants completed questionnaires about the acceptability of the platform. Rates of recruitment and attrition (feasibility), user and technological errors (reliability), and engagement (average number of text message responses to the midday self-monitoring message) were calculated. The investigation team performed multilevel models to explore the effect of TAGS on MVPA levels from preintervention to intervention. In addition, as exploratory analyses, participants were matched to adolescents who previously completed a similar intervention, Network Underwritten Dynamic Goals Engine (NUDGE), without the midday self-monitoring message, to explore differences in MVPA between interventions. RESULTS: The TAGS intervention was mostly feasible, acceptable, and technically and functionally reliable. Adolescents showed adequate levels of engagement. Preintervention to intervention changes in MVPA were small (approximately a 2-minute change). Exploratory analyses revealed no greater benefit of TAGS on MVPA compared with NUDGE. CONCLUSIONS: TAGS shows promise for future trials with additional refinements given its feasibility, acceptability, technical and functional reliability, participants' rates of engagement, and the relative MVPA improvements. Opportunities to strengthen TAGS include reducing the burden of wearing devices and incorporating of other strategies at the 3 PM decision point. Further optimization of TAGS will inform the design of a Just-in-Time Adaptive Intervention for adolescent physical activity and prepare the intervention for more rigorous testing.

The impact of health and environmental messaging with and without product filtering in complex retail markets: the case of pulses.

Introduction: Multiple barriers exist to healthy and environmentally sustainable food choices. Limited consumer understanding of the health and environmental implications of food choices complicates their abilities to make choices that lead to desired outcomes. The complexity of the retail environment itself may crowd out less immediate motivations to address health or environment. Even if consumers understand general impacts of food choices on health and environmental outcomes, there may be non-negligible time and search costs to identifying the products that meet consumers' needs. In many food categories, the foods containing attributes that help achieve health and sustainability outcomes may represent a small percentage of available products. In this research, we examine the case of pulses-beans, chickpeas, lentils, and dry peas. Pulses are nutritious and have a low environmental impact. However, consumption of pulses in the US is quite low, which may be attributable to low consumer knowledge of pulse benefits, as well as difficulty of identifying pulse products in retail environments. Methods: In this research, we examine the choice of pulse-based foods in three conditions: (1) a control condition, (2) a messaging condition communicating the health and environmental benefits of pulse products, and (3) a paired messaging condition with a choice environment intervention that allows respondents to choose to filter products to those that contain pulses. Participants selected a food item from each of six food categories. Results: We find slight, but significant, increases in pulse choice in the messaging only condition relative to the control condition, but dramatic and highly significant increases when participants can filter the products to easily view pulse products. We also find evidence for knowledge being a barrier to healthy/sustainable food choice. Participants exposed to the messaging were more likely to view pulses as environmentally beneficial, and less likely to report that they did not know the health or environmental impacts of pulse foods. Discussion: We find that paired messaging and filtering interventions significantly increase the choice of pulse-based foods, which offer both human health and sustainability benefits.

Registered Nurses' Digital Client Work and Associating Factors: A Cross-Sectional Study.

AIMS: To describe the frequency of digital client work among Finnish registered nurses, including video consultations, secured messaging and digital promotion of care without direct contact with the client. In addition, the study examines the association between various factors related to nurses' characteristics and work environment with digital client work and its frequency. DESIGN: A cross-sectional survey study. METHODS: A total of 2970 nurses responded to a nationwide survey in spring 2023. Descriptive statistics were used to characterise the frequency of different types of digital client work. Binary logistic regression analyses were used to examine the associations. RESULTS: One-third of the respondents reported digital client work during the last 6 months. The majority had worked digitally with their clients daily or weekly. Secured messaging was the most frequently used type of digital client work, whereas video consultations were less frequent. Nurses working in acute care, home-based care or other environments worked more frequently digitally with their clients than those working in inpatient care. Nurses with higher digital dedication and collegial support had greater odds of digital client work than those with lower dedication. Among those who reported frequent digital client work, lower skills in information security were observed. CONCLUSIONS: Given the significant variation in the frequency of digital client work among nurses across different environments, assessing broader digitalisation adoption opportunities is essential. Organisations must ensure that nurses have sufficient skills for secure handling of client data, and efforts should be made in creating motivational and supportive work environments to facilitate digital client work. IMPLICATIONS: By understanding the factors influencing nurses' digital client work, organisations can create stronger structures to support their work. Enhancing digital service availability across different healthcare settings would offer clients more care options, thereby potentially improving their access to healthcare. IMPACT: This research addresses a knowledge gap regarding the current extent of nurses' digital client work in various healthcare environments and explores potential influencing factors. As governments aim to significantly expand the provision of digital healthcare services, understanding the variation in nurses' digital client work is crucial. This information can guide targeted interventions, such as continuous education, and organisational and collegial support, facilitating dedication to use digital technologies and ensuring secure and impactful advancements in digital healthcare. Our research will benefit healthcare organisations, decision-makers, nursing professionals and educational institutions. REPORTING METHOD: Our study adheres to the relevant EQUATOR guidelines and follows the STROBE checklist for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Public Health Messaging to Older Adults About Hypertension.

Hypertension is a major risk factor for cardiovascular disease, cognitive decline, and frailty. Given the increasing burden of hypertension in the aging population, it is imperative to improve hypertension management in that population. Apart from variations in treatment goals, challenges such as polypharmacy, medication side effects, and therapeutic inertia hinder adherence to guideline-directed medical therapies among older people. Effective public health messaging is essential for spreading evidence-based guidelines, raising awareness among clinicians, enhancing patient education and health literacy, and implementing community-based strategies to tackle hypertension. This review examines the current state of public messaging on hypertension in older adults.

Tailored text-messaging versus standard Quitline telephone counselling for smoking cessation among people who smoke from a low-socio-economic status background in Australia: A study protocol for a non-inferiority randomized controlled trial (The Quit By Phone Study).

BACKGROUND AND AIMS: Signficant inequalities in tobacco smoking exist, with higher smoking rates among people from low-socio-economic status (low-SES) populations. Tailored technology-based programs for low-SES smoking populations have the potential for high reach, but require effectiveness data from large-scale trials. This trial among Australians who smoke from a low-SES background will determine the effectiveness and cost-effectiveness of tailored text-message (TTM) support compared with standard Quitline (SQL) telephone support service. DESIGN, SETTING AND PARTICIPANTS: This is a two-arm, parallel group, randomized, non-inferiority trial with allocation concealment and blinded outcome assessment in an Australian population within the greater Sydney region in New South Wales. Participants are adults who smoke daily (n = 1246), are interested in quitting and currently receiving a government pension or allowance, and will be recruited via advertisements. INTERVENTION AND COMPARATOR: Participants will be randomized (1:1 ratio) to receive either 12 months of TTM quit support or enrolment in SQL telephone support. MEASUREMENTS: Assessments will be completed at baseline (telephone interview), within 1 month (check-in call), at 3 months (on-line questionnaire) and 12 months (telephone interview) post-randomization. The primary outcome will be 6-month continuous abstinence verified by carbon monoxide breath test at 12-month follow-up. The study will test whether TTM is non-inferior to SQL by a non-inferiority margin of 2%, i.e. the quit rate in the TTM group will be no worse than 2% less than the quit rate in the SQL group. Secondary outcomes will include self-reported continuous and point prevalence abstinence and acceptability and cost-effectiveness of TTM versus SQL. CONCLUSION: Should the tailored text-message support prove non-inferior and more cost-effective than Quitline for this population, this will provide an opportunity for the upscaling of an effective, inexpensive and tailored quit support service. The trial findings will inform cessation treatment policy for priority populations in Australia and globally.

Using Text Messaging Surveys in General Practice Research to Engage With People From Low-Income Groups: Multi-Methods Study.

BACKGROUND: SMS text messages through mobile phones are a common means of interpersonal communication. SMS text message surveys are gaining traction in health care and research due to their feasibility and patient acceptability. However, challenges arise in implementing SMS text message surveys, especially when targeting marginalized populations, because of barriers to accessing phones and data as well as communication difficulties. In primary care, traditional surveys (paper-based and online) often face low response rates that are particularly pronounced among disadvantaged groups due to financial limitations, language barriers, and time constraints. OBJECTIVE: This study aimed to investigate the potential of SMS text message-based patient recruitment and surveys within general practices situated in lower socioeconomic areas. This study was nested within the Reducing Alcohol-Harm in General Practice project that aimed to reduce alcohol-related harm through screening in Australian general practice. METHODS: This study follows a 2-step SMS text message data collection process. An initial SMS text message with an online survey link was sent to patients, followed by subsequent surveys every 3 months for consenting participants. Interviews were conducted with the local primary health network organization staff, the participating practice staff, and the clinicians. The qualitative data were analyzed using constructs from the Consolidated Framework for Implementation Research. RESULTS: Out of 6 general practices, 4 were able to send SMS text messages to their patients. The initial SMS text message was sent to 8333 patients and 702 responses (8.2%) were received, most of which were not from a low-income group. This low initial response was in contrast to the improved response rate to the ongoing 3-month SMS text message surveys (55/107, 51.4% at 3 months; 29/67, 43.3% at 6 months; and 44/102, 43.1% at 9 months). We interviewed 4 general practitioners, 4 nurses, and 4 administrative staff from 5 of the different practices. Qualitative data uncovered barriers to engaging marginalized groups including limited smartphone access, limited financial capacity (telephone, internet, and Wi-Fi credit), language barriers, literacy issues, mental health conditions, and physical limitations such as manual dexterity and vision issues. Practice managers and clinicians suggested strategies to overcome these barriers, including using paper-based surveys in trusted spaces, offering assistance during survey completion, and offering honoraria to support participation. CONCLUSIONS: While SMS text message surveys for primary care research may be useful for the broader population, additional efforts are required to ensure the representation and involvement of marginalized groups. More intensive methods such as in-person data collection may be more appropriate to capture the voice of low-income groups in primary care research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.3399/BJGPO.2021.0037.

Correcting misperceptions about very low nicotine cigarettes for cigarette-only smokers, dual/poly smokers, other tobacco users, and non-tobacco users.

Background: The U.S. Food and Drug Administration authorized the sale and marketing of two very low nicotine cigarettes (VLNC) as modified risk tobacco products. The misperception that VLNC are healthier than regular cigarettes is common. This study explores effective message strategies to inform the public about health risks associated with VLNC use, encourage cigarette smokers to try VLNC, and prevent other tobacco users and non-users from product initiation. Methods: Following the Reasoned Action approach, a VLNC educational message was developed based on the salient beliefs associated with behavioral intention. The message was tested in an online survey conducted in 2018, where 410 participants were randomly assigned to one of the two message conditions (no-message, VLNC message). Message effects were assessed across four tobacco-use groups (non-tobacco users, cigarette-only smokers, cigarette dual/poly smokers, other tobacco users). Results: Compared to the no-message control, the VLNC message condition showed lower nicotine risk perception for all participants, lower misbelief in VLNC safety for non-users and cigarette-only smokers, higher belief in VLNC carcinogenicity for other tobacco users, stronger belief in second-hand smoke harm for cigarette dual/poly smokers and other tobacco users, and higher VLNC intention for cigarette-only smokers. Conclusions: Different messages are needed for different types of tobacco users. Both cigarette smokers and other tobacco users could benefit from messages that acknowledge the non-addictiveness but emphasize the health risks of VLNC. Regulators could consider making physical harm statements a requirement for VLNC packaging and marketing. New strategies need to be explored to inform cigarette dual/poly smokers.

Efficacy of Behavioral Intervention, Text Messaging, and Extended Intervention to Address Alcohol Misuse in Sexual Minority Men with HIV: A Factorial Randomized Clinical Trial.

This clinical trial examined the individual and combined effects of three different approaches to reducing alcohol misuse among a sample of sexual minority men (SMM) with HIV. Specifically, we used a 2 × 2 × 2 randomized factorial design to compare: (a) behavioral intervention based in motivational interviewing (MI) vs. brief intervention (BI), (b) interactive text messaging (ITM) for alcohol use vs. no ITM, and (c) extended intervention (EI) length of nine months vs. a one-month intervention duration. Participants (N = 188) were SMM with HIV and alcohol misuse recruited in Miami, FL, and Boston, MA. Participants were randomized to one of eight intervention combinations and assessed at 6- and 12-month follow-ups. Large reductions of over 50% in drinks per week and heavy drinking days were observed in all conditions at follow-up. Those who received ITM, compared to those who did not, reported significantly lower drinks consumed per week at 6 and 12 months (incidence rate ratios = 0.73 [95% CI = 0.57, 0.90] and 0.72 [95% CI = 0.56, 0.87], respectively), and increased odds of cessation of alcohol misuse at 12 months, odds ratio = 1.46, 95% CI = 1.03, 2.08. Results provided no evidence of better alcohol use outcomes for either MI or EI relative to their comparison conditions, and no specific combination of intervention components demonstrated a notable benefit. This study suggests a two-session BI can effectuate substantial reductions in alcohol use in SMM with HIV and that adding one month of ITM can yield further improvements. Clinical Trials Number: NCT02709759.

Messaging Preferences about the COVID-19 Vaccine among Adults in Eastern North Carolina.

Racially and ethnically diverse populations and individuals residing in rural areas were disproportionally impacted by the coronavirus pandemic, and Eastern North Carolina (ENC) is one region where such impacts were apparent. To understand at-risk individuals' perceptions and hesitancy to COVID-19 vaccines and the preferred means of receiving vaccination-related messages, we conducted four qualitative focus groups (N = 40) with diverse rural ENC residents. The analysis of the focus group transcripts revealed five themes: (1) reasons people trusted the COVID-19 vaccines, (2) reasons people mistrusted the COVID-19 vaccines, (3) the best means to deliver messages regarding COVID-19 vaccination, (4) the individuals trusted most to deliver such messages, and (5) the decisions people made regarding whether to get vaccinated and how that was connected to God. By incorporating participant perspectives and preferences in receiving messaging into campaigns, there is a potential for greater vaccine uptake.

Participant experiences with a text message and contingency management intervention for alcohol use during pregnancy and lactation in Cape Town, South Africa.

Background: The Western Cape region of South Africa has one of the highest global rates of Fetal Alcohol Spectrum Disorder (FASD), underscoring the urgent need for effective interventions. This qualitative study explores pregnant and lactating participants' perceptions and experiences of a text message and contingency management (CM) intervention. Methods: The study involved post-intervention interviews with 10 pregnant participants and 10 post-partum lactating participants. Coding and a thematic analysis approach were applied to the collected data using NVivo 12. Results: Four main themes emerged from the analysis: (1) program experiences; (2) intervention components; (3) health behavior change; and (4) recommendations for program improvements. The participants valued financial incentives and health-promoting text messages, noting reduced alcohol consumption. Conclusion: The findings highlighted the potential benefits of the intervention in improving individuals' health behaviors. However, logistical barriers and the need for expanded support services were identified, emphasizing the importance of refining intervention strategies in resource-limited settings.

Comparing Email Versus Text Messaging as Delivery Platforms for Supporting Patients With Major Depressive Disorder: Noninferiority Randomized Controlled Trial.

BACKGROUND: The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging-based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain. OBJECTIVE: This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care. METHODS: A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5). RESULTS: Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded "No" to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: -1.90, 95% CI -6.53 to 2.74; 5.78, 95% CI -1.94 to 13.50; and 11.85, 95% CI -3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life. CONCLUSIONS: The study's findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/.

Behaviour change intervention (education and text) to prevent dental caries in secondary school pupils: BRIGHT RCT, process and economic evaluation.

Background: The presence of dental caries impacts on children's daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae. Objectives: To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils. Design: A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations. Setting: Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school. Participants: Pupils aged 11-13 years at recruitment, who have their own mobile telephone. Interventions: Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils' mobile phones about toothbrushing, compared with routine education. Main outcome measures: Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children). Results: Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (£1.02, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution. Conclusions: Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility. Trial registration: This trial is registered as ISRCTN12139369. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.

Tooth decay has an impact on children and young people's daily lives, particularly those living in deprived areas. For young children, programmes to improve toothbrushing with fluoride toothpaste help prevent tooth decay. The Brushing RemInder 4 Good oral HealTh trial (BRIGHT) investigated whether a secondary-school-based toothbrushing programme would work. We developed a new programme which included a lesson and twice-daily text messages sent to pupils' phones. In total, 4680 pupils, aged 11­13 years, from 42 secondary schools in the United Kingdom took part in the trial. At each school, one year group was randomly selected to receive the programme, while the other year group did not receive it. All pupils were followed up for 2.5 years to see whether there were any differences in levels of tooth decay, frequency of toothbrushing, plaque or quality of life. We also considered the programme's value for money and the views of pupils and school staff. We followed up 2383 pupils and found no difference in tooth decay, plaque or quality of life. We found those who had the programme were more likely to brush their teeth twice daily after 6 months than those who did not. The programme was not good value for money overall. However, the programme appeared to be of more benefit at preventing tooth decay in pupils eligible for free school meals compared to those not eligible. In the schools with more pupils eligible for free school meals, the chance of the programme representing good value for money increased. The programme was generally liked by the pupils and school staff. Some pupils found the text messages useful, although others said they were annoying. The programme helped pupils brush their teeth more frequently in the short term, but this did not lead to less tooth decay. Further research is needed to understand how to prevent tooth decay in secondary-school pupils.

Evolutionary Trends in the Adoption, Adaptation, and Abandonment of Mobile Health Technologies: Viewpoint Based on 25 Years of Research.

Over the past quarter-century, mobile health (mHealth) technologies have experienced significant changes in adoption rates, adaptation strategies, and instances of abandonment. Understanding the underlying factors driving these trends is essential for optimizing the design, implementation, and sustainability of interventions using these technologies. The evolution of mHealth adoption has followed a progressive trajectory, starting with cautious exploration and later accelerating due to technological advancements, increased smartphone penetration, and growing acceptance of digital health solutions by both health care providers and patients. However, alongside widespread adoption, challenges related to usability, interoperability, privacy concerns, and socioeconomic disparities have emerged, necessitating ongoing adaptation efforts. While many mHealth initiatives have successfully adapted to address these challenges, technology abandonment remains common, often due to unsustainable business models, inadequate user engagement, and insufficient evidence of effectiveness. This paper utilizes the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework to examine the interplay between the academic and industry sectors in patterns of adoption, adaptation, and abandonment, using 3 major mHealth innovations as examples: health-related SMS text messaging, mobile apps and wearables, and social media for health communication. Health SMS text messaging has demonstrated significant potential as a tool for health promotion, disease management, and patient engagement. The proliferation of mobile apps and devices has facilitated a shift from in-person and in-clinic practices to mobile- and wearable-centric solutions, encompassing everything from simple activity trackers to advanced health monitoring devices. Social media, initially characterized by basic text-based interactions in chat rooms and online forums, underwent a paradigm shift with the emergence of platforms such as MySpace and Facebook. This transition ushered in an era of mass communication through social media. The rise of microblogging and visually focused platforms such as Twitter(now X), Instagram, Snapchat, and TikTok, along with the integration of live streaming and augmented reality features, exemplifies the ongoing innovation within the social media landscape. Over the past 25 years, there have been remarkable strides in the adoption and adaptation of mHealth technologies, driven by technological innovation and a growing recognition of their potential to revolutionize health care delivery. Each mobile technology uniquely enhances public health and health care by catering to different user needs. SMS text messaging offers wide accessibility and proven effectiveness, while mobile apps and wearables provide comprehensive functionalities for more in-depth health management. Social media platforms amplify these efforts with their vast reach and community-building potential, making it essential to select the right tool for specific health interventions to maximize impact and engagement. Nevertheless, continued efforts are needed to address persistent challenges and mitigate instances of abandonment, ensuring that mHealth interventions reach their full potential in improving health outcomes and advancing equitable access to care.

Exploring the utility of a social norm approach in reducing younger drivers' engagement in hand-held phone use while driving: A qualitative study.

INTRODUCTION: Engagement in hand-held phone use while driving among young drivers is a prevalent concern in society, despite countermeasures to deter the behavior. The social norm approach has been effective in reducing negative behaviors in young adults (e.g., binge drinking, drink driving). However, whether this approach can reduce hand-held phone use while driving in this population has not been thoroughly investigated. METHOD: The qualitative study explored young drivers' attitudes and opinions on social norm messages designed to reduce hand-held phone use while driving. In addition, young drivers' opinions on current campaigns were explored to provide further insight into the effectiveness of these messages. Thirty young drivers were interviewed and shown six social norm messages. RESULTS: The data were analyzed using reflexive thematic analysis, resulting in five themes and one sub-theme: (1) Road safety messages with minimal impact on hand-held phone use while driving; (2) What constitutes an effective road safety message for hand-held phone use while driving; (3) Comparisons between social norm messages and road safety messages; (4) The potential benefits of combined social norms, (4a) Improving and optimizing the message; and (5) "It's kinda just numbers on a screen": Negative views on social norm messages. Results highlight the diverse opinions towards road safety campaigns and the need to increase exposure to these messages. Further, a combined social norm message was perceived as most effective in reducing engagement in hand-held phone use while driving. CONCLUSIONS: The current study provides preliminary evidence that the social norm approach may be effective in reducing hand-held phone use among young drivers. Further, this study highlights the need to maximize exposure to phone use while driving campaigns in this high-risk cohort. PRACTICAL APPLICATIONS: Results support the development of a social norm messaging intervention to reduce young drivers hand-held phone use while driving.

Leveraging Personal Technologies in the Treatment of Schizophrenia Spectrum Disorders: Scoping Review.

BACKGROUND: Digital mental health is a rapidly growing field with an increasing evidence base due to its potential scalability and impacts on access to mental health care. Further, within underfunded service systems, leveraging personal technologies to deliver or support specialized service delivery has garnered attention as a feasible and cost-effective means of improving access. Digital health relevance has also improved as technology ownership in individuals with schizophrenia has improved and is comparable to that of the general population. However, less digital health research has been conducted in groups with schizophrenia spectrum disorders compared to other mental health conditions, and overall feasibility, efficacy, and clinical integration remain largely unknown. OBJECTIVE: This review aims to describe the available literature investigating the use of personal technologies (ie, phone, computer, tablet, and wearables) to deliver or support specialized care for schizophrenia and examine opportunities and barriers to integrating this technology into care. METHODS: Given the size of this review, we used scoping review methods. We searched 3 major databases with search teams related to schizophrenia spectrum disorders, various personal technologies, and intervention outcomes related to recovery. We included studies from the full spectrum of methodologies, from development papers to implementation trials. Methods and reporting follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: This search resulted in 999 studies, which, through review by at least 2 reviewers, included 92 publications. Included studies were published from 2010 to 2023. Most studies examined multitechnology interventions (40/92, 43%) or smartphone apps (25/92, 27%), followed by SMS text messaging (16/92, 17%) and internet-based interventions (11/92, 12%). No studies used wearable technology on its own to deliver an intervention. Regarding the stage of research in the field, the largest number of publications were pilot studies (32/92, 35%), followed by randomized control trials (RCTs; 20/92, 22%), secondary analyses (16/92, 17%), RCT protocols (16/92, 17%), development papers (5/92, 5%), and nonrandomized or quasi-experimental trials (3/92, 3%). Most studies did not report on safety indices (55/92, 60%) or privacy precautions (64/92, 70%). Included studies tend to report consistent positive user feedback regarding the usability, acceptability, and satisfaction with technology; however, engagement metrics are highly variable and report mixed outcomes. Furthermore, efficacy at both the pilot and RCT levels report mixed findings on primary outcomes. CONCLUSIONS: Overall, the findings of this review highlight the discrepancy between the high levels of acceptability and usability of these digital interventions, mixed efficacy results, and difficulties with sustained engagement. The discussion highlights common patterns that may underscore this observation in the field; however, as this was a scoping review, a more in-depth systematic review or meta-analysis may be required to better understand the trends outlined in this review.