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BackgroundThe prevalence of human papillomavirus (HPV) and its related cancers is a major global concern. In the United States, routine HPV vaccination is recommended for youth aged 11 or 12 years. Despite HPV being the most common sexually transmitted infection and the vaccine’s proven efficacy, the vaccination rate among US youth remains below the recommended 80% completion rate. Mobile health (mHealth) interventions have demonstrated promise in improving health. Examining and synthesizing the current evidence about the impact of mHealth interventions on vaccination coverage in youth and intervention characteristics could guide future mHealth interventions aimed at mitigating the vaccination gap and disease burden. ObjectiveThis study aims to conduct a systematic review to assess the effectiveness of mHealth interventions on parental intent to vaccinate youth against HPV and youth’s vaccine uptake. MethodsWe searched empirical papers through databases including Google Scholar, PubMed, CINAHL, PsycINFO, and Cochrane Library. The inclusion criteria were the following: (1) published between January 2011 and December 2022; (2) using mHealth aimed to improve HPV vaccination rate; (3) targeted unvaccinated youth or their parents; and (4) measured HPV-related knowledge, vaccination intention, or vaccine uptake. Overall, 3 researchers screened and appraised the quality of the eligible papers using the Melnyk Levels of Evidence and the Cochrane Grading of Recommendations Assessment, Development, and Evaluation methodology. Disagreements in search results and result interpretation were resolved through consensus. ResultsOverall, 17 studies that met the inclusion criteria were included in the final review. Most studies were conducted in the United States (14/17, 82%), used a randomized controlled trial design (12/17, 71%), and adopted behavior change theories or a culture-centric approach (10/17, 59%). mHealth interventions included SMS text message reminders, motivational SMS text messages, computer-tailored or tablet-tailored interventions, smartphone apps, web-based tailored interventions, social media (Facebook) campaigns, digital videos, and digital storytelling interventions. Approximately 88% (15/17) of the mHealth interventions demonstrated positive effects on knowledge, intention, or behaviors related to HPV vaccination. Overall, 12% (2/17) reported limited or no intervention impact on vaccine uptake or vaccine series completion. Effective vaccine uptake was commonly seen in interventions based on behavior change theories and those that provided culturally relevant information. ConclusionsThis systematic review identified the impact of mHealth interventions among unvaccinated youth and their parents, which showed improvement in HPV-related knowledge, vaccination intention, or vaccine initiation. The interventions that incorporated theories and culture-centric approaches revealed the most promising results. Although these outcomes are encouraging, future studies are needed to investigate factors associated with the success of interventions using SMS text messaging or social media. More studies are also needed for a better understanding of the intervention elements that boost the responses of age-specific and ethnicity-specific populations.
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Evaluating Causal and Noncausal Text Messages to Promote Physical Activity in Adults: Randomized Pilot Study
BackgroundPhysical inactivity increases the risk of chronic disease and reduces life expectancy, yet adherence to physical activity (PA) guidelines remains low. SMS text messages are promising for promoting PA, but it is not clear what type of messaging is most effective. Messages with causal information, which explain why a recommendation is being made, may be more persuasive than messages containing only recommendations. ObjectiveThis study aims to compare the effectiveness of causal versus noncausal SMS text messages for promoting PA in US adults. MethodsIn this pilot study, we randomized US adults (n=28 in the analytic sample) aged 18-64 years to receive causal or noncausal SMS text messages roughly every other day for 2 weeks, following a 1-week baseline. PA was measured using Empatica wristbands during intervention and baseline periods, and the International Physical Activity Questionnaire – Short Form (IPAQ-SF) at baseline, postintervention, and 4 weeks later. The primary outcome was the change in mean metabolic equivalent of tasks (METs) per minute from baseline to intervention. The secondary outcomes were (1) PA differences on intervention and nonintervention days (mean METs/min), (2) changes in self-reported METs per week between surveyed periods, and (3) participant satisfaction. We used a linear mixed model to analyze our primary outcome, the Mann-Whitney U test and the chi-square test of independence to analyze quantitative secondary outcomes, and qualitative coding to analyze survey data. ResultsThe causal message group had a greater increase in mean METs per minute from baseline to intervention compared to the noncausal group with a moderate effect size (P=.01; Cohen d=0.54). In the causal group, PA was significantly higher on SMS text message days (mean 2.46, SD 0.12 METs/min) compared to nonmessage days (mean 2.25, SD 0.15 METs/min; P=.02), while there was no difference in the noncausal group (P=.54). No significant between-group difference was found in self-reported PA or satisfaction. ConclusionsCausal information that links suggested PA to health outcomes can increase the effectiveness of SMS text messages promoting PA, indicating the value of incorporating causal information into intervention design. Our results provide further basis for just-in-time interventions, as activity was higher on message days. Further work is needed to better personalize message content and timing to maintain participant engagement.
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- Award ID(s):
- 1907951
- PAR ID:
- 10649519
- Publisher / Repository:
- JMIR
- Date Published:
- Journal Name:
- JMIR Formative Research
- Volume:
- 9
- ISSN:
- 2561-326X
- Page Range / eLocation ID:
- e80090
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.2196/80090
