Comparing Reminders Sent via SMS Text Messaging and Email for Improving Adherence to an Electronic Health Program: Randomized Controlled Trial

Adam Kulhánek, Katerina Lukavska, Roman Gabrhelík, Daniel Novák, Václav Burda, Jindřich Prokop, Marianne T S Holter, Håvar Brendryen, Adam Kulhánek, Katerina Lukavska, Roman Gabrhelík, Daniel Novák, Václav Burda, Jindřich Prokop, Marianne T S Holter, Håvar Brendryen

Abstract

Background: eHealth interventions can help people change behavior (eg, quit smoking). Reminders sent via SMS text messaging or email may improve the adherence to web-based programs and increase the probability of successful behavior change; however, it is unclear whether their efficiency is affected by the modality of the communication channel.

Objective: A 2-armed randomized control trial was conducted to compare the effect of providing reminders via SMS text messaging versus email on the adherence to an eHealth program for smoking cessation and on the probability to initiate a quit attempt.

Methods: Smokers were recruited via an internet-based advertisement. A total of 591 participants who diverted from intended use of the program (ie, failed to log on to a session) were automatically randomized to the experimental (SMS text messaging reminder, n=304) or the active comparator (email reminder, n=287) group.

Results: Unexpectedly, we found that the mode of reminder delivery did not significantly affect either the adherence, namely the number of completed program sessions, with the SMS text messaging reminder group showing a mean of 4.30 (SD 3.24) and the email reminder group showing a mean of 4.36 (SD 3.27) (t586=0.197, P=.84, and Cohen d=0.016), or the outcome, namely the quit smoking attempt rate (34.2% in the SMS text messaging group vs 31.7% in the email group; χ21=0.4, P=.52). Secondary analyses showed that age, gender, and education had significant effects on program adherence and education on the outcome. Moreover, we found a significant interaction effect between the mode of reminder delivery and gender on program adherence, suggesting that the effectiveness of SMS text message reminders might be different for females and males. However, this particular finding should be treated with care as it was based on post hoc subgroup analysis.

Conclusions: This study indicates that the modality of user reminders to log on increased neither the program adherence nor the probability of quitting smoking. This suggests that program developers may save costs using emails instead of SMS text messaging reminders.

Trial registration: ClinicalTrials.gov NCT03276767; https://ichgcp.net/clinical-trials-registry/NCT03276767" title="See in ClinicalTrials.gov">NCT03276767.

Keywords: SMS text messaging; adherence; eHealth; email; randomized controlled trial; reminders; smoking cessation; text message.

Conflict of interest statement

Conflicts of Interest: RG is a shareholder of Adiquit Ltd, which is currently developing apps for treatment of addictions. Nevertheless, no funding was related to this study and the activities had no role in the study design or the collection, analysis, and interpretation of the data, writing of the manuscript, or the decision to submit the paper for publication. DN is a shareholder of Adiquit Ltd developing apps for treatment of addictions, Mindpax Ltd, developing digital tools for psychiatry, and Blindshell Ltd, developing mobile phones for visually impaired users. However, no funding was related to this study and the activities had no role in the study design or the collection, analysis, and interpretation of the data, writing of the manuscript, or the decision to submit the paper for publication. The other authors declare no conflicts of interest.

©Adam Kulhánek, Katerina Lukavska, Roman Gabrhelík, Daniel Novák, Václav Burda, Jindřich Prokop, Marianne T S Holter, Håvar Brendryen. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 18.03.2022.

Figures

Figure 1
Figure 1
Flow diagram of participant selection.
Figure 2
Figure 2
Effects of randomized condition (SMS text messaging versus email reminders) and gender on the electronic health program adherence (the number of completed sessions). Estimated marginal means with 95% CIs are shown.

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