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product review: health txts, mobile health intervention

June 18, 2010

in health communication,mobile health

as i wrote about a few weeks ago, i’ve been taking health txts, a mobile phone text messaging service, for a whirl. health txts is a free (while in BETA), easy-to-use service for sending oneself text reminders and motivational messages about a broad number of health behaviors.

setup

registration and setup are dead easy. i logged in, created a username and password, and proceeded to select whether i wanted random or personalized messages for my goal: increasing exercise. i selected to write my own messages, one of the real advantages of this tool, and to schedule them.

health txts profile
if i don’t get to the gym in the morning i often don’t get there at all. knowing that, i scheduled the messages to hit my phone at the time i should leave for the gym, at the time i should just be thinking about getting off the bike because i’m bored, and at the time i’m considering wimping out of a heavier set.

health txts reminders

daily log

day 1: at a conference. couldn’t go.

day 2: hit ignore. feeling guilty, i left for the gym at 10 a.m. and rode the stationary bike for 40 minutes. felt proud.

day 3: ignored. didn’t care.

there you have it. after day 3, i completely ignored my health txts. i kept them in my “inbox” so that i could read the random reminders. i also considered that if i changed my personalized messages, they might rouse me again. but i took no action, and other than keeping the messages, i did nothing.

that’s not to say i didn’t go to the gym. i did, so it wasn’t lack of self-control, as one person suggested. some days i added more weight, some days i didn’t. some days i stayed on the bike for 40 minutes, some days i didn’t. fact was, the health text reminders weren’t altering my behavior as i’d hoped.

observations

so, why didn’t health txts work for me? i have a few thoughts.

  1. it’s possible that my messages weren’t well designed. changing behavior takes times, and yet i’d tuned out my messages after three days. perhaps they weren’t specific enough, even though i wrote them in a way that resonated with me.  i also chose to make them time-based for the reason i mentioned before. one person commented that my making them time-bound might be what kept them from working, but time-bound is what i needed.
  2. i didn’t update the messages. perhaps if i updated the messages, which is easy to do, i would’ve kept things fresh and myself more responsive.
  3. i didn’t try the guided change approach. health txts offers a guided change process, which takes you through a deliberate action planning and contracting process. through the process you answer for yourself why you want to change, list the consequences of not changing, and so on. i’m going to try that next to see whether it keeps me on track.
  4. the random messages are generic. sample messages from the week include “keep your exercise clothes clean. if not, it’s okay to smell as long as u exercise” and “think of how u feel after u exercise.” these may motivate some people, but for me, they’re akin to a poorly-written, mass-distributed newsletter one tosses off because the information’s too bland and already known.
  5. there’s no accountability. with health txts, you don’t log your behavior. that’s part of the simplicity of use. and health txts does not offer a coach who follows up with you. the lack of accounting to someone and the inability to track my progress left me disconnected from my goal. nothing happens, whether i take action or not.

improvements i’d like to see

#1–3: these could be attributed to “user error,” though i think it’s safe to assume most people wouldn’t keep toying with a service. they’d just move on, particularly if it’s a free service. if health txts provided more user-support tools—pros and cons of certain message types, outlined steps for how to get the most from health txts, and FAQs that’d answer questions like “what if i ignore my text messages?” and “how do i keep myself from gaming the system?”—i think that’d make a big difference.

#4: while the random messages didn’t connect with me, i’ve spoken with others who like them. since these are optional, someone like me can just opt out of receiving them.

#5: the fifth observation is where i’d hone in. i’d really like to see opt-in coaching (like the birds and bees text line) and a way to track one’s progress and commitment. changes like these would greatly improve the service.

health txts, if you’re out there listening, i’d love to talk with you about my experience, hear your observations and response, and share those here.

f

Leave a Comment

{ 6 comments… read them below or add one }

Fred June 18, 2010 at 12:40 pm

This is Fred- the founder of Health Txts. Thanks so much for taking the time to really think about the pros and cons of messaging and how to help people improve their health or change a behavior. I have some general comments based on some of our user testing as well as your results. Sorry it didn’t work for you as hoped. As you have indicated we are in Beta mode so all feedback like this is so helpful.
I think that simple reminders to go to the gym as you had done are helpful for the forgetful or mildly motivated but not for the motivated when thinking about a behavior like exercise that requires significant time commitment. Behaviors like eating healthier seem to have more efficacy because you are going to eat no matter what – but a message seems to help you choose what to eat or not eat at the right time. We have also found that if you want to go to the gym we have found you should start motivating yourself earlier rather than at the moment so you are priming yourself to go. Of course we recommend doing guided change to help you think about your problem and motivate yourself through the messages. In terms of the messages you had written I would add significantly more because getting the same message over and over again at the exact same time is not useful (we recommend doing many messages when completing the program). It makes sense that you just ignored them!
In terms of your suggestions – we have a very basic outline of how to write more effective messages on the site under (writing helpful messages) and are in the process of expanding this dramatically based on our beta testing. With regard to “generic expert messages” and interaction we are working on this now. I also think you might try other messages like stress reduction, gratitude or general motivation. Many people have given us feedback that these types of messages help them refocus in the moment and are very helpful. It appears that for exercise most people know what to do already so these generic messages are not as helpful. I did a presentation at Mobile Health 2010 (slides for day one – including mine: http://mobilehealth2010.org/node/9 ) which may give some insight too.
Fortunately we just received a small business development grant from the National Institute of Health to create an assessment and tailored messaging program for addictive behaviors that includes back and forth messaging including tracking progress and all! We should be able to expand this to other behaviors in the future but the only catch here is that it will not be free like our current version of Health Txts. Overall, we are receiving great feedback and constantly trying to improve the service so thanks for your feedback. And to put a plug in for us… we are the only open access multiple messaging service which has the self-written message component along with the expert messages…and all for free. Thanks again Fran. Keep at it – and we will too.
Fred

Reply

fran June 18, 2010 at 1:43 pm

fred,

thank you for reading, commenting, and advising. i see from janet’s comment that doug, the guy who reflected on my self-control, is one of yours. tell him that his comment made me laugh.

i hope my post came across as even-handed. i like a lot about health txts — the option to create self-written messages being a real plus.

the slides are excellent and give me a sense of where you’re taking this. your plans for future direction address observation #5: tailoring, chaining messages (motivational to action), interaction with other tracking tools, and creating a feedback loop. i’m not surprised expanded services like these can’t be free. i do think they’ll add value to your service and be worth the cost.

armed with your recommendations, i’ll go back to the drawing board, and i’ll check back in again soon.

regards,
f

Reply

Janet McNichol June 18, 2010 at 1:02 pm

I’ve been testing out health txts too. I ran into a bug setting them up, but I contacted Douglas Leu at health txts and he identified the problem in the app and corrected it quickly. I opted to personalize the messages because I wanted reminders about one specific thing — I want to make sure I eat within 30 minutes of when I complete my workout. At this point, I’m taking 6 classes a week, so I know when they end and set the reminders to be received 30 minutes after each of my classes. For me, it works. If I’m thinking about it, I know the message is coming and try to have eaten before I get it. If I loose track of time, it’s a good reminder. I have no interest in receiving generic messages. That sounds like the equivalent of junk mail to me, but I found the service helpful in reinforcing a very specific change I want to make.

Reply

fran June 18, 2010 at 1:47 pm

janet, thanks for sharing your experience. it sounds like you’re doing much of what fred suggests makes the service more effective: using it for eating, having it come in advance of whatever action you need to take, and making it motivational. how many messages do you send yourself? what do they say? and have you updated them since you started?

as i said to him, i’m going back to the drawing board with his and your tips.

f

Reply

Paul Smith June 18, 2010 at 1:55 pm

After your first post, I set up a health text message to motivate me to go to the gym. I still have not told you what the message says, but I will say, the first time I received the message on my phone I thought it was spam and it freaked me out. Ahem.
It still comes to my phone everyday and it has never motivated me to go the gym. But it does make me smile. So in a way, not intended, it has worked for me. There’s nothing like a good smile at least once a day.

Reply

Janet McNichol June 18, 2010 at 2:10 pm

My messages are simple.. they say “Eat now!” I receive one message 30 minutes after the completion of each of my scheduled exercise classes. I’m really just using the messages as a reminder not a motivational tool.

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