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how text messaging can change health behaviors: free-ranging conversation with health txts

November 1, 2010

in free-ranging conversations (interviews with wellness innovators),mobile health

fred muench is a clinical psychologist and the founder of mobile health interventions, a company dedicated to using technology to improve mental health. he consults on research projects at the national center on addiction and substance abuse at columbia university. he’s put all of his knowledge to practical use with health txts and in the irreverent “official guide to dysfunctional parenting.” i reviewed health txts a while back. (not the book. i need no help in this department. i’m just blessed.) since then, fred and i caught up by phone to talk about what he learned from the beta test and how text messaging can support desired behavior change.

fran: what’s the idea behind health txts?

fred: health txts was borne out of my background and experience as a psychologist researching mechanisms of change with addictive behaviors. when people are in treatment, they have no craving. but in their natural environment, that craving comes back full force because of all the triggers and memories associated with use. with health txts, we wanted to create a very simple program that’s a reminder of your goals when you’re in your natural environment.

fran: there’s so much focus on health apps for smartphones, yet more people actually own simple mobile phones. is that why health txts uses SMS?

fred: there’s a lot of excitement about new health apps using smartphones—and rightly so. they present an amazing opportunity. however, it seems like everyone’s so focused on the technology as a means to an end that we forget about the process of designing an actual intervention. having GPS on a phone doesn’t mean anything unless you can inspire behavior change using that technology.

SMS is simple and powerful, and we have some understanding of why it probably works: getting a message in your natural environment makes a goal more salient. but this is just the foundation. there’s so much more we can learn to make SMS significantly more powerful—like what type of message is helpful for which type of person at what moment. i think it’s a mistake to dismiss SMS as antiquated when we haven’t done enough research to maximize its potential.

fran: health txts was in beta when we was last spoke. what did you learn?

fred: with health txts, we offer people a number of different message choices, from general motivation to healthy eating to messages on gratitude. we offer the option of getting prewritten, expert texts or of writing your own. our beta users’ top three goals were motivation, exercise and healthy eating.

we found that people really wanted the expert messages; however, in our survey the majority of people said that the messages they wrote themselves were the most helpful. this was interesting because the research we’re doing is attempting to understand how self-modeling and self-written messages increase goal-directed behavior. we also learned that people appear to prefer motivational and action messages to informational messages.

what surprised me the most was that messages designed to help people exercise seemed least helpful. people tend to plan exercise in advance, so getting a message saying “go to the gym” just didn’t really work for people. they needed to have their gym clothes. the messages that people reported were most helpful were the ones that inspired a cognitive shift, like gratitude. people also reported the healthy eating messages were helpful. we’re trying to understand what types of messages work for what types of goals and, more importantly, what types of people.

fran: now that you’re through beta, what’s next?

fred: we have a grant through the national institute of drug abuse (NIDA) to create an interactive messaging system. users will fill out an assessment, and we’ll send them customized messages based on their assessment. the goal is to tailor the expert messages to each individual while also encouraging them to write their own messages. there are others doing similar types of programs with other goals. for example, kevin patrick has created a similar program for weight management. what’s most exciting in the field is ecological momentary assessment, which is follow-up assessment and tailored feedback on the mobile phone over time.

fran: how does this work?

fred: let’s say you were screening employees for burnout. you could create a message: on a scale from 1 to 5, how burnt out do you feel about work? based on what the employee responds, they’d get a tailored reply. with a rating by the employee of 1 or 2, the text might say: “glad to hear you’re not feeling burnt out. if you start to feel overwhelmed, we’re here for you—x243.” whereas with a 4 or 5, it might be: “life can seem overwhelming now. please seek support ASAP at x243. it’s confidential and can really help you improve your life.” the key is to have numerous messages for each response so it doesn’t get repetitive. the intervention possibilities for such systems are endless. however, supportive messaging could just be a simple expansion of an EAP program.

fran: i used health txts as an individual. i didn’t realize you’re also offering this service to companies.

fred: definitely. we have several companies using it for their employees. we have an open access professional program where EAPs or clinicians or whoever can create their own expert message program for their clients or employees. once they create the messaging program, which can include assessment items, employees sign up. alternatively, employees can receive supportive messages (for nearly any goal) using our existing system. interestingly, what we’ve found is that like with individuals, companies prefer off-the-shelf solutions.


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{ 3 comments… read them below or add one }

Janet McNichol November 1, 2010 at 9:24 pm

I set up some health txts to remind myself to eat within 45 minutes of my scheduled workouts. In the beginning, I appreciated getting the reminder so that I didn’t loose track of time. Recently, my scheduled messages have been arriving at weird times instead of when I scheduled them, so I deactivated my account. I still think it’s a neat concept, but the interface is glitchy and they obviously still have some bugs to work out.


fran November 2, 2010 at 4:59 pm

janet, thanks for sharing that feedback. i’ll pass it on to fred.



Fred Muench November 3, 2010 at 1:14 pm

Hi Janet- Sorry about that. Over the past month we switched servers and are working on a new program to send messages. Everyone on the system had some problems. I apologize for that. We are in good shape again. The other thing I realized is that I make it seem like we are done with the Beta phase. That is actually not the case– we are still in beta mode. The revamped site and new programs will be ready in February for a full official launch. Sorry again for those problems. Fred


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