Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jun 7, 2021
Date Accepted: Dec 20, 2021
Improving Adherence to an eHealth Program: A Randomized Controlled Trial Comparing Reminders by Text Message with E-mail
ABSTRACT
Background:
EHealth interventions can help people change behavior, e.g., quit smoking. Reminders by text message (SMS) or e-mail may improve the adherence to web-based programs and increase the probability of successful behavior change, but whether their efficiency is affected by the modality of the communication channel is unclear.
Objective:
A two-armed randomized control trial was conducted to compare the effect of providing reminders via text messages (SMS) versus e-mail on the adherence to an eHealth program for smoking cessation and on the probability to initiate a quitting attempt.
Methods:
Smokers were recruited via online advertisement. A total of 591 participants who diverted from intended use of the program (i.e., failed to log on to a session) were automatically randomized to the experimental (SMS reminder) or the active comparator (e-mail reminder) group.
Results:
Unexpectedly, we found that the mode of the reminders’ delivery did not significantly affect either the adherence, i.e., the number of completed program sessions: SMS reminders group mean 4.30 (SD 3.24); e-mail reminders group mean 4.36 (SD 3.27); t586=0.197, P=.844, Cohen d=0.016) or the outcome, i.e., quit smoking attempt rate (34.2% in SMS group vs. 31.7% in e-mail group, χ²1=0.4, P=.52. Secondary analyses showed that age, gender and education had significant effects on program adherence and education on outcome. Moreover, we found a significant interaction effect between mode of reminder delivery and gender on program adherence, suggesting that the effectivity of SMS 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 did not increase neither program adherence nor the probability of quitting smoking. This suggests that program developers may save costs using e-mails instead of SMS reminders. Clinical Trial: ClinicalTrials.gov NCT03276767
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