Accepted for/Published in: JMIR Formative Research
Date Submitted: Jun 21, 2022
Open Peer Review Period: Jun 21, 2022 - Aug 16, 2022
Date Accepted: Nov 5, 2022
(closed for review but you can still tweet)
A Mobile Phone Text Messaging Intervention to Manage Fatigue for People with Multiple Sclerosis, Spinal Cord Injury, and Stroke: Development and Usability Testing
ABSTRACT
Background:
Fatigue significantly impacts daily functioning for persons with a disability (PwD). Fatigue management can be challenging, and information provided during routine physician visits to manage and improve fatigue can be overwhelming. One way to relieve the burden of fatigue is to increase knowledge, skills, and confidence for self-management (ie, patient activation). Self-management programs have shown promising effects targeting fatigue for PwD. However, current satisfaction with self-management programs is low for PwD, and tailoring interventions based on personalized needs has been recommended. Short message service (SMS) text messaging using mobile phones is increasingly being used to implement health behavior change interventions in a person's natural environment. Little has been done to link mobile health (mHealth) approaches with patient activation and self-management to effectively address fatigue for PwD
Objective:
To develop and pilot test a mobile phone–based fatigue self-management text messaging intervention targeting patient activation levels in 3 groups of PwD: persons with multiple sclerosis, persons who have had a stroke, and persons with a spinal cord injury.
Methods:
We used evidence-based resources and input from a 6-member consumer advisory board (CAB) and a neurologist to develop the content and delivery process. Development and testing of the fatigue self-management SMS intervention was conducted using a 4-step process, which included (1) development of the initial text messaging library, (2) review and modification of the text messages by the CAB and the neurologist, (3) integration of the content library into a digital platform, and (4) utility testing of the prototype by CAB members
Results:
Six CAB participants rated messages covering 9 domain areas of fatigue self-management with good clarity (mean ratings = 3.5–5.0 out of 5) and relevance (mean ratings = 3.2–5.0 out of 5). Overall, the text messaging content was reported by CAB participants as helpful, clear, and well-suited for a mobile health intervention for PwD. The CAB reached consensus on the time of day messages should be sent (morning) and their frequency (once per day). This feedback led the research team to narrow the program to deliver 48 messages over a 12-week period. The final set of messages was programmed into the digital platform with a predefined timed delivery schedule. The usability of the intervention was high, with 55 out of 66 responses (83%) endorsed with the highest rating.
Conclusions:
This study demonstrates a step-by-step process of developing a fatigue self-management text messaging intervention for persons with various disabilities. For PwD, whose access to health services are often limited, this intervention may provide an alternative delivery model to increase access to fatigue information and deliver content that aligns with the person’s readiness and needs. Clinical Trial: ClinicalTrials.gov NCT04893590; http://clinicaltrials.gov/ct2/show/NCT04893590
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Copyright
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