Harness the Power Of Mobile Technology

More than two-thirds of the world’s population now own a mobile phone.¹ While smartphones have advanced data communication capabilities that enable users to access the Web and use global positioning systems, even the most basic cell phones can send and receive text messages. Texting, while often thought of as the purview of teenagers or even a bad habit, may serve a purpose in the health care arena by providing support to health care consumers to increase healthy behaviors.

An important function of health care services is to encourage and support consumers in the adoption of positive behaviors and management of chronic diseases in order to improve health outcomes. Though time is limited during face-to-face consultations, mobile technologies, such as cell phones and tablets, have the potential to transform the delivery of health messaging. Advantages offered by cell phones over other mobile devices include their relatively low cost, widespread use, and limited processing power needed to record, store, organize, and broadcast real-time information.²

A text is typed information known as a short message service (SMS) sent cell phone to cell phone or another mobile device.³ Text messages, unlike reading materials such as pamphlets, can be stored and easily retrieved at any time, making them an extremely accessible means of receiving information. Text messages are difficult to ignore, as the notification for a new message keeps signaling until the message is read. Furthermore, even if a cell phone has been turned off, the messages will be delivered once it is turned back on. Texting is a powerful tool for behavior change because it is widely available, inexpensive, and instant.

PARTNERING FOR BETTER HEALTH

The United States Department of Health and Human Services established a Text4Health Task Force in November 2010 to identify existing initiatives and recommend strategies to promote the development, implementation, evaluation, and coordination of health text messaging programs.³ The infrastructure of mobile technology presents an opportunity to improve health and health care through new forms of interactive mobile health (mHealth) SMS that promote personal wellness, preventive care, and disease management.

The McMillen Center for Health Education in Fort Wayne, Indiana, established in 1981, is a nonprofit organization dedicated to providing effective and preventive health education that promotes physical, emotional, and social well-being. In 2012, the McMillen Center developed the Brush!^® Early Childhood Oral Health Curriculum in an effort to improve children’s oral health status and prepare them to enter kindergarten. The organization advocates for the establishment of a dental home by age 1 and promotes oral health education for all who influence a child’s health status, including parents, caregivers, educators, and health practitioners. Children in the US miss more than 51 million hours of school each year due to dental-related illnesses. As such, the Brush! curriculum focuses on caries prevention in infants and young children.⁴ The goal of Brush! is to encourage children and their parents to establish a habit of daily dental hygiene and regular dental visits.

One strategy Brush! uses is weekly text messages that encourage and educate parents. Many texts are accompanied by a short video. The use of short videos supports the learning theory that presenting information with media including text, audio, and visual aids can enhance understanding and decrease the complexity of the message.⁵ The text messaging program reaches more than 60,000 parents nationwide whose children are receiving the Brush! curriculum through their preschools, primarily Head Start centers. Parents can sign up on the Brush! website(brushdental.org) or text BRUSH to 35350 to register for free weekly text messages on oral health. The McMillen Center is also testing a 5-week multimedia text intervention to rural Head Start parents and children. An example text message on brushing children’s teeth at bedtime can be found at: bit.ly/btsw05p.

Another example is the Text2Floss program started by Tony Hashemian, DDS, in 2012 at the A.T. Still Arizona School of Dentistry &Oral Health in Mesa. Text2Floss, another two-way text messaging program, is a collaboration with the university and CellTrust Corp. Endorsed by organizations such as the American Dental Hygienists’ Association and the International Federation of Dental Hygiene, users send “text2floss” to 89633. Oral health messages are based on various categories such as expectant mothers, mothers with children, teens 13 to 18, adults 18 to 65, and adults older than 65. Text2Floss has proven positive outcomes. In an article in the Journal of Public Health Dentistry, Hashemian et al⁶ reported that mothers who received the text messages for 7 days improved their own oral health behaviors and knowledge, as well as their behaviors regarding their child’s oral health. Since then, an app for both the iPhone and iPad has been developed. Text2Floss reminds users to brush twice daily and floss and rinse every day. Other highlights include a dental hygiene timer,medical history recorder, and a dental clinic locator. The application also discusses the importance of oral health in overall health and wellness.

Other examples of using text messaging in health interventions include tobacco cessation, prenatal and well-child care, exercise and fitness, and medication adherence. Smart phones are increasingly important for the growth of mHealth, as evidenced by the rise in the development and use of health-related software applications.³

CONCLUSION

The widespread adoption of new methods of communication provides opportunities to improve health behaviors. Text messaging can facilitate better oral health by helping patients improve self-care and by encouraging them to access appropriate professional care when needed. mHealth is a simple and effective means of delivering such information.

REFERENCES

1. Rippe JM. Lifestyle Medicine. London: CRC Press; 2013:250.
2. Riley P. mHealth: The tool you can’t afford to do without. Presented at: SHOPS and mHealth Alliance Hold Online Conference: Using Mobile Technologies to Improve Family Planning, MaternalHealth and Newborn Services in the Developing World. May 2010.
3. Health Resources and Services Administration. Using Health Text Messages to Improve ConsumerHealth Knowledge, Behaviors, and Outcomes: An Environmental Scan. Rockville, Maryland: US Department of Health and Human Services; 2014.
4. Brush! Primary Teeth Are Important. Available at: brushdental.org/parent-resources. Accessed October 15, 2015.
5. Florez-Arango JF, Iyengar MS, Dunn K, Zhang J. Performance factors of mobile rich media job aids for community health workers. J Am Med Inform Assoc. 2011;18:131–137.
6. Hashemian T, Kritz-Silverstein D, Baker R. Text2Floss: the feasibility and acceptability of a text messaging intervention to improve oral health behavior and knowledge. J Public Health Dent.2015;75:34–41.

From Dimensions of Dental Hygiene. November 2015;13(11):16–18.