Design and multi-country validation of SMS for an mHealth, behavioral change, randomized clinical trial on primary prevention of progression to hypertension
Date Submitted: Oct 31, 2014
Open Peer Review Period: Oct 31, 2014 - Dec 26, 2014
Background: Mobile health (mHealth) has been posited to contribute to reduction in health gaps, showing fast and wide spread into developing countries. This growth demands understanding of and preparedness for local cultural contexts. Objective: To describe the design and validation of text messages (SMS) to be used for an mHealth behavioral change intervention to prevent hypertension in three Latin American countries: Argentina, Guatemala, and Peru. Methods: An initial set of 64 SMS were designed to promote healthy lifestyles among individuals in different stages of behavior change, addressing four key domains: salt and sodium intake, fruit and vegetable intake, consumption of high fat and sugar foods, and physical activity. The 64 SMS were organized in nine subsets for field validation. In each country, 36 people, half of them male, were recruited. Four participants per country evaluated each subset of SMS, which had between 6 and 8 SMS of different key domains and stages of change. Understanding and appeal of each SMS was assessed using a 7-item questionnaire. Understanding and appeal ratings were used to reach a final set of 56 SMS. Results: Overall, each of the 64 SMS received a total of 12 evaluations (4 per country). The majority of evaluations, 96.7% of a total of 767, revealed an adequate understanding of the key idea contained in the SMS. On a scale from 0-10, the average appeal score was 8.7 points (range 4-10 points). Based on their low scores, eight SMS per country were discarded. Once the final set of 56 SMS was identified, and based on feedback obtained in the field, wording and content of some SMS was improved: 9 SMS in Argentina, 8 SMS in Guatemala and 16 SMS in Peru. Most SMS selected for the final set (49/56) were the same in all countries, except for small wording differences. Conclusions: The final set of SMS produced had very high rates of understanding and appeal in three different Latin American countries. This study highlights the importance of developing and validating a package of simple preventative SMS, grounded on evidence and theory, across three different Latin American countries with active engagement of end-users.