Systematic review of text-messaging interventions to promote healthy behaviors in pediatric and adolescent populations: implications for clinical practice and research

Background: Unhealthy lifestyle behaviors are major public health problems. Promoting positive behavior change is an ongoing challenge that warrants innovative solutions. Mobile phone use is becoming widespread across populations and merits further exploration as a strategy to promote wellness and reduce health disparities.

Aims: The purpose of this paper is to review the evidence using text messaging as a tool to deliver healthy lifestyle behavior intervention programs in pediatric and adolescent populations. The following question was used to guide the systematic review, "In pediatric and adolescent populations, how does the use of text-message-based interventions versus control or comparison interventions affect healthy lifestyle behaviors?"

Methods: A systematic search for relevant literature was conducted in the following databases: MEDLINE, PubMed, Google Scholar, Cochrane Library, and PsycINFO, and by hand-searching bibliographies. Evidence was compiled from experimental studies in peer-reviewed journals published from 2004 to May 15, 2011. Data were extracted using guidelines set forth by the Centre for Reviews and Dissemination.

Results: Thirty-seven articles were identified from the comprehensive search. Eight articles representing seven studies (two articles were published describing different aspects of the outcomes from one study) met inclusion for this review. Mean age of participants in the study ranged from 8.7 to 17.9 years of age. Differences between groups on healthy lifestyle behaviors were significant in five studies.

Conclusions: This review supports previous literature suggesting that mobile phones are uniquely positioned to bridge gaps in health disparities and reach across demographics. Interventions using short messaging service may be most effective as a reminder system to support disease management behaviors. Existing recommendations for tailored, interactive, and family-centered care are supported with mobile technology recommended to augment clinical practice and health behavior change efforts. However, more rigorous, theory-based intervention research using mobile technology is warranted in pediatric and adolescent populations.