Table 2.

Trials Using mHealth Interventions for Lifestyle Behavior Change

Authors (Year)	Sample Characteristics	Country	mHealth tool	Intervention Components	Design	Results
Participants Identified with CVD or Diabetes
Chow et al. (2012)35	720 adults with coronary artery disease	Australia	SMS (4 messages per week for 24 weeks)	Messages to reduce CVD risk factors: motivation to quit smoking, follow a healthy diet, and exercise	RCT: SMS versus usual care 6 month follow-up	Ongoing trial
Handley et al. (2008)36	226 adults with type 2 diabetes	USA	Weekly IVR	IVR patient education and nurse phone counseling	RCT: IVR versus usual care 12 month follow-up	Per-patient cost of $65K per QALY, 14% increase in the proportion of patients achieving vigorous activity relative to controls
Migneault et al. (2012)37	337 urban African-American adults with hypertension	USA	32 weekly IVR counseling sessions	Patient reported health information collected on study-issued home measurement devices with motivational and behavior-change messages targeting medication adherence, physical activity, and diet	RCT: IVR versus usual care 8 month follow-up	Significant improvement in overall diet quality score (p<0.03), fiber intake (p<0.02), and energy expenditure (p=0.02) in the intervention group; no significant differences in medication adherence
Newton et al. (2009)38	78 adolescents from 4 regional diabetes services	New Zealand	Weekly SMS messages	Motivational reminder messages to wear a pedometer and be active	RCT: SMS versus usual care 12 week follow-up	No improvement in physical activity
Nolan et al. (2011)39	680 adults at high risk of CVD or with CVD diagnoses	Canada	6 weekly 1-hour group teleconferences with lifestyle counseling sessions	Baseline advice & education for both groups plus 6 weekly 1-hour teleconference lifestyle counseling sessions	RCT: teleconferencing on lifestyle versus active control (risk factor feedback, brief advice, handouts) 6 month follow-up	Significant improvements in exercise and diet in teleconference group (p<0.001) and in systolic and diastolic BP relative to control (p<0.001)
Reid et al. (2007)40	99 adult smokers recently hospitalized with CVD	Canada	IVR post-hospital discharge calls on days 3, 14, and 30	Questions about smoking status, confidence in staying smoke-free, use of pharmacotherapy, and self-help information with feedback to a nurse who set up phone counseling sessions for those reporting smoking-abstinence problems	RCT: IVR versus usual care 12 month follow-up	Greater proportion abstinent (odds ratio 2.34, 95% CI: 0.92–5.92; p=0.07)
Wong et al. (2013)41	105 professional drivers with pre-diabetes	Hong Kong	SMS 3 times per week for 3 months, then weekly, then monthly	Messages regarding diabetes knowledge and lifestyle modification	RCT: SMS versus usual care 24 month follow-up	Risk of DM onset 5.6% versus 16% at 12 months (RR=.35; 95% CI: .10, 1.24) but non-significant results at 24 months
Other Participants
Appel et al. (2011)42	415 obese adults with at least one cardiovascular risk factor	USA	Weekly website learning modules	Website learning modules (self-monitoring weight, calorie intake, exercise) with monthly e-mail messages summarizing progress	RCT: remote weight loss support, versus remote support plus in-person support, versus self-directed behavior change control group 24 month follow-up	Greater weight loss at 24 months with remote support (−4.6 kg) and remote plus in-person support (−5.1 kg) compared to control (−0.8kg, p<0.001)
de Niet et al. (2012)43	141 overweight or obese children	Nether-lands	Weekly SMS messages	Patient-reported data on exercise & diet with tailored behavior-change feedback	RCT: SMS versus usual care 12 month follow-up	No improvement in weight, eating behavior, or wellbeing
Estabrooks et al. (2009)44	22 parent-child dyads with overweight children	USA	10 weekly IVR counseling sessions	Tailored messages regarding changes in home environment to promote activity and healthy eating	RCT: IVR versus individual workbook education versus group counseling 12 month follow-up	Greater improvement in child BMI in the IVR group than the other two groups (p<0.01)
Free et al. (2011)45	5800 adult smokers willing to make a quit attempt	United Kingdom	SMS messages (5 per day first 5 weeks, 3 per day last 26 weeks)	Motivational and behavior-change messages	RCT: SMS messages versus SMS attention control 6 month follow-up	Increase in biochemically-confirmed quit rates (10.7% versus 4.9%; p<.0001)
King et al. (2014)46	127 inactive midlife and older adults	USA	IVR counseling sessions (roughly 15 delivered over a year)	Instructional sessions emphasizing cognitive and behavioral skills, based on current stage of motivational readiness to change, for moderate-intensity physical activity adoption	RCT: IVR versus human counseling 18 month follow-up	No difference in moderate-to-vigorous physical activity levels or percentage meeting national physical activity guidelines
Norman et al. (2013)47	52 overweight or obese adults	USA	2–5 SMS per day, with ability to tailor number and time of messages	Diet and physical activity messages (some were interactive) providing tips, suggestions, prompts, and reminders for improved weight management behaviors	RCT: SMS versus usual care 4 month follow-up	Significant improvements in fruit/vegetable intake, eating behavior scores (all p’s<0.05); weight loss 5.4 lbs compared to 1.4 in controls (p<0.05)
Park et al. (2012)48	67 post-menopausal women with abdominal obesity	South Korea	3 SMS messages per week, 3rd message also sent via internet	Participants posted self-measured waist circumference, body weight, blood pressure, plus info about diet and exercise to website. SMS and internet messages to participants included recommendations on diet and exercise based on website postings.	Quasi-experiment with matched controls 12 week follow-up	Significantly greater improvement in waist circumference, body weight, blood pressure, total cholesterol, and LDL-C (all p’s <0.006)
Shapiro et al. (2012)49	170 overweight or obese adults	USA	SMS and MMS sent 4 times per day	Behavior change strategies targeting weight loss behaviors utilizing tips, motivational messages, requesting daily step counts and weekly weights	RCT: SMS with monthly e-newsletters versus e-newsletters alone 12 month follow-up	No difference in weight loss; SMS adherence associated with improved weight-related behaviors, increased pedometer-measured physical activity and other outcomes
Turner-McGrievy et al. (2011)50	96 overweight adults	USA	Podcasts and daily tweets delivered via mobile-devices	Both groups received 2 podcasts per week, Podcast+Mobile group instructed to interact with counselors and other participants via Twitter	RCT: podcast+Twitter versus podcast alone 6 month follow-up	No difference in weight loss

Abbreviations: BMI Body Mass Index, BP Blood Pressure, CVD Cardiovascular Disease, DM Diabetes Mellitus, IVR Interactive Voice Response, LDL-C Low-Density Lipoprotein Cholesterol, MMS Multimedia Messaging Service, QALYs Quality-Adjusted Life Years, RCT Randomized Controlled Trial, SMS Short Message Service