A mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial.

AIM: To determine the effectiveness and cost-effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease (IHD).

METHODS AND RESULTS: In this single-blind, parallel, two-arm, randomized controlled trial adults (n = 171) with IHD were randomized to receive a mobile phone delivered intervention (HEART; n = 85) plus usual care, or usual care alone (n = 86). Adult participants aged 18 years or more, with a diagnosis of IHD, were clinically stable as outpatients, able to perform exercise, able to understand and write English, and had access to the Internet. The HEART (Heart Exercise And Remote Technologies) intervention involved a personalized, automated package of text messages and a secure website with video messages aimed at increasing exercise behaviour, delivered over 24 weeks. All participants were able to access usual community-based cardiac rehabilitation, which involves encouragement of physical activity and an offer to join a local cardiac support club. All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake (PVO2; primary outcome), self-reported physical activity, health-related quality of life, self-efficacy and motivation (secondary outcomes). Results showed no differences in PVO2 between the two groups (difference -0.21 ml kg(-1)min(-1), 95% CI: -1.1, 0.7; p = 0.65) at 24 weeks. However significant treatment effects were observed for selected secondary outcomes, including leisure time physical activity (difference 110.2 min/week, 95% CI: -0.8, 221.3; p = 0.05) and walking (difference 151.4 min/week, 95% CI: 27.6, 275.2; p = 0.02). There were also significant improvements in self-efficacy to be active (difference 6.2%, 95% CI: 0.2, 12.2; p = 0.04) and the general health domain of the SF36 (difference 2.1, 95% CI: 0.1, 4.1; p = 0.03) at 24 weeks. The HEART programme was considered likely to be cost-effective for leisure time activity and walking.

CONCLUSIONS: A mobile phone intervention was not effective at increasing exercise capacity over and above usual care. The intervention was effective and probably cost-effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services.

Improving coronary heart disease self-management using mobile technologies (Text4Heart): a randomised controlled trial protocol

BACKGROUND: Cardiac rehabilitation (CR) is a secondary prevention program that offers education and support to assist patients with coronary heart disease (CHD) make lifestyle changes. Despite the benefits of CR, attendance at centre-based sessions remains low. Mobile technology (mHealth) has potential to reach more patients by delivering CR directly to mobile phones, thus providing an alternative to centre-based CR. The aim of this trial is to evaluate if a mHealth comprehensive CR program can improve adherence to healthy lifestyle behaviours (for example, physically active, fruit and vegetable intake, not smoking, low alcohol consumption) over and above usual CR services in New Zealand adults diagnosed with CHD.

METHODS/DESIGN: A two-arm, parallel, randomised controlled trial will be conducted at two Auckland hospitals in New Zealand. One hundred twenty participants will be randomised to receive a 24-week evidence- and theory-based personalised text message program and access to a supporting website in addition to usual CR care or usual CR care alone (control). The primary outcome is the proportion of participants adhering to healthy behaviours at 6 months, measured using a composite health behaviour score. Secondary outcomes include overall cardiovascular disease risk, body composition, illness perceptions, self-efficacy, hospital anxiety/depression and medication adherence.

DISCUSSION: This study is one of the first to examine an mHealth-delivered comprehensive CR program. Strengths of the trial include quality research design and in-depth description of the intervention to aid replication. If effective, the trial has potential to augment standard CR practices and to be used as a model for other disease prevention or self-management programs.

The HEART mobile phone trial: the partial mediating effects of self-efficacy on physical activity among cardiac patients

BACKGROUND: The ubiquitous use of mobile phones provides an ideal opportunity to deliver interventions to increase physical activity levels. Understanding potential mediators of such interventions is needed to increase their effectiveness. A recent randomized controlled trial of a mobile phone and Internet (mHealth) intervention was conducted in New Zealand to determine the effectiveness on exercise capacity and physical activity levels in addition to current cardiac rehabilitation (CR) services for people (n = 171) with ischemic heart disease. Significant intervention effect was observed for self-reported leisure-time physical activity and walking, but not peak oxygen uptake at 24 weeks. There was also significant improvement in self-efficacy.

OBJECTIVE: To evaluate the mediating effect of self-efficacy on physical activity levels in an mHealth delivered exercise CR program.

METHODS: Treatment evaluations were performed on the principle of intention to treat. Adjusted regression analyses were conducted to evaluate the main treatment effect on leisure-time physical activity and walking at 24 weeks, with and without change in self-efficacy as the mediator of interest.

RESULTS: Change in self-efficacy at 24 weeks significantly mediated the treatment effect on leisure-time physical activity by 13%, but only partially mediated the effect on walking by 4% at 24 weeks.

CONCLUSION: An mHealth intervention involving text messaging and Internet support had a positive treatment effect on leisure-time physical activity and walking at 24 weeks, and this effect was likely mediated through changes in self-efficacy. Future trials should examine other potential mediators related to this type of intervention.

A theory-based video messaging mobile phone intervention for smoking cessation: randomized controlled trial

BACKGROUND: Advances in technology allowed the development of a novel smoking cessation program delivered by video messages sent to mobile phones. This social cognitive theory-based intervention (called "STUB IT") used observational learning via short video diary messages from role models going through the quitting process to teach behavioral change techniques.

OBJECTIVE: The objective of our study was to assess the effectiveness of a multimedia mobile phone intervention for smoking cessation.

METHODS: A randomized controlled trial was conducted with 6-month follow-up. Participants had to be 16 years of age or over, be current daily smokers, be ready to quit, and have a video message-capable phone. Recruitment targeted younger adults predominantly through radio and online advertising. Registration and data collection were completed online, prompted by text messages. The intervention group received an automated package of video and text messages over 6 months that was tailored to self-selected quit date, role model, and timing of messages. Extra messages were available on demand to beat cravings and address lapses. The control group also set a quit date and received a general health video message sent to their phone every 2 weeks.

RESULTS: The target sample size was not achieved due to difficulty recruiting young adult quitters. Of the 226 randomized participants, 47% (107/226) were female and 24% (54/226) were Maori (indigenous population of New Zealand). Their mean age was 27 years (SD 8.7), and there was a high level of nicotine addiction. Continuous abstinence at 6 months was 26.4% (29/110) in the intervention group and 27.6% (32/116) in the control group (P = .8). Feedback from participants indicated that the support provided by the video role models was important and appreciated.

CONCLUSIONS: This study was not able to demonstrate a statistically significant effect of the complex video messaging mobile phone intervention compared with simple general health video messages via mobile phone. However, there was sufficient positive feedback about the ease of use of this novel intervention, and the support obtained by observing the role model video messages, to warrant further investigation.

A multimedia mobile phone-based youth smoking cessation intervention: findings from content development and piloting studies

BACKGROUND: While most young people who smoke want to quit, few access cessation support services. Mobile phone-based cessation programs are ideal for young people: mobile phones are the most common means of peer communication, and messages can be delivered in an anonymous manner, anywhere, anytime. Following the success of our text messaging smoking cessation program, we developed an innovative multimedia mobile phone smoking cessation intervention.

OBJECTIVE: The aim of the study was to develop and pilot test a youth-oriented multimedia smoking cessation intervention delivered solely by mobile phone.

METHODS: Development included creating content and building the technology platform. Content development was overseen by an expert group who advised on youth development principles, observational learning (from social cognitive theory), effective smoking cessation interventions, and social marketing. Young people participated in three content development phases (consultation via focus groups and an online survey, content pre-testing, and selection of role models). Video and text messages were then developed, incorporating the findings from this research. Information technology systems were established to support the delivery of the multimedia messages by mobile phone. A pilot study using an abbreviated 4-week program of video and text content tested the reliability of the systems and the acceptability of the intervention.

RESULTS: Approximately 180 young people participated in the consultation phase. There was a high priority placed on music for relaxation (75%) and an interest in interacting with others in the program (40% would read messages, 36% would read a blog). Findings from the pre-testing phase (n = 41) included the importance of selecting "real" and "honest" role models with believable stories, and an interest in animations (37%). Of the 15 participants who took part in the pilot study, 13 (87%) were available for follow-up interviews at 4 weeks: 12 participants liked the program or liked it most of the time and found the role model to be believable; 7 liked the role model video messages (5 were unsure); 8 used the extra assistance for cravings; and 9 were happy with two messages per day. Nine participants (60%) stopped smoking during the program. Some technical challenges were encountered during the pilot study.

CONCLUSIONS: A multimedia mobile phone smoking cessation program is technically feasible, and the content developed is appropriate for this medium and is acceptable to our target population. These results have informed the design of a 6-month intervention currently being evaluated for its effectiveness in increasing smoking cessation rates in young people.

A mobile phone based method to assess energy and food intake in young children: a validation study against the doubly labelled water method and 24 h dietary recalls

Mobile phones are becoming important instruments for assessing diet and energy intake. We developed the Tool for Energy Balance in Children (TECH), which uses a mobile phone to assess energy and food intake in pre-school children. The aims of this study were: (a) to compare energy intake (EI) using TECH with total energy expenditure (TEE) measured via doubly labelled water (DLW); and (b) to compare intakes of fruits, vegetables, fruit juice, sweetened beverages, candy, ice cream, and bakery products using TECH with intakes acquired by 24 h dietary recalls. Participants were 39 healthy, Swedish children (5.5 ± 0.5 years) within the ongoing Mobile-based Intervention Intended to Stop Obesity in Preschoolers (MINISTOP) obesity prevention trial. Energy and food intakes were assessed during four days using TECH and 24 h telephone dietary recalls. Mean EI (TECH) was not statistically different from TEE (DLW) (5820 ± 820 kJ/24 h and 6040 ± 680 kJ/24 h, respectively). No significant differences in the average food intakes using TECH and 24 h dietary recalls were found. All food intakes were correlated between TECH and the 24 h dietary recalls (ρ = 0.665-0.896, p < 0.001). In conclusion, TECH accurately estimated the average intakes of energy and selected foods and thus has the potential to be a useful tool for dietary studies in pre-school children, for example obesity prevention trials.

Perceptions of mobile plan unit pricing and terms and conditions

Purpose: The purpose of this paper is to test the efficacy of disclosing unit pricing and increasing the type size of complex terms and conditions in advertising. This is in line with recommendations made by global telecommunications regulators, including in Australia, to protect consumers in selecting mobile plans.

Design/methodology/approach: The authors employed a 2 (unit price disclosed: no, yes)×3 (type size: nine-, 12- and 15-point terms and conditions) full factorial, between-subjects experimental design using a scenario and fictional advertisements for 24-month mobile phone plans. This was complemented by 24 in-depth interviews with consumers who had recently purchased “real” plans and their assessment of these.

Findings: Extra information in the form of unit pricing has a positive influence on consumers’ value perceptions, but not on perceived confusion or risk. Presenting complex terms and conditions in larger type increases consumers’ perceived confusion and risk, but not perceived value, as consumers have difficulty understanding the complicated information presented.

Research limitations/implications: This study focused on a single country market for one product type of mobile phones, using a limited range of mobile plans. Practical implications: Public policymakers and providers are advised to pre-test planned changes to advertising’s informational content prior to implementation to identify the efficacy of proposed changes to protect consumers. Consumers may also need to be educated to accurately interpret complex plans.

Originality/value: The study contributes to the domain of informational content in advertising as a form of consumer protection. The effect of unit pricing and larger type for terms and conditions on consumer perceptions has not been examined previously in complex product settings.

User-generated content and the changing news cycle

Blogs represent a major development in media consumption and practice.  The Pew Center in the United States reported in mid-2005 that about eight million Americans had created blogs and 32 million read them.  That's equivalent to two-thirds the number of people who read a daily newspaper during a week, a challenging giguew in the context of dwindling circulations.  Blogs represent the start of the 'personal media' revolution, but are only the tip of a range of new media developments.  This paper describes the blog phenomenon and notes its arrival via a series of major new stories.  It suggests we are seeing the emergence of a new news cycle, as blogs and other internet-based media usurp broadcast's role in breaking news.  The paper describes a range of emerging digital journalism forms that make up the 'personal media' revolution.  These include blogs delivered via mobile phones (moblogs); video-based blogs (v-logs); newspapers' use of podcasting to deliver content; and wikis, or peer-generated online content. The media's reaction to this new form of content is described, and the other concludes by looking at the forces driving this new form of journalism.

Becoming l(IT)erate : pre-service English teachers and ICTs

One of the recommended principles for classroom practice from the Digital Rhetorics Project is ‘Teachers First’, emphasising the need to prioritise the requirements of teachers in learning new technologies and in understanding their relationship to literacy education (Lankshear, Green and Snyder 2000, p. 121). While most of my pre-service English Education students use digital technologies for their own purposes and understand the benefits of doing so, it is not always straightforward regarding how technology can be effectively utilised in their classroom and for what purposes. This article reports work conducted with pre-service English Education teachers in an elective unit that focuses upon digital technologies in secondary classrooms. Using Green’s 3D model of literacy as a way of understanding the complex interrelationships between the cultural, critical and operational aspects of literacy, the students experiment with digital technologies such as mobile phones, wikis and blogs.

Response rates in telephone surveys: managing contactability

Telephone interviewing is the major data collection method for the market research industry. Although social trends such as mobile phones and call screening make it harder to contact people, better technology and contact regimes can assist companies to ameliorate the situation. A study of fieldwork managers responsible for over 75% of all phone interviews in Australia revealed limited use of contact enhancing strategies such as longer survey periods and more callbacks. Commercial imperatives for timely surveys and a lack of end-user concern for response rate issues, along with costs concerns, were believed to be responsible.

Putting pre-service teachers first

One of the recommended principles for classroom practice from the Digital Rhetorics Project is "teachers first", emphasising the need to prioritise the needs of teachers in learning new technologies and understanding their relationship to literacy education (Lankshear, Green, & Snyder, 2000), p.121). While most of my pre-service English Education students use digital technologies for their own purposes and understand the benefits of doing so, it is not always straightforward as to how technology can be effectively utilised in their classroom and for what purposes. This paper reports on work conducted with pre-service English Education teachers in an elective unit that focuses upon digital technologies in secondary classrooms. Using Green's 3D model of literacy as a way of understanding the complex interrelationships between the cultural, critical and operational aspects of literacy, the students experiment with digital technologies such as mobile phones, wikis and blogs.

River pilots for time`s flow: identifying factors to guide on-line distance education students in the use of their learning time

This research draws on recent studies of student time perception and use.
Case studies are used contrast the time use experiences of tertiary distance
education (on-line) students with tertiary students studying in traditional faceto-face classes with an online component. Previous studies and experience highlight a mismatch between the measurable and hence ”real” amount of time students spend at their computer and online, with the perceived” (and resented) time spent in online learning. This study uses investigates the recognition and application of factors affecting student perception of time spent in studying and learning online. It also compares the effectiveness of these factors when applied to distance education based wholly online classes, and face-to-face classes with an online component.
Some of the factors were measurably successful in reducing students’
perceptions of time “wasted” online, while others produced considerable
insight into face-to-face students perceptions of time used in study. The
factors included much greater focus on the person who was a student and
their expectations and time/life experiences while learning; the support and
use of alternative technologies such as mobile phones as learning and
communication too; a higher level of administrative and academic technical
support for the students; convergence of delivery methods; and strategic
involvement of teaching staff in design and delivery of learner management
systems.

Producing animations to educate MSM and MSW to fashion safe sex practices and address low perceptions of personal risk

This project will produce animations in order to increase understandings of safe sex practices and address low perceptions of personal risk among two of the most vulnerable groups to HIV infection in Thailand. The animations will be incorporated into a prevention outreach program via Ipods, mobile phones and mobile-based portable devices to men who have sex with men (MSM) in their 'hide-outs', that is, parks, clubs and public toilets and male sex workers (MSW) in sex venues such as brothels, go-go bars and beats. To produce these animations, the project is first researching the sexual practices of MSM and MSW because of the lack of any substantive investigation of their social and sexual networks. This use of technology, informed by social research rather than behavioral studies, offers new possibilities to stem rapidly rising infection rates because it takes into account the diverse MSM and MSW identities. Overall, an estimated one- fifth (21%) of new HIV infections in Thailand occur in men who have unsafe sex with men. This disquieting increase highlights the fact that MSM are not adequately reached through HIV prevention programmes, most likely because little is known about their particular situations, contexts and practices.

Research into cyberbullying : student perspectives on cybersafe learning environments

This paper reports a qualitative study designed to investigate the issues of cybersafety and cyberbullying and report how students are coping with them. Through discussion with 74 students, aged from 10 to 17, in focus groups divided into three age levels, data were gathered in three schools in Victoria, Australia, where few such studies had been set. Social networking sites and synchronous chat sites were found to be the places where cyberbullying most commonly occurred, with email and texting on mobile phones also used for bullying. Grades 8 and 9 most often reported cyberbullying and also reported behaviours and internet contacts that were cybersafety risks. Most groups preferred to handle these issues themselves or with their friends rather then alert parents and teachers who may limit their technology access. They supported education about these issues for both adults and school students and favoured a structured mediation group of their peers to counsel and advise victims.

Cyber bullying and cyber safety

Cyberbullying is a concern for governments, educational authorities, teachers, parents and children alike. Using technology (i.e. mobile phones, emails, instant messaging, blogs, websites) to annoy, harass, intimidate, abuse or threaten others has become known as cyberbullying.