Txt4Health: Assessing the Health Belief Model

Background:  Txt4health is a mobile health program that engages individuals in the Greater New Orleans community in diabetes risk awareness and behavior change through interactive text messages.  The txt4health communicates with participants regarding diabetes health information, tools for goal setting, and prompts for behavior change over the course of 14 weeks. 

Program background:  Txt4health is based on the Health Belief Model (HBM) attempting to initiate behavior change through raising awareness of participant health risk perception and providing cues to action.  The program evaluation includes the use of a validated Patient Activation Measure (PAM) which assesses an individual’s readiness to manage their own health.  This presentation uses the HBM paradigm and PAM to understand self-reported health behavior.

Evaluation Methods and Results:  A multi-method approach was used to evaluate the txt4health program.  This included a population-based, pre- and post-marketing campaign survey (N=1402) combining telephone RDD with internet; participant satisfaction survey (N=59) administered through a text-delivered URL link as well as program data (N=1,200) from the interactive text messaging program.  The 13-item PAM was administered in the post-campaign survey as well as the programs satisfaction survey that can be linked to program participation data.  The population-based survey shows a higher than expected percentage of people indicating readiness to manage their own health. Similarly, program participants who are aware of their risk for diabetes indicated greater desire to manage their health and a higher engagement in healthy behaviors indicated by their response to PAM and self-reported behaviors. 

Conclusions:  Awareness of risk for diabetes is associated with greater readiness to engage in health management as demonstrated by self-reported healthy behaviors.  The results validate using HBM to understand health behaviors in the population-based survey and among the sub-sample of participants of the txt4health program. As mhealth programs scale from the trial level to the population level, it will be important to utilize theory based, validated measures such as that used by the txt4health  to understand how the program initiates health behavior change

Implications for research and/or practice:  Awareness of risk for diabetes is associated with greater readiness to engage in health management as demonstrated by self-reported healthy behaviors.  The results validate using HBM to understand health behaviors in the population-based survey and among the sub-sample of participants of the txt4health program. As mhealth programs scale from the trial level to the population level, it will be important to utilize theory based, validated measures such as that used by the txt4health  to understand how the program initiates health behavior change