Using Text Messaging As a Healthy Lifestyle Promotion Strategy in a Cancer Prevention Program for Urban Latino Families

Background: Cancer is the leading cause of morbidity and mortality among Hispanics, the fastest growing segment of the U.S. population. Compared to the general population, Hispanics have disproportionately high rates of two cancer risk factors: obesity and physical inactivity. Healthy weight and active lifestyle are critical to reducing cancer risk in the Hispanic community. 

Program background: Y Living: A Healthy Lifestyle Program for Cancer Prevention and Risk Reduction is a multi-component program developed in partnership with the local YMCA in response to community needs. 163 families (237 adults) enrolled in Y Living, a 12-week healthy lifestyle program for families designed to increase physical activity, improve diet quality and prevent excess weight gain. Text messaging was used to enhance Y Living in several ways. Program participants received weekly text messages from YLiving4Health, a community-wide education and outreach campaign to promote awareness of cancer prevention and risk reduction among YMCA members. Y Living program coordinators sent broadcast text messages to connect participants to free/low-cost community events/resources, reinforce knowledge and skills learned in the program, and provide ongoing social support to participants.  In addition, coordinators use polling text messages to assess participant program knowledge.

Evaluation Methods and Results: MessageSpace, a web-based text messaging communication management system developed by the research team for health promotion campaigns, includes features allowing asynchronous delivery of messages directly to participants, auto mass message handling/scheduling based on project protocol, and grouping of participants according to assigned attributes for sending tailored messages and maintaining participant message histories. Participants complete pre- and post-assessments of anthropometrics, fitness, diet, and PA. Preliminary results of the first 49 program completers show improvements in body composition: body weight (mean difference -1.85lb, SD 4.82; p=.01); body mass index (mean difference -.81, SD 2.86; p=.06); waist circumference (mean difference -4.22in, SD 17.38; p=.09). Significant improvements in cancer awareness, physical activity and dietary behaviors were also observed. MessageSpace is used to monitor participant exposure to text messages. To date, 82 program participants received ≥1 broadcast message. 138 broadcasts and 31 polls have been sent; on average, 6% of participants respond to polls.

Conclusions: Text-messaging is a promising communication method for supporting health behavior change interventions for Latino families. Developing a systematic messaging plan is essential to ensuring that message timing and content align with the intervention program and also meet the needs of participants.

Implications for research and/or practice: Despite availability of this new communication tool, adoption of the tool by program implementers is challenging. Development of text messages to support the program requires planning, coordination, and training.