Text-message reminders to improve sunscreen use: A randomized, controlled trial using electronic monitoring

April W. Armstrong, Alice J. Watson, Maryanne Makredes, Jason E. Frangos, Alexandra B. Kimball, Joseph C. Kvedar

Research output: Contribution to journalArticle

176 Citations (Scopus)

Abstract

Objective: To evaluate the effectiveness of cellular telephone text messaging as a reminder tool for improving adherence to sunscreen application. Design: We conducted a randomized, controlled trial of the effect of an electronic text-message reminder system on adherence to sunscreen application. Adherence to daily sunscreen use was evaluated using a novel electronic monitoring device. Setting: Participants were recruited from the general community. Participants: Seventy participants constituted a volunteer sample from the general community. The inclusion criteria required participants to be 18 years or older, to own a cellular telephone with text-message features, and to know how to retrieve text messages. Intervention: Half of the participants received daily text-message reminders via cellular telephone for 6 weeks, and the other half did not receive reminders. The text-message reminders consisted of 2 components: a "hook" text detailing daily local weather information and a "prompt" text reminding users to apply sunscreen. Main Outcome Measure: The primary end point of the study was adherence to sunscreen application measured by the number of days participants applied sunscreen during the 6-week study period. Results: All 70 participants completed the 6-week study. There were no statistically significant differences in baseline characteristics between the 2 study groups. At the end of the study period, the 35 participants who did not receive reminders had a mean daily adherence rate of 30.0% (95% confidence interval, 23.1%-36.9%). In comparison, the 35 participants who received daily textmessage reminders had a mean daily adherence rate of 56.1% (95% confidence interval, 48.1%-64.1%) (P<.001). Among the participants in the reminder group, 24 (69%) reported that they would keep using the text-message reminders after the study, and 31 (89%) reported that they would recommend the text-message reminder system to others. Subgroup analysis did not reveal any significant demographic factors that predicted adherence. Conclusions: Despite awareness of the benefits of sunscreen, adherence is low, even in this population, for whom adherence was knowingly monitored. Shortterm data demonstrate that using existing cellular telephone text-message technology offers an innovative, low-cost, and effective method of improving adherence to sunscreen application. The use of ubiquitous communications technology, such as text messaging, may have implications for large-scale public health initiatives. Trial Registration: clinicaltrials.gov Identifier: NCT00535769.

Original languageEnglish (US)
Pages (from-to)1230-1236
Number of pages7
JournalArchives of Dermatology
Volume145
Issue number11
DOIs
StatePublished - Nov 2009

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Text Messaging
Sunscreening Agents
Randomized Controlled Trials
Cell Phones
Reminder Systems
Confidence Intervals
Technology
Weather
Volunteers
Public Health
Demography
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Dermatology

Cite this

Armstrong, A. W., Watson, A. J., Makredes, M., Frangos, J. E., Kimball, A. B., & Kvedar, J. C. (2009). Text-message reminders to improve sunscreen use: A randomized, controlled trial using electronic monitoring. Archives of Dermatology, 145(11), 1230-1236. https://doi.org/10.1001/archdermatol.2009.269

Text-message reminders to improve sunscreen use : A randomized, controlled trial using electronic monitoring. / Armstrong, April W.; Watson, Alice J.; Makredes, Maryanne; Frangos, Jason E.; Kimball, Alexandra B.; Kvedar, Joseph C.

In: Archives of Dermatology, Vol. 145, No. 11, 11.2009, p. 1230-1236.

Research output: Contribution to journalArticle

Armstrong, AW, Watson, AJ, Makredes, M, Frangos, JE, Kimball, AB & Kvedar, JC 2009, 'Text-message reminders to improve sunscreen use: A randomized, controlled trial using electronic monitoring', Archives of Dermatology, vol. 145, no. 11, pp. 1230-1236. https://doi.org/10.1001/archdermatol.2009.269
Armstrong, April W. ; Watson, Alice J. ; Makredes, Maryanne ; Frangos, Jason E. ; Kimball, Alexandra B. ; Kvedar, Joseph C. / Text-message reminders to improve sunscreen use : A randomized, controlled trial using electronic monitoring. In: Archives of Dermatology. 2009 ; Vol. 145, No. 11. pp. 1230-1236.
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N2 - Objective: To evaluate the effectiveness of cellular telephone text messaging as a reminder tool for improving adherence to sunscreen application. Design: We conducted a randomized, controlled trial of the effect of an electronic text-message reminder system on adherence to sunscreen application. Adherence to daily sunscreen use was evaluated using a novel electronic monitoring device. Setting: Participants were recruited from the general community. Participants: Seventy participants constituted a volunteer sample from the general community. The inclusion criteria required participants to be 18 years or older, to own a cellular telephone with text-message features, and to know how to retrieve text messages. Intervention: Half of the participants received daily text-message reminders via cellular telephone for 6 weeks, and the other half did not receive reminders. The text-message reminders consisted of 2 components: a "hook" text detailing daily local weather information and a "prompt" text reminding users to apply sunscreen. Main Outcome Measure: The primary end point of the study was adherence to sunscreen application measured by the number of days participants applied sunscreen during the 6-week study period. Results: All 70 participants completed the 6-week study. There were no statistically significant differences in baseline characteristics between the 2 study groups. At the end of the study period, the 35 participants who did not receive reminders had a mean daily adherence rate of 30.0% (95% confidence interval, 23.1%-36.9%). In comparison, the 35 participants who received daily textmessage reminders had a mean daily adherence rate of 56.1% (95% confidence interval, 48.1%-64.1%) (P<.001). Among the participants in the reminder group, 24 (69%) reported that they would keep using the text-message reminders after the study, and 31 (89%) reported that they would recommend the text-message reminder system to others. Subgroup analysis did not reveal any significant demographic factors that predicted adherence. Conclusions: Despite awareness of the benefits of sunscreen, adherence is low, even in this population, for whom adherence was knowingly monitored. Shortterm data demonstrate that using existing cellular telephone text-message technology offers an innovative, low-cost, and effective method of improving adherence to sunscreen application. The use of ubiquitous communications technology, such as text messaging, may have implications for large-scale public health initiatives. Trial Registration: clinicaltrials.gov Identifier: NCT00535769.

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