Unpacking the Black Box: A Formative Research Approach to the Development of Theory-Driven, Evidence-Based, and Culturally Safe Text Messages in Mobile Health Interventions.
Unpacking the Black Box: A Formative Research Approach to the Development of Theory-Driven, Evidence-Based, and Culturally Safe Text Messages in Mobile Health Interventions.
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DOI：
10.2196/mhealth.4994
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发表时间：
2016-01-22
影响因子：
5
通讯作者：
Tobe SW
中科院分区：
文献类型：
--
作者：
Maar MA;Yeates K;Toth Z;Barron M;Boesch L;Hua-Stewart D;Liu P;Perkins N;Sleeth J;Wabano MJ;Williamson P;Tobe SW
过去十年，移动蜂窝用户数量稳步增长。现有移动网络上 SMS 消息的可访问性很高，并且即使在较旧且不先进的移动电话上以及在无线覆盖范围较弱的地理环境中也几乎具有普遍可用性。人们对这种廉价的移动电信技术进行了深入的探索，以改善健康服务并促进弱势群体的行为改变。然而，一个被忽视的研究领域是对有效 SMS 消息的开发和完善所需的形成性研究过程的记录和批判性分析。这项定性研究的目的是确定可能影响循证短信有效性的主要因素，这些短信旨在减少资源匮乏地区高血压管理中的健康不平等，包括高收入国家的原住民和低收入国家的农村人口。具体来说，我们有兴趣揭示影响适当的信息内容传输并最终影响一系列社会文化环境中健康行为改善的一系列中介因素。在一个旨在解决高血压健康不平等问题的国际研究项目的背景下，与加拿大原住民和坦桑尼亚参与者进行了合作定性研究，以解构短信中包含的循证健康信息的内容和传输，并就调节这种沟通有效性的主要因素制定了基础理论。我们还研究了这些中介因素与行为改变轮模型的行为系统的三个基本条件（能力、机会和动机）和文化安全的相互关系。共进行了四个焦点小组，共有 45 名参与者。我们的扎根理论研究揭示了研究人员创建的基于证据的短信与移动健康干预措施中接收者收到的消息之间如何产生差异。这些差异主要是由 SMS 消息中的六个意义中介造成的：(1) 消极或非肯定的倡导框架，(2) 引起恐惧或压力的内容，(3) 压迫性或独裁内容，(4) 与文化和传统做法不一致，(5) 与健康的社会决定因素和人口中文化多样性的现实脱节，以及 (6) 内容缺乏清晰度和/或实用性。这 6 个意义中介为信息发展的合理策略提供了基础，因为它们直接影响目标人群行为改变的能力、机会和动机。短信的质量对移动健康干预的有效性影响很大。我们的研究强调迫切需要采取干预措施来纳入和评估短信的质量，并检查每个目标文化和人口群体中意义的中介因素。报告移动健康干预研究的这一方面将使研究人员摆脱当前短信开发的黑匣子，从而提高过程的透明度以及结果的质量。
Mobile-cellular subscriptions have increased steadily over the past decade. The accessibility of SMS messages over existing mobile networks is high and has almost universal availability even on older and unsophisticated mobile phones and in geographic settings where wireless coverage is weak. There is intensive exploration of this inexpensive mobile telecommunication technology to improve health services and promote behavior change among vulnerable populations. However, a neglected area of research is the documentation and critical analysis of the formative research process required in the development and refinement of effective SMS messages. The objective of this qualitative research study was to identify major factors that may impact on the effectiveness of evidence-based SMS messages designed to reduce health inequities in hypertension management in low resource settings, including Aboriginal populations in high-income countries and rural populations in low-income countries. Specifically, we were interested in uncovering the range of mediators that impact on appropriate message content transmission and, ultimately, on health behavior improvements in a range of these sociocultural settings. Collaborative qualitative research with Canadian Aboriginal and Tanzanian participants was conducted to deconstruct the content and transmission of evidence-based health information contained in SMS messages in the context of an international research project designed to address health inequalities in hypertension, and to develop a grounded theory of the major factors that mediate the effectiveness of this communication. We also examined the interrelationship of these mediators with the three essential conditions of the behavior system of the Behavioral Change Wheel model (capability, opportunity, and motivation) and cultural safety. Four focus groups with a total of 45 participants were conducted. Our grounded theory research revealed how discrepancies develop between the evidence-based text message created by researchers and the message received by the recipient in mobile health interventions. These discrepancies were primarily generated by six mediators of meaning in SMS messages: (1) negative or non-affirming framing of advocacies, (2) fear- or stress-inducing content, (3) oppressive or authoritarian content, (4) incongruity with cultural and traditional practices, (5) disconnect with the reality of the social determinants of health and the diversity of cultures within a population, and (6) lack of clarity and/or practicality of content. These 6 mediators of meaning provide the basis for sound strategies for message development because they impact directly on the target populations’ capability, opportunity, and motivation for behavior change. The quality of text messages impacts significantly on the effectiveness of a mobile health intervention. Our research underscores the urgent need for interventions to incorporate and evaluate the quality of SMS messages and to examine the mediators of meaning within each targeted cultural and demographic group. Reporting on this aspect of mobile health intervention research will allow researchers to move away from the current black box of SMS text message development, thus improving the transparency of the process as well as the quality of the outcomes.