Study looks at feasibility of text message use to deliver health educational information to teens

Teenagers spend a lot of time texting, receiving an average of 3,417 texts a month, or 114 per day, according to the Nielsen consumer research group.

A new study from the University of Arizona looks at the feasibility of using text messaging to deliver educational information about nutrition and physical activity to teens.

The study, which appears in the January-February issue of the Journal of Nutrition Education and Behavior, looks at whether teenagers would be interested in receiving texts about health on their phones and how they would like those messages presented.

Conducted over a one-year period, the study of 177 adolescents, ages 12-18, found that most teens were open to receiving such texts, but the way in which they were worded made a big difference.

"Kids are texting all the time, so it's a communication they're very familiar with and it appeals to them," said Melanie Hingle, UA assistant research professor of nutritional sciences and lead author of the study. "But we realized very quickly once we got down to the actual development of the messages that we didn't know the first thing about what kind of tone or information kids would be interested in."

Researchers quickly learned - and this may come as no surprise to those with teenagers at home - that the teens didn't like to be told what to do. Therefore, phrases like "you should," "always" and "never" did not go over well, while softer words like "try" and "consider" were much better received. Likewise, texts introduced by the words "did you know" also generally were disliked, with teens saying the phrase made them immediately not want to know whatever came next.

Texts the teens liked best included those that specifically referenced their age group, such as, "American girls aged 12-19 years old drink an average of 650 cans of soda a year!" They also liked messages that were interactive, like fun quizzes; messages that were actionable, like simple recipes; and messages that included links to websites where they could learn more about a topic if desired.

The teens also appreciated the occasional fun fact not necessarily related to health - some bit of trivia they could share with their friends, like the fact that carrots were originally purple or that ears of corn have an even number of rows.

And they didn't want to be inundated with texts - no more than two a day.

Hingle, a registered dietitian, says she sees text messaging as a potentially valuable supplement to in-person nutrition education and fitness programs for teens.

"A lot of the previous interventions that have been developed in nutrition are very top-down, in that we're the experts and we're telling people what to do," Hingle said. "We didn't want to do that in these text messages, and we didn't think it was very effective, so we had kids at every step of the process working with us to help us to come up with topics and refine the voice and style."

Now that researchers know teens are open to receiving health information via text, it could pave the way for the development of future text message-based programs.

"When we started, we didn't even know if this was a good idea because phones are used to contact your friends and for social engagements, not about educational messages," said Mimi Nichter, UA professor of anthropology and co-author of the study.

"What we, as anthropologists, wanted to know about the culture of kids was: What does health mean to them, and given that, what do you offer them? What's palatable for them, not just for the mouth, but for their way of thinking?" said Nichter, who has for years studied body image, food intake and dieting among teens.

The texting study was part of a larger USDA-funded study at the UA exploring how mobile technology may be used to promote healthy lifestyles for teens. The interdisciplinary project, dubbed "Stealth Health," has united researchers across the UA campus in research and development projects related to mobile health applications.

Promoting health and physical activity during the teen years can be critical, with the risk for developing obesity increasing during adolescence, Hingle said.

"They're at the age right now that they start making decisions for themselves with regard to food and physical activity," she said. "Up until about middle school, parents are a lot more involved in making those decisions, so from a developmental standpoint, it's a good time to intervene."