Text-message reminders to improve sunscreen use: a randomized, controlled trial using electronic monitoring.
OBJECTIVE
To evaluate the effectiveness of cellular telephone text messaging as a reminder tool for improving adherence to sunscreen application.


METHODS
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.


METHODS
Participants were recruited from the general community.


METHODS
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 text-message 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. Short-term 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.
Armstrong
April W
AW
Teledermatology Program, Department of Dermatology, University of California-Davis Health System, 3301 C St, Ste1400, Sacramento, CA 95816, USA.
Watson
Alice J
AJ
Makredes
Maryanne
M
Frangos
Jason E
JE
Kimball
Alexandra B
AB
Kvedar
Joseph C
JC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002140:California; D040421:Cell Phone / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011322:Primary Prevention / Q000295:instrumentation / Q000379:methods; D011336:Probability; D012016:Reference Values; D017010:Reminder Systems; D012307:Risk Factors; D012737:Sex Factors; D012878:Skin Neoplasms / Q000517:prevention & control; D013473:Sunscreening Agents / Q000627:therapeutic use*; D013685:Telecommunications / Q000639:trends*; D055815:Young Adult
D013473:Sunscreening Agents