Feasibility, acceptability and validity of SMS text messaging for measuring change in depression during a randomised controlled trial

BMC Psychiatry

Hugh MacPherson²  David Torgerson²  Ben Cross³  Rhian Gabe²  Magdalene Hover¹  Ada Keding²  Stewart J Richmond³ 

[1] Department of Paediatrics, Hull and East Yorskshire Hospitals NHS Trust, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK;Department of Health Sciences, University of York, Heslington YO10 5DD, York, UK;Sydera Research Associates, 34 Shipman Road, Market Weighton YO43 3RB, York, UK

关键词: Validity;    Randomised controlled trial;    Outcome assessment;    Depression;    SMS;    Text messaging;   

Others  :  1171038
DOI  :  10.1186/s12888-015-0456-3

 received in 2014-05-01, accepted in 2015-03-25,  发布年份 2015

【 摘 要 】

Background

Despite widespread popularity, text messaging has rarely been used for data collection in clinical research. This paper reports on the development, feasibility, acceptability, validity, and discriminant utility of a single item depression rating scale, delivered weekly via an automated SMS system, as part of a large randomised controlled trial.

Methods

755 depressed patients (BDI-II score ≥20) were recruited from primary care into a randomised trial of acupuncture versus counselling or usual care, and invited to opt into a repeated-measures text messaging sub-study. Two weeks following random allocation, trial participants were sent a weekly text message for 15 weeks. Texts were a single question asking, on a scale from 1 to 9, the extent to which they felt depressed. Feasibility and acceptability of the automated SMS system were evaluated according to cost, ease of implementation, proportion consenting, response rates, and qualitative feedback. Concurrent validity was estimated by correlating SMS responses with the Patient Health Questionnaire (PHQ-9). SMS responses were compared between groups over time to explore treatment effects.

Results

527 (69.8%) trial participants consented to the texting sub-study, of whom 498 (94.5%) responded to at least one message. Participants provided a valid response to an average of 12.5 messages. Invalid responses accounted for 1.1% of texts. The automated SMS system was quick to set-up, inexpensive, and well received. Comparison of PHQ-9 and SMS responses at 3 months demonstrated a moderate to high degree of agreement (Kendall’s tau-b = 0.57, p < 0.0001, n = 220). SMS depression scores over the 15 weeks differed significantly between trial arms (p = 0.007), with participants allocated to the acupuncture and counselling arms reporting improved depression outcomes compared to usual GP care alone, which reached statistical significance ten weeks after randomisation. Overall, the single item SMS scale also appeared more responsive to changes in depression, resulting from treatment, than the PHQ-9.

Conclusions

Automated SMS systems offer a feasible and acceptable means of monitoring depression within clinical research. This study provides clear evidence to support the regular use of a simple SMS scale as a sensitive and valid outcome measure of depression within future randomised controlled trials.

Trial registration

Current Controlled Trials - ISRCTN63787732 webcite

http://www.controlled-trials.com/ISRCTN63787732/ACUDEP webcite

Date of registration: 15/12/2009

【 授权许可】

   
2015 Richmond et al.; licensee BioMed Central.

【 图 表 】

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