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Evaluating Public Health Interventions

One of the most important tools available to public health practitioners is the intervention. These interventions can take a variety of forms - from targeted ad campaigns to educational workshops designed to inform the public about steps they can take to improve their health.

Campaigns to increase public use of stairs rather than elevators or escalators.

Two recent articles in The American Journal of Preventative Medicine aim to evaluate the progress of public health interventions that utilize different tactics. The first article examines the use of targeted ad campaigns to increase public use of stairs rather than, for example, elevators or escalators. The second looks at the utility of text message reminders as an intervention tactic, as well as whether or not such messages have a lasting effect on public behavior.

To the credit of public health practitioners, they are constantly innovating new kinds of interventions to keep up with advancing technologies. If these kinds of interventions are indeed successful, they will provide a framework upon which the public health community can design all kinds of interventions to meet the challenges posed by future challenges to health outcomes.

The review of stair use interventions includes an aggregation by the researchers of 67 studies between 1995 and 2015. 71% of these studies examined public intervention settings, 21% involved workplace interventions, and 4% looked at interventions in a combination of the two settings.

The underlying idea behind these kinds of interventions is that, since only 49% of American adults meet the CDC’s physical activity guidelines, encouraging an easily accessible form of exercise such as stair climbing is a step towards increasing overall activity levels. When the researchers aggregated these studies the found several important themes.

First, public setting interventions were more effective overall than interventions in workplaces. There are a variety of reasons why this could be the case, but the researchers suggest that one possibility is the fact that stairwells tend not to be located as close to elevators as stairs are to escalators in public settings.

Second, messages that appealed to the fitness benefits of climbing stairs tended to produce more behavioral changes than those associated with health benefits. Interestingly, messages that appealed to the positive effects of stair climbing emphasizing the small time commitment associated with taking the stairs also produced positive results.

Although the researchers caution against generalizing too much, public health practitioners should keep in mind that people are more motivated by achieving positive fitness results without expending too much time when designing these kinds of interventions.

In reviewing the efficacy of text message interventions, the researchers in the second article aggregate 35 studies conducted in 2015. These studies included text messages as reminders on a variety of topics including smoking cessation, weight loss, physical activity, cancer prevention, and nutrition among others. The frequency of text messages varied across studies, but the researchers found that the number of messages was not necessarily correlated with higher likelihood of behavioral changes.

Text messages as health reminders

The results of these studies when taken together are mixed. On the one hand, half of the studies showed positive to mixed results on the effectiveness of text messages as a form of intervention. However, the researchers are cautious because the remaining half did not point to significant behavioral changes regardless of the health topic involved in the messages.

Nevertheless, the ubiquity of cell phones in modern America lead the researchers to suggest further studies to increase the effectiveness of text message interventions. Given the mixed results, the researchers are of the belief that text messages can be used to improve public health outcomes with further study.

Since Americans are becoming more rather than less dependent on cell phones over time, public health practitioners should not give up on texts as a way to improve health outcomes.  

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Topics: Public Health interventions text messagining