Project Cell & Tell: Native Texting Circle - Mhealth in the Urban American Indian & Alaska Native Clinical Setting

Project Cell & Tell was a mHealth (mobile health) pilot intervention delivered in collaboration with the Denver Indian Health and Family Services (DIHFS) urban clinic. The intervention extended reach and relevancy of a face-to-face classroom-based health education curriculum called Honoring the Gift of Heart Health (HGHH). Short Message Service (SMS) and Multimedia Messaging Service (MMS) were used to deliver health information. Pre and post health knowledge surveys were collected from both conditions. Cell & Tell delivered a five-week schedule of text messages. Following the delivery of messages, SMS participants attended a focus group and those in the MMS condition participated in a digital photovoice workshop to construct community-level media rich documents using pictures taken with in-phone cameras. The project aimed to increase health knowledge to reduce cardiovascular disease risk factors by viewing and responding to targeted health text messages. Recruitment for Cell & Tell focused on DIHFS clients only; sampling frame membership was defined as those people that received services from the DIHFS clinic in the last 12 months from the date of enrollment. Enrollment included people in the age range of 30 – 70 years old. Sixteen people received the SMS intervention and sixteen people received the MMS intervention. The primary aims of this intervention were to test feasibility of a mHealth approach using the cell phone as an information dissemination tool in the urban American Indian/Alaska Native population and to determine whether SMS or MMS messages were more effective to increase knowledge. The hypothesis was that the MMS condition would increase health knowledge more than the SMS condition because photo elicitation grounded health knowledge in a more personalized context. Quantitative analysis suggested positive trends of health knowledge for both the SMS and MMS.  The MMS condition did outperform the SMS condition. Moreover, four specific types of knowledge were analyzed: Heart Attack knowledge, Heart Health knowledge, Physical Activity knowledge, and Nutritional knowledge. Statistically significant increases were found in Heart Attack knowledge (F(1,21)=8.92, p<.01); both conditions increased knowledge from baseline (SMS = 41.16; MMS = 39.81) to after intervention assessment (SMS= 43.08; MMS= 43.63). High degrees of participant engagement occurred in both conditions. Qualitative data supports the findings that this is a feasible approach within an Urban American Indian clinic based on positive reaction in focus groups to the messages and the delivery, with most participants stating that they would like the intervention to continue.