Hello everyone, my name is Steven Zeng today I’ll be talking about my master’s work
that I conducted at the University of Toronto, in collaboration with Professors Robert Wu,
Khai Truong, and Fanny Chevalier.
Our paper is about the role of automated text messaging in facilitating the acceptance of
Chronic Obstructive Pulmonary Disease, or COPD.
COPD is a terminal and progressive condition which mainly affects older adults.
It manifests with symptoms such as chronic coughing, shortness of breath, wheezing, and
frequent fatigue, which generally get worse over time.
Because these symptoms are impairing, individuals with COPD must accept that they may need to
change their pre-existing lifestyle based on their disease progression, such as limiting
physical or social activities.
They must also accept that they can still maintain a high quality of life if they develop
new, adaptive habits, such as exercising regularly, developing a healthy diet, and taking the
proper medication.
Acceptance is the last of the four stages of the grieving process in COPD, as defined
by Boer et al.
Patients who have not fully accepted COPD struggle to engage in healthy behaviors which
would slow the progression of the condition.
Patients who are able to accept the fact that they have COPD are better able to manage and
adapt to it, resulting in the delay of symptom progression and a higher quality of life.
Note that the journey through these stages is not a smooth, linear one.
Because COPD is progressive, individuals with it can fall back into a non-acceptance stage
even after they’ve reached acceptance.
Acceptance of COPD is an ongoing, perpetual journey.
So the idea is to help people to reach and maintain the state of acceptance, and not
stall in the other stages of grievance.
And how can we help?
Based on previous works and formative interviews, we chose to explore the use of daily text
messaging as a way to facilitate acceptance.
We have two kinds of messages: Knowledge-focused messages provide the receiver with a practical
fact about COPD that individuals can use in their daily lives.
For instance, this one gives practical information about the benefits of drinking fluids.
Mindset-focused messages aim to bring empathy, motivation, and positivity to individuals
with COPD.
Like this one, acknowledging the difficult emotions one might have been through and closing
with a positive, uplifting note.
So why text messages?
People with COPD tend to be older adults who have low digital literacy, and thus have more
barriers accessing health related information and communities online, so low tech like text
messaging may have better engagement and deeper reach.
People who are struggling to accept their condition may not want to take an active role
in managing their condition, so we need a method which would be able to benefit patients
without requiring too much effort.
And finally, text messaging has been shown to be effective in enabling improved health
outcomes in other areas such as pediatric asthma, breast feeding, and medication adherence,
showing promise for a successful intervention.
And why these kinds of messages?
We ground our approach on the Health Belief Model, a psychology model which describes
how factors can affect an individual’s beliefs, actions, and ultimately their health outcomes.
Within this model, we propose that acceptance is a mental action in which the patient acknowledges
the existence of COPD and the restrictions that come with it and is still willing to
engage in healthy behaviors fitting for their particular health trajectory.
What we propose then, is to leverage entry points into the HBM to facilitate the action
of acceptance.
Knowledge-focused messages aim to influence the modifying factor of knowledge, and mindset-focused
messages act as cues to action for the mental action of acceptance.
We conducted a user experiment to evaluate our approach, with 8 participants, sending
text messages daily over the course of 60 days.
Participants received a total of 30 knowledge-focused, and 30 mindset-focused messages, in random
order.
And we conducted surveys aimed at measuring each participant’s level of acceptance at
the beginning, middle, and end of the study period, as well as 30 days after finishing
the study to gauge lasting impact.
Hypothesis testing on the quantitative questionnaire results showed a statistically significant
improvement in individuals’ acceptance towards COPD and a decrease in the other stages of
nonacceptance.
Qualitative results from our follow up interviews supported the quantitative results.
Most participants were encouraged by the positivity in the messages, with some saying they were
more motivated and less scared.
One particularly striking example was a participant who was influenced by a text message to run
a race that he had been thinking about.
While participants did not necessarily gain new knowledge from the messages, they were
given reminders and reinforcement on their existing knowledge and habits.
We did see some variance in the ways participants responded to the same messages.
For instance, in response to this message that says:
"You may believe you got what you deserved for smoking.
Know that even if you smoked in the past, no one deserves to have COPD."
One participant responded positively, saying that she has the same discourse and found
it nice to have confirmation that her thinking was right.
But another participant found the message to be a terrible one, finding it guilt inducing.
In conclusion, there are some important takeaways and potential avenues for exploration from
our study.
We’ve shown that with the right kind of language, text messages can help individuals
with COPD take healthy actions.
This begs the question of whether we can demonstrate an effect on individuals’ health or longevity.
We’ve also shown different COPD patients can react differently to the same message.
Based on this finding, we can explore the delivery of personalized and context-aware
messages and whether that has an enhanced effect on participants.
And, we've demonstrated that knowledge and mindset-focused text messages delivered over
a period of time can help to facilitate the process of accepting COPD.
Our experiment was done with only one experimental group of 8 volunteers.
Future work can explore more variables with a larger and more diverse sample.