Date of Award

Spring 1-1-2016

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

ATLAS Institute

First Advisor

Clayton Lewis

Second Advisor

Sheana Bull

Third Advisor

Douglas Novins

Fourth Advisor

Sarah Hug

Fifth Advisor

Mark Gross

Abstract

Background and Significance: Project Cell & Tell (C&T) was a mobile health (mHealth) pilot intervention delivered in collaboration with the Denver Indian Health and Family Services (DIHFS) urban clinic. Content for the mHealth project was adapted from a classroom-based health education curriculum called Honoring the Gift of Heart Health (HGHH) and designed to be a standalone mHealth intervention. Short Message Service (SMS; text only) and Multimedia Messaging Service (MMS; text with images) were used to deliver health information over a five week period using three types of messages: information, quiz, and homework. Each participant received two informational SMSs, two quizzes, and a single homework message per week. The research questions were:

(1.) To what extent is the cell phone, as used in C&T, a feasible dissemination tool to increase knowledge of cardiovascular disease (CVD) risk factors in an urban American Indian Alaska Native (AI/AN) population?

(2.) In an urban AI/AN population, to what extent, if any, does the inclusion of text with photo elicitation (MMS) increase health knowledge and motivation more than text messaging (SMS)?

(3.) How applicable were the social science ideas about organic intellectuals and counterhegemonic discourse in shaping the intervention?

Methods: Sixteen people received the SMS intervention and 16 people received the MMS intervention. Following the delivery of messages, SMS participants (4, 25%) attended focus groups, and those in the MMS condition (6, 37%) participated in digital photovoice sessions. Baseline and post-intervention health knowledge surveys were collected from participants.

Results: Quantitative analysis suggested a positive trend in health knowledge for both the SMS and MMS conditions. Four specific types of health knowledge constructs 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

Conclusions: This dissertation project showed that using SMS and MMS cell phone functions to increase health knowledge of cardio vascular disease (CVD) in an urban AI/AN clinic was feasible, that participants who used MMS with photo elicitation gained more health knowledge than those using SMS capabilities, an increase in knowledge regarding signs and symptoms of heart attack by means of mHealth was possible, and blended social theory and behavioral health models could contribute to the cultural adaptation of mHealth strategies to engage underserved AI/ANs.

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