ArticleJMIR mHealth and uHealth2019
A Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel.
Article in JMIR mHealth and uHealth, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 58 citations in OpenAlex.
- Rehabilitation Applications Based on Behavioral Therapy for People With Knee Osteoarthritis: Systematic Review.JMIR mHealth and uHealth · 2024Pooled it
- Mobile Apps for Dental Caries Prevention: Systematic Search and Quality Evaluation.JMIR mHealth and uHealth · 2021Pooled it
- Effectiveness of a BCW theory-based exercise adherence intervention protocol in Chinese maintenance hemodialysis patients: a randomized controlled trial.Frontiers in public health · 2025Trial
- Moderators of the Effect of a Self-directed Digitally Delivered Exercise Program for People With Knee Osteoarthritis: Exploratory Analysis of a Randomized Controlled Trial.Journal of medical Internet research · 2021Trial
- Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial.Journal of medical Internet research · 2020Trial
- Individuals' perceptions and experiences of mHealth for home-based rehabilitation in knee osteoarthritis: A qualitative study.Osteoarthritis and cartilage open · 2026Article
- Messages and Notifications for the "OA Coach" Knee Osteoarthritis Self-Management Mobile App: Codevelopment and Evaluation Using a Participatory Research Design With Focus Groups and Surveys.Journal of medical Internet research · 2026Article
- Co-Design and Development of the SmilesUp Text Messaging Intervention Using Behavioral Theory to Support Parents of Children With Early Childhood Caries: Mixed Methods Study.JMIR pediatrics and parenting · 2025Article
- Development and initial evaluation of a digital service package for community-dwelling older females with pelvic floor dysfunction.BMC health services research · 2025Article
- Article
- A Qualitative Evaluation of Two Electronic-Rehabilitation Programmes for Managing Persistent Knee Pain.Musculoskeletal care · 2025Article
- Factors Influencing Rehabilitation Exercise Behavior in Elderly Rotator Cuff Repair Patients: A Qualitative Study Based on the Theory of Behavior Change Wheel.Patient preference and adherence · 2025Article
- Behavioral Nudging With Generative AI for Content Development in SMS Health Care Interventions: Case Study.JMIR AI · 2024Article
- Development and Use of Mobile Messaging for Individuals With Musculoskeletal Pain Conditions: Scoping Review.JMIR mHealth and uHealth · 2024Article
- Promoting planting in front gardens: a systematic approach to intervention development.UCL open. Environment · 2024Article
- Article
- Motivation and Barriers to Postoperative Rehabilitation Exercise in Type 2 Diabetic Patients with Rotator Cuff Injuries: A Qualitative Study.Patient preference and adherence · 2024Article
- SmilesUp text message intervention for early childhood dental caries prevention: A protocol for a randomised controlled trial.PloS one · 2024Article
- Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study.JMIR research protocols · 2023Article
- Developing and adapting two electronic-rehabilitation programmes for persistent knee pain.Musculoskeletal care · 2023Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundKnee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design.
objectiveThe study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework.
methodsThe intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program.
resultsThe target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ≥3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported <3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence.
conclusionsThis study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise.
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Registered trials
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