Project Overview +

This project expands the existing MPOWER text message library to include 

  • tailored exercise messages, 
  • weekly photovoice activity, and 
  • feedback messages. 

New messages are tested with focus groups before use in the program.

Aims +

Aim 1. To develop tailored messages on six weight-related target behaviors, to be sent to the mobile phones of obese adolescents as an adjunct to an intensive multidisciplinary weight management program.

Aim 2. To evaluate the acceptability and relevance among adolescents in a weight management program, of specific types of tailored messages that emphasize personalization, feedback and content matching.

Aim 3. To test under field conditions the feasibility and acceptability of using a computer application to automatically deliver tailored messages to adolescents in a weight management program.

Aim 4. To pilot test the intervention developed through Aims 1-3, to assess its impact on adherence, attrition, [and BMI] among adolescents enrolled in a weight management program, as well as its cost-effectiveness.

Participants +

Newly enrolled participants in the MPOWER program offered through the Pediatric department (13-17 year old English speakers with a BMI in the 95 percentile or higher)

Intervention +

This research project aims to enhance and test an intervention to send tailored SMS (short message service) messages addressing 6 target behaviors:

  1. reduction of screen time;
  2. regular consumption of a healthy breakfast;
  3. decreased consumption of sweetened beverages;
  4. decreased consumption of fast food;
  5. increased consumption of fruits and vegetables; and
  6. increased physical activity.

Text messages are sent to mobile phones of obese adolescents enrolled in a multidisciplinary weight management program (MPOWER). The intervention aims improve adherence to treatment plans and increase program retention in the overall weight management program.

Phase 1: Expansion of Message Library and Enhancement of Computer Application

The library of tailored messages already developed are expanded to include sufficient messages for a 20-week intervention as well as an additional behavior.

The previously developed computer application is enhanced to: (1) automatically send tailored messages to study participants' mobile phones at varying times of day, based on patient preference, and (2) receive text replies from participants and to provide continuous tailoring by following-up with a tailored response.

Phase 2: Evaluation of Messages

Focus groups are conducted with current and past MPOWER participants to evaluate the acceptability of the messages developed in phase 1. The messages are assessed for relevance, perceived likelihood of impacting behavior, and ease of comprehension.

Phase 3: Feasibility and Acceptability Test of Intervention

We develop and implement a quality assurance process to ensure that data required for the tailoring intervention are obtained and stored on a consistent basis.

We evaluate participants' preferences regarding message frequency, as well as the technical performance of the computer application in handling problem situations. Based on these results, we refine the intervention prior to pilot testing

Phase 4: Pilot Test and Analysis of Costs and Cost-effectiveness

The 20-week intervention developed in phases 1-3 is pilot tested. Primary outcomes include MPOWER session attendance, adherence to MPOWER homework assignments, satisfaction with the program, and program drop out. Secondary outcomes include pre-post changes in BMI, the six target behaviors, self-efficacy, and intrinsic motivation. We also analyze cost-effectiveness, to gain experience for performing these analyses in a larger randomized trial.

Findings +


05/01/2009 - 04/30/2014


National Institute for Child Health and Human Development

Principal Investigator:

Susan J. Woolford, MD, MPH


Victor J. Strecher, PhD, MPH