Technology: Revolutionizing the Delivery of Health Behavior Change Interventions with Integrated Care

  • Stephen O. AgboolaEmail author
  • Kamal Jethwani


Worldwide, there is increasing demand for healthcare services due to population growth, longevity, and the exponential increase in the prevalence of chronic diseases. The rising rate of chronic diseases is attributable to the quartet of modifiable health risk behaviors of physical inactivity, poor nutrition, tobacco use, and excessive alcohol consumption. In the United States (USA), for example, the burden on the healthcare system has led to a disequilibrium in the demand and supply of healthcare services. As a result, this demand-supply mismatch is paving the way for newer care delivery models. Central to these innovative delivery models is active patient participation which is critical for optimizing clinical outcomes. More recently, there are increasing calls for integration of behavioral services into primary care delivery. The concurrent exponential growth of technological innovations is playing a key role in revolutionizing healthcare delivery. Health information technology solutions are diverse and leverage a variety of technological platforms including instant messaging, mobile or web application software, and miniature-sensing devices in phones and other personal devices. The marriage of these technological interventions and different models of behavior change is proving to increase relevance and effectiveness of these interventions. And, these innovative solutions are creatively being used to engage patients outside of traditional care settings to help them adopt and sustain positive lifestyle behaviors. Despite these early successes, there are some ethical concerns about data security which has generated calls for increased regulations to maintain data security and privacy.


Health behaviors Chronic diseases Technology Behavior change techniques Telehealth mHealth 


  1. Abraham, C., & Michie, S. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychology, 27(3), 379–387.CrossRefPubMedGoogle Scholar
  2. Agboola, S. O., Searl, M., Havasy, R., Lopez, L., Kvedar, J. C., & Jethwani, K. (2013). Text to Move (TTM) Study—A randomized controlled trial exploring the effect personalized text messages and physical activity monitoring in T2DM patients. Journal of Mobile Technology in Medicine, 2(4S), 8.CrossRefGoogle Scholar
  3. Alcohol [Internet]. (2014) Geneva, Switzerland: World Health Organization [updated May; cited October 30, 2014]. Retrieved from
  4. Alcohol and public health [Internet]. (2014). Atlanta, GA: Centers for Disease Control and Prevention [updated August 19; cited October 30, 2014]. Retrieved from
  5. Ambrose, J. A., & Barua, R. S. (2004). The pathophysiology of cigarette smoking and cardiovascular disease: An update. Journal of the American College of Cardiology, 43(10), 1731–1737.CrossRefPubMedGoogle Scholar
  6. Anderson, G. (2004). Chronic conditions: Making the case for ongoing care. Baltimore, MD: John Hopkins University.Google Scholar
  7. Armstrong, A. W., Watson, A. J., Makredes, M., Frangos, J. E., Kimball, A. B., & Kvedar, J. C. (2009). Text-message reminders to improve sunscreen use: A randomized, controlled trial using electronic monitoring. Archives of Dermatology, 145(11), 1230–1236.CrossRefPubMedGoogle Scholar
  8. Atienza, A. A., King, A. C., Oliveira, B. M., Ahn, D. K., & Gardner, C. D. (2008). Using hand-held computer technologies to improve dietary intake. American Journal of Preventive Medicine, 34(6), 514–518.CrossRefPubMedGoogle Scholar
  9. Carter, M. C., Burley, V. J., Nykjaer, C., & Cade, J. E. (2013). Adherence to a smartphone application for weight loss compared to website and paper diary: Pilot randomized controlled trial. Journal of Medical Internet Research, 15(4), e32.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Caulfield, B. M., & Donnelly, S. C. (2013). What is connected health and why will it change your practice? QJM, 106(8), 703–707.CrossRefPubMedGoogle Scholar
  11. Chronic diseases and health promotion [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2014 [updated May 9; cited October 30, 2014]. Retrieved from
  12. Cogswell ME, Zhang Z, Carriquiry AL, Gunn JP, Kuklina EV, Saydah SH, …, Moshfegh, A. J. (2012). Sodium and potassium intakes among US adults: NHANES 2003-2008. The American Journal of Clinical Nutrition, 96(3), 647–657.Google Scholar
  13. DeVol, R., & Bedroussian, A. (2007). An Unhealthy America: The economic burden of chronic disease. Milken Institute (2007) Santa Monica, California [cited October 30, 2014]. Retrieved from
  14. Eysenbach, G. (2001). What is e-health? Journal of Medical Internet Research, 3(2), E20.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Free, C., Knight, R., Robertson, S., Whittaker, R., Edwards, P., Zhou, W., … Roberts, I. (2011). Smoking cessation support delivered via mobile phone text messaging (txt2stop): A single-blind, randomized trial. Lancet, 378(9785), 49–55.Google Scholar
  16. Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., … Haines A. (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: A systematic review. PLoS Medicine, 10(1), e1001362.Google Scholar
  17. Gochman, D. S. (1997). Handbook of health behavior research I. New York, NY: Springer.CrossRefGoogle Scholar
  18. Harsha, D. W., & Bray, G. A. (2008). Weight loss and blood pressure control (pro). Hypertension, 51(6), 1420–1425. discussion 1425.CrossRefPubMedGoogle Scholar
  19. Kanny, D., Liu, Y., Brewer, R. D., & Lu, H. (2013). Centers for Disease Control and Prevention (CDC) Binge drinking—United States, 2011. MMWR Surveillance Summaries, 62(Suppl. 3), 77–80.Google Scholar
  20. Kumar, S., Nilsen, W. J., Abernethy, A., Atienza, A., Patrick, K., Pavel, M., … Swendeman, D. (2013). Mobile health technology evaluation: The mHealth evidence workshop. American Journal of Preventive Medicine, 45(2), 228–236.Google Scholar
  21. Meeker, M., & Wu, L. (2013). Internet trends 2013. All things D D11 conference 2013; May 28–30, 2013; California [cited October 30, 2014]. Retrieved from
  22. Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A., & French, D. P. (2011). A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychology & Health, 26(11), 1479–1498.CrossRefGoogle Scholar
  23. National Center for Chronic Disease Prevention and Health Promotion. (2013). State Indicator report on fruits and vegetables [cited October 30, 2014]. Retrieved from
  24. Nollen, N. L., Mayo, M. S., Carlson, S. E., Rapoff, M. A., Goggin, K. J., & Ellerbeck, E. F. (2014). Mobile technology for obesity prevention: A randomized pilot study in racial- and ethnic-minority girls. American Journal of Preventive Medicine, 46(4), 404–408.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Obesity and overweight [Internet]. Geneva, Switzerland: World Health Organization; 2014 [updated August; cited October 30]. Retrieved from
  26. Ogden, J. (2003). Some problems with social cognition models: A pragmatic and conceptual analysis. Health Psychology, 22(4), 424–428.CrossRefPubMedGoogle Scholar
  27. Painter, J. E., Borba, C. P., Hynes, M., Mays, D., & Glanz, K. (2008). The use of theory in health behavior research from 2000 to 2005: A systematic review. Annals of Behavioral Medicine, 35(3), 358–362.CrossRefPubMedGoogle Scholar
  28. Patrick, K., Raab, F., Adams, M. A., Dillon, L., Zabinski, M., Rock, C. L., … Norman, G. J. (2009). A text message-based intervention for weight loss: Randomized controlled trial. Journal of Medical Internet Research, 11(1), e1.Google Scholar
  29. Pena-Robichaux, V., Kvedar, J. C., & Watson, A. J. (2010). Text messages as a reminder aid and educational tool in adults and adolescents with atopic dermatitis: A pilot study. Dermatology Research and Practice, 2010, 6. doi: 10.1155/2010/894258. Epub 2010 Sep 1.CrossRefGoogle Scholar
  30. Petterson, S. M., Liaw, W. R., Phillips, R. L., Jr., Rabin, D. L., Meyers, D. S., & Bazemore, A. W. (2012). Projecting US primary care physician workforce needs: 2010–2025. Annals of Family Medicine, 10(6), 503–509.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Physical activity [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2014 [updated July 14; cited October 30, 2014]. Retrieved from
  32. Riley, W. T., Rivera, D. E., Atienza, A. A., Nilsen, W., Allison, S. M., & Mermelstein, R. (2011). Health behavior models in the age of mobile interventions: Are our theories up to the task? Translational Behavioral Medicine, 1(1), 53–71.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Shrier, L. A., Rhoads, A., Burke, P., Walls, C., & Blood, E. A. (2014). Real-time, contextual intervention using mobile technology to reduce marijuana use among youth: A pilot study. Addictive Behaviors, 39(1), 173–180.CrossRefPubMedGoogle Scholar
  34. Smoking & tobacco use [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2014 [updated February 6; cited October 30, 2014]. Retrieved from
  35. Telehealth [Internet]. (n.d.). Health Resources and Services Administration, U.S. Department of Health and Human Services [cited October 30, 2014]. Retrieved from
  36. The world in 2014: ICT facts and figures [Internet]. Geneva, Switzerland: International Telecommunication Union; 2014 [cited October 30, 2014]. Retrieved from
  37. Tobacco [Internet]. Geneva, Switzerland: World Health Organization; 2014 [updated May; cited October 30, 2014]. Retrieved from
  38. US Department of Health and Human Services. (2014) The health consequences of smoking—50 years of progress: A report of the Surgeon General. Atlanta, GA: US Dept of Health and Human Services, Centers for Disease Control and Prevention [cited October 30, 2014]. Retrieved from
  39. van Genugten, L., van Empelen, P., & Oenema, A. (2014). Intervention use and action planning in a web-based computer-tailored weight management program for overweight adults: Randomized controlled trial. JMIR Research Protocols, 3(3), e31.CrossRefPubMedPubMedCentralGoogle Scholar
  40. What is telemedicine? [Internet]. Washington, DC: American Telemedicine Association [cited October 30, 2014]. Retrieved from
  41. World Health Organization. (2009). Self-care in the context of primary health care Report of the Regional Consultation Bangkok, Thailand, 7–9 January 2009. India: World Health Organization. Report No.: SEA-HSD-320 [cited October 30, 2014]. Retrieved from = 1

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Partners Connected HealthBostonUSA
  2. 2.Massachusetts General HospitalBostonUSA
  3. 3.Harvard Medical SchoolBostonUSA

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