How motivational messaging may help patients to stay on course with MyPal

Dr Jonathan Reston and Heather Parker, MyPal team members and behaviour change specialists at Atlantis Healthcare UK, explain how the MyPal Adult study will incorporate personalised motivational messaging to optimise participant engagement.

Jonathan Reston and Heather Parker.

Most of us are now connected to a range of digital services throughout the day thanks to the rise of smartphones. Apps that help us manage our health are becoming increasingly common and can be extremely helpful for everything from tracking exercise and diet to recording symptoms, to providing reminders and activities. As anyone who’s tried using these apps may have found, it’s often easy to record that run, or note those calories, for the first few weeks. But over time, that motivation can slowly wane – and the apps become disused, no longer providing a benefit.

MyPal and motivational messaging

One of the personalised components of the MyPal experience for adult study participants that we have developed is regular motivational messaging delivered via MyPal app notifications. The aim of this messaging is to help keep patients engaged with the regular PRO reporting requirements over their study period.

Designing our approach to encourage better patient engagement

In designing our approach, we first undertook a literature review of psychological and social factors related to engagement with online surveys and digital behaviour change interventions. We found that engagement is predicted by a range of factors, particularly motivation, expectations, emotional distress, need for cognition, self-efficacy to meet the study requirements, and perceived personal relevance – in this case, how the MyPal study is relevant to someone who is managing cancer in a palliative care context.

These factors guided our development of targeted, brief motivational messages that target these factors and reduce potential risk of participant disengagement from the study. We incorporated a number of behaviour change techniques within the series of messages, working collaboratively as a team of health psychology, medical and palliative care experts. Motivation is assessed by asking the patient to indicate how much they agree with the statement: I feel that I want to take responsibility of my own health. Then an example of a message targeted at this ‘motivation’ factor would be:

“When doing what you can to help manage your [insert as appropriate to the individual] it’s important to find a balance between managing your condition, and getting on with enjoying your life. MyPal is there to help make tracking how things are going easier, so you can focus on getting the most out of your days.”


Personalisation: The right messages for the individual

To determine which messages are most relevant to send to each patient, we designed a short survey to assess each of these factors when they first join the study, again after three months, and at the end of the study period to help evaluate change over time. Using the individual’s responses to the survey and prioritising the factors in order of importance, the MyPal platform will send a tailored series of motivational messages that focuses on those of highest importance. If the survey responses change at the three-month follow up point, the order of messages will adjust according to new priorities.

This survey wording, along with the proposed style of messages and intended frequency were pre-tested and refined based on feedback from palliative cancer patients. Participants will receive two messages in each of the first four weeks, and then one message per week through the remainder of the study to help reinforce their key factors and help them maintain motivation in reporting symptoms through their MyPal app.

The MyPal project started in January 2019. The Adult study will be conducted across several clinical sites across Europe: Sweden, Italy, Greece, and the Czech Republic, with first patients targeted to start in May 2020.

MyPal, and digital tools like it, have the potential to improve patient care, but they can only do so as long as patients and healthcare professionals use them. Motivational messaging is one promising approach to promoting that vital engagement.

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