A chat with Robert Gold, PhD, DrPH: Exploring how to use mobile SMS messaging to reduce health disparities in the United States

Robert Gold, PhD, DrPH

As the Dean of the University of Maryland School of Public Health and the President-elect of SOPHE, Robert S. Gold PhD, DrPH, FAAHB feels challenged to carve out enough time to dedicate to his personal research interests. Luckily for SurroundHealth, Dr. Gold took time out to talk to us about the role mobile SMS messaging can play in reducing health disparities.  

SurroundHealth:  Can you describe the area of research you are focused on?

 Dr. Gold:  I am really excited about a project to experiment with 2-way, tailored text messages.  We are looking to connect with members of the faith community and underserved areas in Prince Georges, Maryland to try and assist with access to care and self-management of health conditions that threaten a person’s wellbeing.  There are 6 or 7 critical behaviors that we are looking at (tobacco, sedentary lifestyle, diet, blood sugar, cholesterol, and blood pressure).  In most of the current text messaging campaigns that are being done, the focus tends to be on a single risk factor or disease entity rather than a constellation of risk factors.  I’d like to tackle the entire constellation all at once if possible.

 SurroundHealth:  So, how exactly is the 2-way texting going to work?

Dr. Gold:  We will be working with the health department, local hospital system, political leaders, faith-based leaders and others to build a database of health services and assets available in a community. Based on needs, the person will receive text messages encouraging them to receive a specific health service or screening.  If an individual is unsure where to get the service or screening, our database allows us to send an automated text response with addresses of the closest providers based on the person’s ZIP code. 

SurroundHealth: Your research sounds like it is creating an intersection between technology for health information and coalition building for healthier communities.

 Dr. Gold:  Yes, coalition building is critical.  If you can build a coalition, you will achieve a level of access and trust that no one can achieve alone.  Also, there is no single discipline that can address any major health issue today.  Coalitions not only need to include stakeholders and leaders in community but also the strength that comes from an interdisciplinary team. 

SurroundHealth:  What have been the ahas that have surfaced so far?

 Dr Gold:  The biggest aha came when we first started thinking about this intervention. Cell phone technology is available to about 98% of the population with about 75% reading any text message received within 15 minutes and 60% responding within 1 hour.  The power of that depth of penetration and speed is unmatched by any other technology that I know of.

SurroundHealth: And, it cuts across economic barriers.

Dr. Gold: Absolutely! I often experience knee-jerk reactions where people assume underserved populations don’t have access to technology.  That’s because they are thinking about in-home computers with high bandwidth access to the internet.  People of all income levels will not leave home unless they have 2 things – their phone and their keys. Public health practitioners do not always recognize that the cell phone is an important instrument for behavior change strategies. But, that is changing.

SurroundHealth: How did you get the coalition members of your project to see the potential of the 2-way texting program and believe it was possible?

Dr. Gold: I asked what things they have trouble remembering. Then, for a 2-week period I sent them text messages to remind them.  I also opened the system to them so they could “play with it” and see how easy it was to use.  I rarely will try to do something with technology without having people in the room to demonstrate and practice using it.  If you can show technology in meaningful ways to people, this makes it easier for them to believe.

SurroundHealth:  Technology changes so fast.  How can health professionals keep up with the changes AND stay innovative in applying technology to health interventions?

Dr. Gold:  Technology is the tool and tools are going to change.  Health professionals have to understand the logic of the tool.  Here’s the best analogy… If the only tool you have in your hand is a hammer, then you define every problem as a nail.  We need to start without the tools and assess what needs to be accomplished.  Then, we need to ask, “What are the tools currently available to best address those needs?”  You can’t look for problems to solve with a specific technology… that’s a backward way to think.  No matter how advanced you are in use of technology, if you focus on the technology rather than the thinking of the application, you will constantly feel like you are behind. We need to change the way we think about technology. 

SurroundHealth: As a leader in the field of public health and health communication technologies, where do you turn for inspiration?

Dr. Gold:  My greatest inspiration is the very talented people I work with on a regular basis. They don’t have to be specialists to be an enormous inspiration.  They have to be people who care and are willing to commit to something. I’ve always believed that the day as a teacher I don’t learn as much from my students as they should expect to learn from me, then that’s the day I have to get out of education. For me, the greatest inspiration is whomever I am fortunate enough to be working with at any point in time.

Interview and blog by SurroundHealth blogger, Susan Eno Collins, MS, CHES, RD.  Susan is a Community Leader of SurroundHealth — a social network where health professionals from different backgrounds come together to learn from one another’s expertise and to share knowledge and resources.  Membership is free.Members of SurroundHealth share a passion for improving the health and well-being of communities and individuals.  We focus on a wide range of health issues such as health literacy, cultural humility, and behavior change strategies. 


About Susan Collins, MS, CHES, RD, SurroundHealth Blogger

I am Community Leader for SurroundHealth (www.surroundhealth.net), a social network where health professionals from different backgrounds come together to learn from one another's expertise and to share knowledge and resources. We share a passion for improving the health and well-being of communities and individuals. I am also a registered dietitian and certified health education specialist.
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2 Responses to A chat with Robert Gold, PhD, DrPH: Exploring how to use mobile SMS messaging to reduce health disparities in the United States

  1. Robin Vlamis says:

    Great to hear about Dr. Gold’s texting initiative in Maryland! I agree that nowadays cell phone use cuts across all economic levels. However, I would be interested to know how his coalition deals with text message charges. People of lower SES levels may have basic phone plans, which put limits on the number of text messages sent and received, with strict penalties for over-usage. Are people willing to participate in the program if it could potentially cost them in high cell phone bills?

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