(003) A text message intervention to promote health behaviors in cardiac risk patients: the Text4Health randomized controlled trial

Abstract:

Background: Nonadherence to key health behaviors among patients with cardiac risk conditions (e.g., type 2 diabetes [T2D]) is a major public health problem. Positive psychology (PP) interventions, which utilize short tasks (e.g., using personal strengths, recalling positive events) to cultivate well-being, could help to effectively promote cardiac health behaviors in combination with traditional approaches.



Text message interventions may represent a novel, accessible means to deliver a PP-based health behavior intervention. TMIs are simple, represent minimal burden for patients, and have shown some success in health promotion in cardiac populations. However, such programs should be maximally personalized to optimize patient engagement. Accordingly, we developed and tested a PP-based TMI that utilized an adaptive algorithm to promote cardiac health.



Methods: This was a pilot randomized trial (N=60) of a 12-week PP-health behavior adaptive TMI (plus provision of step counters), compared to step counter provision alone, among 60 patients with multiple cardiac risk conditions (2+ of hypertension, T2D, and hyperlipidemia). For those randomly assigned to the adaptive TMI, the program sent daily messages that used the participant’s feedback about prior messages to dynamically selects specific new messages with attributes (e.g., PP vs. health behavior messages) that fit the person’s preferences and needs. Over time, the daily message content was increasingly curated to deliver those messages that the individual found most useful in self-managing their illness. Alongside these daily messages, participants received twice-weekly goal-focused messages that prompted participants to set and reach specific goals related to physical activity, healthy eating, or medication adherence. Finally, participants had brief check-in calls with study trainers at 4 and 8 weeks to review progress.

The primary aim of this study was to assess the feasibility and accessibility of the adaptive TMI, with feasibility measured via the number of text messages receiving responses and acceptability measured via participant responses regarding the ease and utility of the messaging. As a key secondary analysis, we assessed between-group differences in psychological (e.g., positive affect), behavioral (e.g., objectively-measured physical activity), and health-related (e.g., physical function, lipids) outcomes at 12 and 24 weeks, assessed via random effects models.

Results: We enrolled and randomized 60 participants in the trial, and by the time of the presentation, can present all results regarding the primary and secondary study aims.

Conclusions: This randomized trial will provide critical information regarding the feasibility, acceptability, and preliminary impact of a scalable, adaptive TMI for patients at elevated cardiac risk. If intervention shows potential benefit, the next step will be to test it in a larger randomized trial powered to detect changes in health behaviors and clinically relevant outcomes. Ultimately, this intervention could be broadly utilized to promote health and prevent cardiac events, leading to substantial public health impact.