A controlled trial of mobile short message service among participants in a rural cardiovascular disease prevention program

Abstract

The statewide Colorado Healthy Heart Solutions (CHHS) program provides cardiovascular disease (CVD) risk factor screening and education to the medically underserved and has been shown to improve CVD risk profiles. We aimed to enhance its effectiveness through addition of a mobile health (mHealth) intervention using SMS messaging (termed Cardio SMS). We conducted a prospective, non-randomized controlled pilot trial of this intervention implemented at 5 rural program sites (number of participants N = 204) compared with a contemporaneous propensity-score matched control group from 14 CHHS sites not receiving the intervention (N = 408) between 2012 and 2014. All participants were free of CVD at baseline, and follow-up time was 12-months. The primary outcome was program engagement, defined as the number of completed interactions with the program during the entire follow-up period. Secondary outcomes were program retention, defined as any interaction during the last two months of the study; change in self-reported healthy behaviors (physical activity, weight loss, smoking cessation, fat intake); and change in CVD risk factors. There were trends for differences between groups across multiple outcomes, but most did not reach statistical significance, except for a greater decrease in self-reported fat intake in the intervention vs. control groups (26.3% vs 10.6%, P = 0.001). In addition, a subset of surveyed participants who viewed the SMS messages as motivating showed greater program retention (P = 0.03). Given the relative ease and scalability of SMS interventions in rural underserved communities, further study of SMS as part of multicomponent strategies for CVD prevention is warranted.

Keywords: Cardiovascular disease; Mobile health; Primary prevention.

Fig. 1

Program engagement, retention and retesting among intervention group participants who responded to the survey (N = 91, 46% of the participants in the intervention group). Higher proportions of participants who answered “Yes” to both of the questions “Do you think CHHS text messages are motivating for you all the time?” and “Do you think CHHS text messages help you with healthy eating and active living all the time?” remained engaged with the program (P = 0.07), underwent retesting (P < 0.001) and were retained in the program (P = 0.03).