Text Message and Internet Support for Coronary Heart Disease Self-Management: Results From the Text4Heart Randomized Controlled Trial

Leila Pfaeffli Dale, Robyn Whittaker, Yannan Jiang, Ralph Stewart, Anna Rolleston, Ralph Maddison, Leila Pfaeffli Dale, Robyn Whittaker, Yannan Jiang, Ralph Stewart, Anna Rolleston, Ralph Maddison

Abstract

Background: Mobile technology has the potential to deliver behavior change interventions (mHealth) to reduce coronary heart disease (CHD) at modest cost. Previous studies have focused on single behaviors; however, cardiac rehabilitation (CR), a component of CHD self-management, needs to address multiple risk factors.

Objective: The aim was to investigate the effectiveness of a mHealth-delivered comprehensive CR program (Text4Heart) to improve adherence to recommended lifestyle behaviors (smoking cessation, physical activity, healthy diet, and nonharmful alcohol use) in addition to usual care (traditional CR).

Methods: A 2-arm, parallel, randomized controlled trial was conducted in New Zealand adults diagnosed with CHD. Participants were recruited in-hospital and were encouraged to attend center-based CR (usual care control). In addition, the intervention group received a personalized 24-week mHealth program, framed in social cognitive theory, sent by fully automated daily short message service (SMS) text messages and a supporting website. The primary outcome was adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score (≥3) at 3 and 6 months. Secondary outcomes included clinical outcomes, medication adherence score, self-efficacy, illness perceptions, and anxiety and/or depression at 6 months. Baseline and 6-month follow-up assessments (unblinded) were conducted in person.

Results: Eligible patients (N=123) recruited from 2 large metropolitan hospitals were randomized to the intervention (n=61) or the control (n=62) group. Participants were predominantly male (100/123, 81.3%), New Zealand European (73/123, 59.3%), with a mean age of 59.5 (SD 11.1) years. A significant treatment effect in favor of the intervention was observed for the primary outcome at 3 months (AOR 2.55, 95% CI 1.12-5.84; P=.03), but not at 6 months (AOR 1.93, 95% CI 0.83-4.53; P=.13). The intervention group reported significantly greater medication adherence score (mean difference: 0.58, 95% CI 0.19-0.97; P=.004). The majority of intervention participants reported reading all their text messages (52/61, 85%). The number of visits to the website per person ranged from zero to 100 (median 3) over the 6-month intervention period.

Conclusions: A mHealth CR intervention plus usual care showed a positive effect on adherence to multiple lifestyle behavior changes at 3 months in New Zealand adults with CHD compared to usual care alone. The effect was not sustained to the end of the 6-month intervention. A larger study is needed to determine the size of the effect in the longer term and whether the change in behavior reduces adverse cardiovascular events.

Trial registration: ACTRN 12613000901707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364758&isReview=true (Archived by WebCite at http://www.webcitation.org/6c4qhcHKt).

Keywords: behavior; cardiovascular diseases; cellular phone; intervention; lifestyle change; mHealth; text messaging.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Trial registration flowchart.

References

    1. World Health Organization. 2015. [2015-07-16]. Fact sheet N317: cardiovascular diseases (CVDs)
    1. World Health Organization. World Economic Forum Essential Medicines and Health Products Information Portal. 2011. [2015-07-16]. From burden to best buys: reducing the economic impact of NCDs in low- and middle-income countries
    1. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM, Franklin B, Sanderson B, Southard D, American Heart Association Exercise‚ Cardiac Rehabilitation‚Prevention Committee‚ the Council on Clinical Cardiology. American Heart Association Council on Cardiovascular Nursing. American Heart Association Council on EpidemiologyPrevention. American Heart Association Council on Nutrition‚ Physical Activity‚Metabolism. American Association of Cardiovascular and Pulmonary Rehabilitation Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007 May 22;115(20):2675–82. doi: 10.1161/CIRCULATIONAHA.106.180945.
    1. Piepoli M, Corrà U, Adamopoulos S, Benzer W, Bjarnason-Wehrens B, Cupples M, Dendale P, Doherty P, Gaita D, Höfer S, McGee H, Mendes M, Niebauer J, Pogosova N, Garcia-Porrero E, Rauch B, Schmid JP, Giannuzzi P. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology. Eur J Prev Cardiol. 2014 Jun;21(6):664–81. doi: 10.1177/2047487312449597.
    1. Heran B, Chen J, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;(7):CD001800. doi: 10.1002/14651858.CD001800.pub2.
    1. Lawler P, Filion K, Eisenberg M. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2011 Oct;162(4):571–584.e2. doi: 10.1016/j.ahj.2011.07.017.
    1. Clark A, Hartling L, Vandermeer B, McAlister FA. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med. 2005 Nov 1;143(9):659–72.
    1. Turk-Adawi K, Grace S. Narrative review comparing the benefits of and participation in cardiac rehabilitation in high-, middle- and low-income countries. Heart Lung Circ. 2015 May;24(5):510–20. doi: 10.1016/j.hlc.2014.11.013.
    1. Doolan-Noble F, Broad J, Riddell T, North D. Cardiac rehabilitation services in New Zealand: access and utilisation. N Z Med J. 2004 Jul 9;117(1197):U955.
    1. Suaya J, Shepard D, Normand S-LT, Ades PA, Prottas J, Stason WB. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007 Oct 9;116(15):1653–62. doi: 10.1161/CIRCULATIONAHA.107.701466.
    1. Bjarnason-Wehrens B, McGee H, Zwisler A, Piepoli MF, Benzer W, Schmid JP, Dendale P, Pogosova N-GV, Zdrenghea D, Niebauer J, Mendes M, Cardiac Rehabilitation Section European Association of Cardiovascular PreventionRehabilitation Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey. Eur J Cardiovasc Prev Rehabil. 2010 Aug;17(4):410–8. doi: 10.1097/HJR.0b013e328334f42d.
    1. Dalal H, Zawada A, Jolly K, Moxham T, Taylor RS. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ. 2010;340:b5631.
    1. Neubeck L, Redfern J, Fernandez R, Briffa T, Bauman A, Freedman SB. Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review. Eur J Cardiovasc Prev Rehabil. 2009 Jun;16(3):281–9. doi: 10.1097/HJR.0b013e32832a4e7a.
    1. The World in 2013: ICT Facts and Figures. Geneva: International Telecommunication Union; 2013. [2015-07-16]. .
    1. Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev. 2010;32:56–69. doi: 10.1093/epirev/mxq004.
    1. Fjeldsoe B, Marshall A, Miller Y. Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med. 2009 Feb;36(2):165–73. doi: 10.1016/j.amepre.2008.09.040.
    1. Wei J, Hollin I, Kachnowski S. A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. J Telemed Telecare. 2011;17(1):41–8. doi: 10.1258/jtt.2010.100322.
    1. Fry J, Neff R. Periodic prompts and reminders in health promotion and health behavior interventions: systematic review. J Med Internet Res. 2009;11(2):e16. doi: 10.2196/jmir.1138.
    1. Maddison R, Pfaeffli L, Whittaker R, Stewart R, Kerr A, Jiang Y, Kira G, Leung W, Dalleck L, Carter K, Rawstorn J. A mobile phone intervention increases physical activity in people with cardiovascular disease: results from the HEART randomized controlled trial. Eur J Prev Cardiol. 2015 Jun;22(6):701–9. doi: 10.1177/2047487314535076.
    1. Quilici J, Fugon L, Beguin S, Morange PE, Bonnet JL, Alessi MC, Carrieri P, Cuisset T. Effect of motivational mobile phone short message service on aspirin adherence after coronary stenting for acute coronary syndrome. Int J Cardiol. 2013 Sep 20;168(1):568–9. doi: 10.1016/j.ijcard.2013.01.252.
    1. Park L, Howie-Esquivel J, Chung M, Dracup K. A text messaging intervention to promote medication adherence for patients with coronary heart disease: a randomized controlled trial. Patient Educ Couns. 2014 Feb;94(2):261–8. doi: 10.1016/j.pec.2013.10.027.
    1. Prochaska J, Spring B, Nigg C. Multiple health behavior change research: an introduction and overview. Prev Med. 2008 Mar;46(3):181–8. doi: 10.1016/j.ypmed.2008.02.001.
    1. Dale LP, Whittaker R, Jiang Y, Stewart R, Rolleston A, Maddison R. Improving coronary heart disease self-management using mobile technologies (Text4Heart): a randomised controlled trial protocol. Trials. 2014;15:71. doi: 10.1186/1745-6215-15-71.
    1. Dale LP, Whittaker R, Eyles H, Ni Mhurchu C, Ball K, Smith N, Maddison R. Cardiovascular disease self-management: pilot testing of an mHealth healthy eating program. J Pers Med. 2014;4(1):88–101. doi: 10.3390/jpm4010088.
    1. New Zealand Guidelines Group. 2002. [2015-07-14]. Evidence-based best practice guideline: cardiac rehabilitation .
    1. American College of Sports Medicine . ACSM'S Guidelines for Exercise Testing and Prescription. Baltimore: Lippincott; 2010.
    1. Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004 Apr;31(2):143–64. doi: 10.1177/1090198104263660.
    1. Bandura A. Self-efficacy in health functioning. In: Ayers S, Baum A, McManus C, editors. Cambridge Handbook of Psychology, Health and Medicine. Cambridge: Cambridge University Press; 2007.
    1. Sharp P, Salyer J. Self-efficacy and barriers to healthy diet in cardiac rehabilitation participants and nonparticipants. J Cardiovasc Nurs. 2012;27(3):253–62. doi: 10.1097/JCN.0b013e31821efdc2.
    1. Katch H, Mead H. The role of self-efficacy in cardiovascular disease self-management: a review of effective programs. Patient Intelligence. 2010 Oct;2:33–44. doi: 10.2147/PI.S12624.
    1. Hare D, Toukhsati S, Johansson P, Jaarsma T. Depression and cardiovascular disease: a clinical review. Eur Heart J. 2014 Jun 1;35(21):1365–72. doi: 10.1093/eurheartj/eht462.
    1. Cameron L, Jago L. Emotion regulation interventions: a common-sense model approach. Br J Health Psychol. 2008;13(Pt 2):215–21. doi: 10.1348/135910708X288800.
    1. Text4Heart. [2015-07-17].
    1. Khaw K, Wareham N, Bingham S, Welch A, Luben R, Day N. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med. 2008 Jan 8;5(1):e12. doi: 10.1371/journal.pmed.0050012.
    1. Maddison R, Roberts V, Bullen C, McRobbie H, Jiang Y, Prapavessis H, Glover M, Taylor S, Brown P. Design and conduct of a pragmatic randomized controlled trial to enhance smoking-cessation outcomes with exercise: The Fit2Quit study. Mental Health and Physical Activity. 2010 Dec;3(2):92–101. doi: 10.1016/j.mhpa.2010.09.003.
    1. Wellington: Ministry of Health. 2008. [2015-07-15]. New Zealand Health Survey 2006/07 Adult Questionnaire .
    1. Bush K, Kivlahan D, McDonell M, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998 Sep 14;158(16):1789–95.
    1. Godin G, Shephard R. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985 Sep;10(3):141–6.
    1. D'Agostino R, Russell M, Huse D, Ellison RC, Silbershatz H, Wilson PW, Hartz SC. Primary and subsequent coronary risk appraisal: new results from the Framingham study. Am Heart J. 2000 Feb;139(2 Pt 1):272–81.
    1. Morisky D, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 2008 May;10(5):348–54.
    1. Lorig K, Sobel D, Ritter P, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. 2001;4(6):256–62.
    1. Broadbent E, Petrie K, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006 Jun;60(6):631–7. doi: 10.1016/j.jpsychores.2005.10.020.
    1. Snaith R. The hospital anxiety and depression scale. Health Qual Life Outcomes. 2003;1:29. doi: 10.1186/1477-7525-1-29.
    1. MacPherson L. Statistics New Zealand. 2014. Oct 03, [2015-07-16]. New Zealand Income Survey: June 2014 quarter .
    1. Drake B, Quintiliani L, Sapp A, Li Y, Harley AE, Emmons KM, Sorensen G. Comparing strategies to assess multiple behavior change in behavioral intervention studies. Transl Behav Med. 2013 Mar 1;3(1):114–121. doi: 10.1007/s13142-013-0195-2.
    1. Hajek P, Stead L, West R, Jarvis M, Hartmann-Boyce J, Lancaster T. Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev. 2013;8:CD003999. doi: 10.1002/14651858.CD003999.pub4.
    1. Fjeldsoe B, Neuhaus M, Winkler E, Eakin E. Systematic review of maintenance of behavior change following physical activity and dietary interventions. Health Psychol. 2011 Jan;30(1):99–109. doi: 10.1037/a0021974.
    1. Varnfield M, Karunanithi M, Lee CK, Honeyman E, Arnold D, Ding H, Smith C, Walters DL. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial. Heart. 2014 Nov;100(22):1770–9. doi: 10.1136/heartjnl-2014-305783.
    1. Zullig L, Peterson E, Bosworth H. Ingredients of successful interventions to improve medication adherence. JAMA. 2013 Dec 25;310(24):2611–2. doi: 10.1001/jama.2013.282818.
    1. van Elderen T, Maes S, Dusseldorp E. Coping with coronary heart disease: a longitudinal study. J Psychosom Res. 1999 Aug;47(2):175–83.

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