ITM support for patients with chronic respiratory and cardiovascular diseases: a protocol for a randomised controlled trial

Abstract

IntroductionSimple and scalable strategies are needed to improve ‘out-of-hospital’ support and management for people living with cardiovascular disease (CVD) and respiratory disease. Text messaging via mobile phones has been shown to be effective in helping promote lifestyle change and is supported by quantitative and qualitative evidence. The aim of this study is to test the effectiveness and implementation of a 6-month text messaging support programme for people with CVD and respiratory disease as an addition to cardiac and pulmonary outpatient rehabilitation.Methods and analysisPragmatic randomised controlled trial (n=310) to test the effectiveness of a 6-month text message support programme on clinical outcomes in people with CVD and chronic respiratory disease who are attending outpatient cardiac and pulmonary rehabilitation. The study includes a nested process evaluation to inform scalability and implementation across settings. The intervention group will receive a text message support programme comprising five messages per week for 26 weeks and the control group will continue with standard care. The primary outcome is exercise capacity (6 min walk distance). Secondary outcomes include clinical measures (proportion of people meeting the Australian guideline-recommended blood pressure and cholesterol targets), lifestyle outcomes (smoking rates, achievement of national guidelines for nutrition and physical activity), quality of life, mood (Hospital Anxiety and Depression Scale), medication adherence and attendance at and completion of rehabilitation.Ethics and disseminationPrimary ethics approval was received from the Sydney Local Health District Hospital Human Research Ethics Committee and associated Governance committees at sites. Results will be disseminated via the usual scientific forums including peer-reviewed publications and presentations at international conferences. At its conclusion, the study will determine the effectiveness and implementation of a simple programme that aims to improve health outcomes and attendance at rehabilitation for people with CVD and chronic respiratory disease.Trial registration numberACTRN12616001167459

Understanding Preferences for Lifestyle-Focused Visual Text Messages in Patients With Cardiovascular and Chronic Respiratory Disease: Discrete Choice Experiment

“…This study was conducted as part of the process evaluation component of an integrated text messaging (ITM) study [ 17 ]. Ethics approval was obtained from the Ethics Review Committee of the Sydney Local Health District (HREC/16/RPAH/362), Sydney, Australia.…”

“…Once the survey design was specified, visual messages were crafted according to the required attribute-level combinations of each choice set. The content of the visual messages was sourced from the original SMS text messages developed for the ITM study (developed based on the published process) [ 17 , 39 ] along with stakeholder websites. The ITM SMS text messages themselves were developed based on the behavior change taxonomy of Michie et al [ 40 ].…”

“…Once refinements were made, a link to the web-based survey was sent to 141 participants via their nominated email address. These participants had already been recruited as part of the ITM study [ 17 ]. Eligible respondents consisted of adults with a medical history of CVD (including coronary heart disease, cardiomyopathy, peripheral arterial disease, and stroke) or chronic respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, chronic asthma, and bronchiectasis).…”

“…Strong evidence supports the effectiveness of SMS text messaging interventions to promote smoking cessation [ 14 ], weight loss [ 15 ], and increased physical activity [ 16 ]. A randomized controlled trial is currently underway to evaluate the effectiveness of a text message support program for patients with CVD and chronic respiratory disease [ 17 ]. This is based on a previous randomized controlled trial, the Text Me study, which showed that a lifestyle-focused SMS text messaging intervention was effective in improving cardiovascular risk factors in patients with coronary heart disease [ 18 ].…”

Text Message Analysis Using Machine Learning to Assess Predictors of Engagement With Mobile Health Chronic Disease Prevention Programs: Content Analysis

“…Our team has previously developed and supported patients with SMS text message-based mHealth programs who have chronic diseases, including CVD [15][16][17][18], diabetes [17], renal disease [19], and chronic obstructive pulmonary disease [18]. Across our programs, we developed a database of different SMS text messages and participant replies.…”