The World Health Organization states that cardiovascular disease (CVD) has been the number one global cause of death; with an estimation of 17.5 million people dying from CVD in 20121, representing 31% of all global deaths. CVD has been and is currently the major cause of death in Australia2 accounting for over 43,600 deaths in 2013; with dementia and cerebrovascular disease following behind.
Most CVD can be prevented using population-wide strategies, by addressing an individual’s behavioural risk factor such as their intake of tobacco, unhealthy diet/obesity, physical inactivity and alcohol abuse. The George Institute conducted a study – The Tobacco, Exercise and Diet Messages (TEXT ME) which aimed to investigate whether simple reminders about behaviour change sent via mobile phone text messages can decrease an individual’s cardiovascular (CV) risk.
The study was conducted throughout Australian tertiary centres as a single-blind, randomised controlled trial with 6 months of follow-up; and comprised of a relatively large cohort. TEXT ME evaluated the feasibility, acceptability and effect on CV risk of repeated lifestyle reminders sent via mobile phone text messages compared to usual care. A total of 720 patients with documented coronary heart disease (CHD) over a two year period, were randomised to either standard of care or the TEXT ME intervention – the TEXT ME group received behaviour change reminders via SMS text message in addition to standard care.
The study implemented and utilised a simple and inexpensive text messaging system that is suitable for extensive use; tested in a randomised controlled and blinded study. The primary outcome of the study was to measure the change in low-density lipoprotein (LDL) cholesterol level as measured by fasting blood sample. Secondary outcomes of the study was to analyse the change in other biomedical risk factors, behavioural risk factors, quality of life and depression. In addition to those outcomes, participants were also monitored for myocardial infarction, stroke, death or any re-hospitalisation.
Patients within the TEXT ME intervention received four messages per week for 24 weeks. These messages were categorised into four groups and included information on: general heart health facts which informed patients on CVD, information on medications and risk factors, nutrition messages, physical activity messages and smoking cessation messages. Currently, there are limited studies that exist which use a mobile phone text messaging system that alters CV risk factors. In addition, there is no evidence of known study that has previously evaluated the acceptability, feasibility and efficacy of a text message-delivered intervention for addressing multiple CV risk factors in people with established diseases.
The results of the TEXT ME study conveyed that patients who received text message reminders can achieve significant reductions in cholesterol, systolic blood pressure and body mass index1. Furthermore, it was found that the group receiving the text messages were nearly 2.4 times as likely to exercise, in addition to 44% of patients more likely to control their blood pressure and 33% more likely to quit smoking2. The study proved to be of a high level of acceptability with an overwhelming number finding the messages to be of use and appropriate.
The TEXT ME study tested the utility of a text messaging-based intervention to reduce CV risk factors in patients with known CHD. The TEXT ME study is the first to provide reliable data on the effectiveness of a text message intervention for managing multiple CV risk factors. Over 350 billion text messages (SMS messages) are sent every month across the world’s mobile networks. Utilizing the text messaging platform is inexpensive, safe and easily understood and has potential to improve behaviour change and ultimately CV risk of people who have access to mobile telephones.