Cost-effectiveness of a text message programme for the prevention of recurrent cardiovascular events Design and rationale of the tobacco, exercise and diet messages (TEXT ME) trial of a text message-based intervention for ongoing prevention of cardiovascular disease in people with coronary disease: a randomised controlled trial protocol Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Clinical Trial. Effectiveness of Text Messaging as an Adjuvant to Health Advice in Smoking Cessation Programs in Primary Care. A Randomized Clinical Trial Development of a set of mobile phone text messages designed for prevention of recurrent cardiovascular events Design Considerations in Development of a Mobile Health Intervention Program: The TEXT ME and TEXTMEDS Experience Development and Outcomes of a Text Messaging Tobacco Cessation Intervention With Urban Adolescents. Behavioural intervention to increase physical activity among patients with coronary heart disease: protocol for a randomised controlled trial. Text Message Delivered Peer Network Counseling for Adolescent Smokers: A Randomized Controlled Trial
Objective To estimate the cost-effectiveness of Tobacco , Exercise and Diet Messages ( TEXT ME ) , a text message-based intervention that provides advice , motivation , information and support to improve health-related behaviours . Methods A lifetime Markov model was used to estimate major vascular events ( myocardial infa rct ions and strokes ) avoided , quality -adjusted life years ( QALYs ) gained , costs to the health system and the incremental cost per QALY gained . The model was informed by data from a r and omised controlled trial of TEXT ME , with evidence from systematic review s and meta-analyses used to estimate the effects of changes in risk factors on the risk of major vascular events . Expected costs and health outcomes were estimated with uncertainty surrounding these characterised using probabilistic sensitivity analysis and a number of scenario analyses . Results For a target population of 50 000 patients with documented coronary heart disease , the intervention is expected to lead to 563 fewer myocardial infa rct ions , 361 fewer strokes and 1143 additional QALYs .  TEXT ME is expected to lead to an overall saving of $ 10.56 million for the health system over the patients ’ lifetimes . The intervention can therefore be considered cost-saving and health-improving . Neither parameter nor structural uncertainty had a significant impact on the conclusion that TEXT ME is cost-effective . Conclusions The provision of TEXT ME is predicted to lead to better health outcomes and an overall saving in costs for the health system . Trial registration number anzctr.org.au identifier : ACTRN12611000161921 Background Although supporting lifestyle change is an effective way of preventing further events in people with cardiovascular disease , providing access to such interventions is a major challenge . This study aims to investigate whether simple reminders about behaviour change sent via mobile phone text message decrease cardiovascular risk . Methods and analysis R and omised controlled trial with 6 months of follow-up to evaluate the feasibility , acceptability and effect on cardiovascular risk of repeated lifestyle reminders sent via mobile phone text messages compared to usual care .  A total of 720 patients with coronary artery disease will be r and omised to either st and ard care or the TEXT ME intervention . The intervention group will receive multiple weekly text messages that provide information , motivation , support to quit smoking ( if relevant ) and recommendations for healthy diets and exercise . The primary end point is a change in plasma low-density lipoprotein cholesterol at 6 months . Secondary end points include a change in systolic blood pressure , smoking status , quality of life , medication adherence , waist circumference , physical activity levels , nutritional status and mood at 6 months . Process outcomes related to acceptability and feasibility of TEXT ME will also be collected . Ethics and dissemination Primary ethics approval was received from Western Sydney Local Health Network Human Research Ethics Committee — Westmead . Results will be disseminated via the usual scientific forums including peer- review ed publications and presentations at international conferences . Clinical trials registration number ACTRN12611000161921 IMPORTANCE Cardiovascular disease prevention , including lifestyle modification , is important but underutilized . Mobile health strategies could address this gap but lack evidence of therapeutic benefit . OBJECTIVE To examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors . DESIGN AND SETTING The Tobacco , Exercise and Diet Messages ( TEXT ME ) trial was a parallel-group , single-blind , r and omized clinical trial that recruited 710 patients ( mean age , 58 [ SD , 9.2 ] years ; 82 % men ; 53 % current smokers ) with proven coronary heart disease ( prior myocardial infa rct ion or proven angiographically ) between September 2011 and November 2013 from a large tertiary hospital in Sydney , Australia . INTERVENTIONS Patients in the intervention group ( n = 352 ) received 4 text messages per week for 6 months in addition to usual care . Text messages provided advice , motivational reminders , and support to change lifestyle behaviors . Patients in the control group ( n=358 ) received usual care . Messages for each participant were selected from a bank of messages according to baseline characteristics ( eg , smoking ) and delivered via an automated computerized message management system . The program was not interactive . MAIN OUTCOMES AND MEASURES The primary end point was low-density lipoprotein cholesterol ( LDL-C ) level at 6 months . Secondary end points included systolic blood pressure , body mass index ( BMI ) , physical activity , and smoking status . RESULTS At 6 months , levels of LDL-C were significantly lower in intervention participants , with concurrent reductions in systolic blood pressure and BMI , significant increases in physical activity , and a significant reduction in smoking . The majority reported the text messages to be useful ( 91 % ) , easy to underst and ( 97 % ) , and appropriate in frequency ( 86 % ) . [ table : see text ] . CONCLUSIONS AND RELEVANCE Among patients with coronary heart disease , the use of a lifestyle-focused text messaging service compared with usual care result ed in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors . The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12611000161921 Introduction Smoking remains a major risk factor for chronic diseases . Health advice is considered one of the most cost-effective interventions ; however , changes produced by counseling tend not to persist over time , it is necessary to implement enforcement mechanisms . Methods R and omized clinical trial to evaluate the effectiveness of a combined program that includes health advice and text messaging to mobile phone ( SMSalud ® ) . Patients were r and omized to one of two interventions : health advice ( control group ) or health advice and text messaging (  intervention group ) . We included 320 smoker patients who met the inclusion criteria : being motivated , aged over 18 years , having a mobile phone , being able to read and send messages . Patients were excluded if they had a history of mental or behavioral disorders , or depression . The primary endpoint was the percentage of patients who had stopped smoking by 6 months and confirmed by CO breath test . Results By 6 months after the start of the program , 24.4 % ( 39/160 ) of patients in the intervention group and 11.9 % ( 19/160 ) of controls had stopped smoking ( OR : 2.3 ; 95 % CI : 1.3 - 4.3 , p = .007 ) . Patients with no dependence or mild dependence were more likely to stop ( 28.3 % , 36/127 vs. 11.4 % , 22/193 ; OR : 3.0 , 95 % CI : 1.7 - 5.5 , p < .001 ) . The rate of continuous abstinence at 12 months was 16.3 % ( 26/160 ) in intervention group patients and 5.6 % ( 9/160 ) in controls ( OR : 3.2 ; 95 % CI : 1.3 - 5.9 ) . ] . Conclusions The combined program is effective for smoking cessation . Patients with less tobacco dependence have a higher probability of success . Implication s Health advice is effective for promoting changes in lifestyle but these changes do not persist over time , so we have to use strengthening mechanisms , as e-health , and specifically , mobile phone based interventions . SMSalud ® is an innovate program that includes text messaging and health advice , and it 's effective for smoking cessation . The only feature that seems to affect the probability of smoking cessation is the degree of tobacco dependence Background : Supporting lifestyle change is an effective way of preventing recurrent events in people with cardiovascular disease ( CVD ) . However , there is a need to develop innovative strategies that increase access to programmes for individuals at high risk of CVD . This study aim ed to develop a bank of text messages design ed to provide advice , motivation , and support for decreasing cardiovascular risk . Design : Iterative development process with mixed methods Methods : An initial bank of 120 text messages was drafted based on behaviour change techniques , guidelines , and input from clinicians and public health experts . A question naire was then administered to participants ( n = 53 ) for evaluation of message content , usefulness , and language . To test the process of delivery , a pilot study was conducted using a specifically design ed computer programme that delivered messages to multiple mobile phones according to a pre-specified schedule . Data were collected regarding message timing , delivery , and usefulness . Results : In the qualitative question naire , 92 % of participants found the messages easy to underst and and 86 % found the messages contained useful information . Positive feedback was also obtained from the pilot study . Based on these results , together with suggestions provided , several messages were reworded and an additional 44 were written . The need for semi-personalization was also identified and a r and om set of 103 individualized messages was created . Conclusions : A final bank of 137 mobile telephone text messages design ed to support behaviour change and decrease cardiovascular risk have been developed through a multistep iterative process . This provides a scientific approach for future developers of health-related text messages Background Mobile health ( mHealth ) has huge potential to deliver preventative health services . However , there is paucity of literature on theoretical constructs , technical , practical , and regulatory considerations that enable delivery of such services . Objectives The objective of this study was to outline the key considerations in the development of a text message-based mHealth program ; thus providing broad recommendations and guidance to future research ers design ing similar programs . Methods We describe the key considerations in design ing the intervention with respect to functionality , technical infrastructure , data management , software components , regulatory requirements , and operationalization . We also illustrate some of the potential issues and decision points utilizing our experience of developing text message ( short message service , SMS ) management systems to support 2 large r and omized controlled trials : TEXT messages to improve MEDication adherence & Secondary prevention ( TEXTMEDS ) and Tobacco , EXercise and dieT MEssages ( TEXT ME  ) . Results The steps identified in the development process were : ( 1 ) background research and development of the text message bank based on scientific evidence and disease-specific guidelines , ( 2 ) pilot testing with target audience and incorporating feedback , ( 3 ) software-hardware customization to enable delivery of complex personalized programs using prespecified algorithms , and ( 4 ) legal and regulatory considerations . Additional considerations in developing text message management systems include : balancing the use of customized versus preexisting software systems , the level of automation versus need for human inputs , monitoring , ensuring data security , interface flexibility , and the ability for upscaling . Conclusions A merging of expertise in clinical and behavioral sciences , health and research data management systems , software engineering , and mobile phone regulatory requirements is essential to develop a platform to deliver and manage support programs to hundreds of participants simultaneously as in TEXT ME and TEXTMEDS trials . This research provides broad principles that may assist other research ers in developing mHealth programs BACKGROUND This paper describes the development of an urban adolescent text messaging tobacco cessation intervention and preliminary findings from a r and omized , controlled trial . The authors successfully adapted a face-to-face intervention into a personalized , automated , and interactive 5-day texting protocol . METHODS Respondent-driven sampling was used beginning at a community substance abuse facility . Seventy-two tobacco-dependent adolescents were r and omized into an automated computer texting program that delivered either the experimental condition of 30 motivational interviewing- and social network counseling-based personalized messages or the attention control condition consisting of a texting program covering general ( non-smoking-related ) health habits . All teens were provided smartphones for the study and were assessed at baseline and at 1 , 3 , and 6 months post intervention . Analyses examined condition × time interactions . RESULTS At 6 months , the experimental condition decreased the number of cigarettes smoked in the past 30 days , increased intentions not to smoke in the future , and increased peer social support compared with controls . Effect sizes were moderate to large . CONCLUSIONS These findings are unique , as they target urban adolescents with a mobile health format and add to the growing literature on the efficacy of text-delivered interventions BACKGROUND Although physical activity has significant health benefits in the treatment of patients with coronary heart disease , patients often do not follow prescribed physical activity recommendations . Behavioural strategies have been shown to be efficacious in increasing physical activity among those patients with coronary heart disease who are attending structured cardiac rehabilitation programmes . Research has also shown that tailoring consultation according to patients ' needs and sending motivational reminders are successful ways of motivating patients to be physically active . However , there is a lack of evidence for the efficacy of behavioural interventions based on individualised consultation in promoting physical activity among those patients with coronary heart disease who are not attending structured physical activity programmes . OBJECTIVE This paper outlines the study protocol for a trial which is currently underway , to examine the effect of a behavioural change intervention delivered through individualised consultation calls and motivational reminder text messages on the level of physical activity among patients with coronary heart disease . SETTING Two large hospitals in Jordan . PARTICIPANTS Eligible patients aged between 18 and 70 years , who are clinical ly stable , are able to perform physical activity and who have access to a mobile telephone have been r and omly allocated to control or intervention group . DESIGN AND METHODS Two-group r and omised controlled trial . Behavioural intervention will be compared with usual care in increasing  physical activity levels among patients with coronary heart disease . The control group ( n=85 ) will receive advice from their doctors about physical activity as they would in usual practice . The intervention group ( n=71 ) will receive the same advice , but will also receive behavioural change intervention ( goal - setting , feed-back , self-monitoring ) that will be delivered over a period of six months . Intervention will be delivered through individually tailored face-to-face and telephone consultations , supported by motivational SMS text messages to encourage and remind patients to attain these goals . The participants and the research er delivering the intervention are not blinded to group assignment . RESULTS Recruitment started in February 2012 and preliminary findings are expected in November 2012 . CONCLUSION It is hypothesised that behavioural intervention delivered through tailored individualised consultation supported by motivational SMS text message reminders will help CHD patients to increase their level of PA . TRIAL REGISTRATION The study is registered as a clinical trial at IS RCT N register ( IS RCT N48570595 ) Abstract Although adolescent tobacco use has declined in the last 10 years , African American high school seniors ’ past 30-day use has increased by 12 % , and as they age they are more likely to report lifetime use of tobacco . Very few urban youth are enrolled in evidence d-based smoking prevention and cessation programming . Therefore , we tested a text messaging smoking cessation intervention design ed to engage urban youth through an automated texting program utilizing motivational interviewing-based peer network counseling . We recruited 200 adolescents ( 90.5 % African American ) into a r and omized controlled trial that delivered either the experimental intervention of 30 personalized motivational interviewing-based peer network counseling messages , or the attention control intervention , consisting of text messages covering general ( non-smoking related ) health habits . All adolescents were provided smart phones for the study and were assessed at baseline , and at 1 , 3 , and 6 months post intervention . Utilizing repeated measures general linear models we examined the effects of the intervention while controlling for race , gender , age , presence of a smoker in the home , and mental health counseling . At 6 months , participants in the experimental condition significantly decreased the number of days they smoked cigarettes and the number of cigarettes they smoked per day ; they significantly increased their intentions not to smoke in the future ; and significantly increased peer social support among girls . For boys , participants in the experimental condition significantly reduced the number of close friends in their networks who smoke daily compared to those in the control condition . Effect sizes ranged from small to large . These results provide encouraging evidence of the efficacy of text messaging interventions to reduce smoking among adolescents and our intervention holds promise as a large-scale public health preventive intervention platform
The intervention can therefore be considered cost-saving and health-improving .
Neither parameter nor structural uncertainty had a significant impact on the conclusion that TEXT ME is cost-effective .
Conclusions The provision of TEXT ME is predicted to lead to better health outcomes and an overall saving in costs for the health system .
Objective To estimate the cost-effectiveness of Tobacco , Exercise and Diet Messages ( TEXT ME ) , a text message-based intervention that provides advice , motivation , information and support to improve health-related behaviours .