An adaptive text message intervention to promote health behavior adherence in patients with cardiac risk conditions: The Text4Health Program

Sophie Staton, LCSW, MSW

Massachusetts General Hospital – Licensed Clinical Social Worker (LCSW)

Scientific Abstract

Background: Despite the cardiovascular benefits of adherence to physical activity (PA) and a healthy diet, most patients at risk for cardiac disease are unable to maintain recommended levels of these behaviors. Existing health behavior interventions are time-intensive, attended by a minority of patients, and do not target psychological well-being, despite its links to health behaviors and lower cardiac risk. Text message interventions (TMIs) may address many limitations of traditional health behavior interventions, and those that utilize adaptive algorithms may provide tailored health behavior and well-being content. Accordingly, we developed a 12-week TMI that delivers daily text messages related to physical activity, diet, and well-being and that continuously adapts based on participant feedback to messages. In this pilot randomized trial, we aim to examine the TMI’s feasibility, acceptability, and preliminary efficacy in 60 patients at elevated risk of cardiovascular disease.

Methods: Eligible participants are adults with at least two cardiac risk factors (i.e., hyperlipidemia, type 2 diabetes, hypertension) who report low PA or suboptimal diet. Upon completion of baseline measures, participants are randomized to TMI or a wait-list control condition. For 12 weeks, participants in the TMI group receive daily text messages related to well-being or health behaviors and rate their utility via text message. Additionally, they engage in twice-weekly interactive text message sessions to set and review progress towards health behavior goals. TMI feasibility will be assessed through rates of successful TMI selection and transmission. Acceptability will be assessed through ratings of message utility. Psychological, behavioral, and health-related outcomes will be assessed for between group differences at 12 and 24 weeks.

Results: Recruitment is ongoing. 54 participants have been randomized (Mage = 65.58 years; 58.2% female).

Conclusion: If this TMI is shown to be effective, this study will inform subsequent, more focused trials to evaluate the efficacy of an adaptive TMI to increase PA and reduce adverse events in high-risk, high-yield patient populations.

research Areas


Sophie C. Staton, LCSW, Lauren E. Harnedy, BA, Christopher M. Celano, MD, Sonia Kim, BA, Emily Feig, PhD, Christina N. Massey, PhD, and Jeff C. Huffman, MD

Principal Investigator

Jeff C. Huffman, MD

Affiliated Website