Risk factors

Text messages a powerful tool in CHD risk factor modification


Text messaging can motivate patients with coronary heart disease to improve their adherence to dietary guidelines.

According to a randomised controlled trial of more than 700 patients with proven CHD, receipt of just one diet-related text message per week increased adherence over six months.

Adherence to at least four key dietary guidelines increased from 53% at baseline to 93% after six months with text messages compared to 56% at baseline and 75% at six months with standard care.

The TEXT-ME study focused on NHMRC and National Heart Foundation recommendations regarding fruit, vegetable and fish consumption, replacing saturated fats with unsaturated fats, and limiting takeaway foods, salt and alcohol.

“There was a mean increase of 4.6 serves of vegetables per week, 4.9 serves of fruits per week and 121.7 g of fish per week in the intervention group at six months, while the control group had no increase in serves of vegetables and a mean increase of 1.0 serve of fruits and 30.8 g of fish,” the study authors said.

“It is important to highlight that although the text-messaging intervention improved adherence to the dietary guideline recommendations, the proportions of patients meeting the recommendations for consumption of vegetables, fruits and fish were still low, with less than 15% of patients achieving the recommendations for vegetables and less than 50% for fruits and fish at six-months follow-up.”

The improvements in adherence to dietary guidelines also appeared to mediate improvements in LDL-cholesterol and BMI.

Dr Karla Santo, a cardiologist and research fellow at The George Institute for Global Health and research associate at the University of Sydney’s Westmead Applied Research Centre, said the study was part of a larger effort on motivating other lifestyle changes including physical activity and smoking cessation.

She told the limbic there was some crossover with participants reporting that messages in one component of the study triggered healthier behaviours in the others.

The language and content of the text messages were developed based on secondary prevention guidelines, techniques around behaviour change, and patient and clinician input.

She said another larger, nationwide project is currently underway which would also follow patients in the longer term.

“We do know that improvements might either stabilise or decrease but for the moment we don’t have any data on that.”

The Westmead Applied Research Centre is hoping to eventually deliver a program that clinicians can refer patients to as a stand-alone intervention or perhaps as part of cardiac rehabilitation, Dr Santo added.

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