# Promoting lifestyle change through text messages to patients with hypertension: A randomized controlled trial in Swedish primary care

## TL;DR

A study in Sweden found that sending health-related text messages to people with high blood pressure helped them reduce alcohol use and become more active.

## Contribution

This is the first study to evaluate the impact of health-promoting text messages on lifestyle changes in hypertension patients within Swedish primary care.

## Key findings

- Text message recipients reduced alcohol use above four standard drinks per week.
- Recipients were more likely to be physically active compared to the control group.
- Motivational ratings from the Theory of Planned Behavior did not predict lifestyle changes.

## Abstract

We aimed to investigate whether health-promoting text messages sent to patients with hypertension in primary care could affect lifestyle habits, and if the Theory of Planned Behavior could be used to identify moderators of intervention effects.

From September 2020 to December 2022, patients with hypertension were randomly selected from the patient register at 10 Swedish primary health care centers and randomized 1:1 to receive health-promoting text messages or treatment as usual (N = 401). The intervention group received four text messages per week for six months. Self-reported measures of lifestyle habits were collected through a questionnaire at baseline and after six months. Predictors of behavioral change according to the Theory of Planned Behavior were collected through a baseline questionnaire. The data were analyzed according to the intention-to-treat principle. We compared lifestyle habits between the intervention and control groups at follow-up with adjustment for baseline measures through logistic regression analysis and analysis of covariance.

The text message group had a statistically significant decrease in the proportion of participants with alcohol use above four standard drinks per week (OR 0.35, 95 % CI 0.15–0.81), and in the proportion of participants being physically inactive (OR 0.60, 95 % CI 0.37–0.98). The effect could not be explained or predicted by a pragmatic adaptation of the Theory of Planned Behavior.

Health-promoting text messages could be offered to Swedish primary care patients with hypertension as part of the effort to improve their lifestyle habits.

•This trial assessed the effects of six months of health-promoting text messages.•We analyzed lifestyle changes in primary care patients with hypertension.•The text message recipients decreased alcohol use and increased physical activity.•Ratings on motivational questions did not predict effects on lifestyle habits.

This trial assessed the effects of six months of health-promoting text messages.

We analyzed lifestyle changes in primary care patients with hypertension.

The text message recipients decreased alcohol use and increased physical activity.

Ratings on motivational questions did not predict effects on lifestyle habits.