The HeartHealth Program: A Mixed Methods Study of a Community-Based Text Messaging Support Program for Patients With Cardiovascular Disease From 2020 to 2024

TL;DR

The HeartHealth program uses text messages to support patients with heart disease, showing improvements in diet, activity, and medication adherence.

Contribution

This study demonstrates the successful implementation and scalability of a low-cost SMS-based cardiovascular health support program.

Findings

60.5% of participants reported improved diet healthiness due to the program.

53.6% of participants reported increased physical activity levels.

The program successfully delivered 99.41% of its 851,058 SMS messages.

Abstract

The HeartHealth program is a 6-month SMS text messaging–based support program offered to patients with a recent cardiovascular hospitalization or recent cardiovascular clinic visit in Western Sydney, Australia. Its customized content focuses on cardiovascular risk factors, lifestyle, treatments, and general heart health information.

This study aimed to evaluate the implementation of the HeartHealth program.

A mixed methods study was conducted assessing program reach, effectiveness, implementation, and maintenance using program data, participant feedback surveys, and staff focus group discussions. Consecutive adult patients who had attended cardiology clinics or had been discharged from cardiology hospitalization at Westmead Hospital, between April 2020 and April 2024, were included in the analysis. Content analysis was used to interpret the qualitative data.

A total of 23,095 patients were invited, 8804 (38.1%) enrolled into the program, and 7964 out of 8804 (90.5%) completed the 6-month duration. Participants enrolled in the HeartHealth program had a mean age of 58.6 years, 60.3% (5302/8788) were male, and 62.4% (5382/8624) were recruited from an outpatient clinic setting. A total of 851,058 SMS text messages were sent, with 99.41% (846,009/851,058) delivered successfully. A total of 3533 out of 7964 (44.4% of program completers) participants completed the postintervention survey, and 4 HeartHealth staff members participated in a focus group discussion. Among the participants who completed the survey, 60.5% (2137/3533) reported that the program improved the healthiness of their diet, 53.6% (1894/3533) reported improved physical activity levels, and 56.1% (1982/3533) reported that it helped remind them to take their medications. Content analysis of participant feedback identified that the program was effective in prompting participants to change their diet, providing emotional support, reminding them of the importance of behavior change, improving their confidence in managing their health, and keeping participants focused. Key barriers included limited personalization, language options, and SMS text messaging scheduling flexibility. Recommended adaptations focused on enhancing personalization, greater engagement by local clinical teams, and expanding program dissemination.

The program had a broad reach, translated to improved patient-reported health behaviors, and provided participants with needed support at low cost and low resource requirements. This analysis highlights the successful implementation and scalability of the HeartHealth program and provides key learnings for health systems that are looking to implement similar programs in the future.

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