Trial Summary

The goal of Chat 4 Heart Health is to improve control of cardiovascular disease risk factors using a multilevel intervention leveraging mobile phone–based text messages integrated within healthcare systems to improve control of the American Heart Association's Life's Essential 8 (LE8) lifestyle factors. The LE8 includes eating better, being more active, quitting tobacco, getting healthy sleep, managing weight, controlling cholesterol, managing blood sugar, and managing blood pressure. When unmanaged, these lifestyle factors lead to common coexisting chronic conditions like hypertension and diabetes, as well as greater morbidity, healthcare costs, and death. Population sthat experience health disparities (including minoritized ethnic groups, patients with limited English proficiency, and patients with lower income) are disproportionately affected by cardiovascular diseases, have worse disease control, and experience greater sequelae. Self-management of chronic disease by patients has strong evidence of benefit. It includes self-care, lifestyle changes, taking medications as prescribed, and managing exacerbations of chronic conditions. Text messaging interventions have improved health behaviors, including physical activity and medication adherence. Incorporating behavioral "nudges," defined as a small change in choice architecture that "alters people's behavior in a predictable way," into text messages may further augment its impact. However, text message interventions have typically not been delivered to large samples, have not focused on populations that experience health disparities, and have not leveraged healthcare systems' electronic health record (EHR) data to personalize content and maximize the scale, reach, and impact of the intervention. Using a patient-level randomized pragmatic trial, Chat 4 Heart Health will test the comparative effectiveness of 3 text messaging delivery strategies: (1) generic text messages; (2) interactive artificial intelligence (AI)–based chatbot text messaging that uses evidenced-based communication strategies with attention to patient context and sociocultural factors that influence self-management; and (3) interactive AI-based chatbot text messaging plus proactive pharmacist management. Chat 4 Heart Health will enroll ~2,200 patients from clinics in 3 healthcare systems that care for large populations experiencing health disparities: Denver Health and Hospital Authority, Salud Family Health Centers, and STRIDE Community Health Center. The study team will use healthcare system EHR data to identify eligible patients, deliver the intervention, and assess patient-centered outcomes. The study findings will provide evidence regarding the best population-based strategy for universal delivery to engage all patient populations experiencing health disparities in self-management to improve LE8 adherence. The intervention will be delivered in real-world settings to augment routine clinical care and improve access to care. The study team will incorporate lessons learned from one healthcare system into adaptations for the other healthcare systems in the study.

NIH Project Information