January 11, 2019: Nudge: Text Messaging at Scale in Diverse Health Systems to Support Adherence to Cardiac Medication (Sheana Bull, PhD, MPH, Michael Ho, MD, PhD)


Sheana Bull, PhD, MPH
Professor, Colorado School of Public Health
Director, mHealth Impact Lab

Michael Ho, MD, PhD
Professor of Medicine, University of Colorado School of Medicine
Staff Cardiologist, Eastern Colorado Health Care System (Denver Veterans Affairs)


Nudge: Text Messaging at Scale in Diverse Health Systems to Support Adherence to Cardiac Medication


Nudge; Cardiovascular disease; Mobile technology; Digital technology; Health promotion; Artificial intelligence; mHealth; Behavioral economics

Key Points

  • Medication non-adherence causes one-third of medicine-related hospitalizations. Mobile and digital technologies for health promotion and disease self-management offer an opportunity to adapt behavioral “nudges.”
  • The Nudge Demonstration Project will use population-level pharmacy data to deliver “nudges” via mobile phone text messaging and artificially intelligent chat bots. The nudges provide the patient with a reminder that their medicine refill is due.
  • The Nudge study team plans to engage patients, providers, and health system stakeholders in designing, refining, and implementing the pilot intervention within 3 diverse health systems.

Discussion Themes

There are overlapping notions between “nudge” theory and other socioeconomic theories. The study team relied on supporting literature as well as input from patient stakeholders to design the content of the nudge messages.

“Text message fatigue” is a potential concern that could affect study participation. Investigators relied on guidance from stakeholders to gauge the most appropriate frequency of messages.

Details about the use of a personal cell phone as the primary device messaging system, as well as privacy parameters, are explained in the opt-out letter presented to study participants.

For more information, visit the Nudge Demonstration Project on the Living Textbook.


#cardiovasculardisease, #pctGR, #mobile, #digitaltechnologies, #healthpromotion, #artificialintelligent, @Collaboratory1, @texhern, @lmhcurtis

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