Text Messaging

Grand Rounds March 27, 2026: Text Messaging and Video Stories to Support Hypertension Self-Management in Black Veterans: A Randomized Clinical Trial (Sarah L. Cutrona, MD, MPH)

Posted on by Sophia Ramirez

Speaker

Sarah L. Cutrona, MD, MPH
Acting Director, Center for Health Optimization and Implementation Research (CHOIR)
VA Bedford Healthcare System
Professor, Division of Health Informatics and Implementation Science
Department of Population and Quantitative Health Sciences
UMass Chan Medical School

Keywords

Blood Pressure; Hypertension; Self-Management; Video; Texting; Black Americans; Veterans

Key Points

  • Black Americans experience disproportionate morbidity and mortality due to hypertension (HTN). Simultaneously, self-management is made more difficult by differential rates of diagnosis and treatment titration; decreased access to, trust in, and engagement with the healthcare system; and cost, access, and environmental barriers. This study sought to improve HTN control and self-management among about 600 Black Veterans by supplementing a preexisting video story intervention with longitudinal texting support.
  • Those in the intervention arm watched 5 video stories featuring other Black Veterans, chose their preferred storyteller, and received educational and interactive messages aligned with that storyteller. Those in the control arm received only interactive messages. The researchers hypothesized that peer stories would promote participants’ emotional engagement with the messages via a parasocial relationship with the storyteller, enhancing self-efficacy, influencing health behaviors and ultimately improving HTN control.
  • While participants in both arms saw marginal improvements in systolic and diastolic blood pressure (BP), there was no significant difference in the BP change between the arms. The intervention saw high treatment fidelity (92%) and sustained engagement, with over 55% of participants responding to texts through the end of the 6-month period. The researchers concluded that the interactive text messages, which were present in both arms, were an effective way to maintain engagement in a multi-month study and may serve as a useful strategy for future longitudinal interventions supporting Black Veterans.

Discussion Themes

The control group was intentionally kept active – i.e., received educational texts – to isolate the specific impact of storytelling rather than just the impact of receiving text messages.

The intervention was shaped by direct feedback from veteran consultants, who provided guidance on tone, word choice, and structure to ensure the messages felt authentic.

Attendees noted that negative studies are vital for informing future research and that the intervention provided valuable moments of outreach to a population facing socioeconomic vulnerabilities and isolation.

Grand Rounds February 21, 2025: Texting for Behavior Change: Lessons Learned Across 2 Interventions to Improve Chronic Care Management (Michael Ho, MD, PhD; Sheana Bull, PhD)

Posted on by Sophia Ramirez

Speakers

Michael Ho, MD, PhD
Kaiser Permanente Colorado

Sheana Bull, PhD
University of Colorado School of Public Health

Keywords

Text Messaging; Artificial Intelligence; Chatbots; Health Behaviors

Key Points

  • Ample evidence now exists demonstrating the benefit of using text messaging in support of health behavior and access to care. It’s ubiquitous, increasing reach; theory in message design is impactful; and it can improve adherence to medical appointments and health behaviors.
  • Two NIH Collaboratory Trials, Nudge and Chat 4 Heart Health (C4HH), test the effectiveness of text messaging interventions to support behavior change. Nudge randomized patients to receive usual care, generic texts, behavioral texts, or behavioral texts plus chatbot messages. Their primary outcome was medication adherence.
  • C4HH, the subsequent trial, is randomizing patients to receive a generic text message curriculum; an AI chatbot messaging curriculum; or AI chatbot messages plus proactive pharmacist support. Their primary outcome is cardiovascular risk factors, as measured by the American Heart Association’s “Life’s Essential 8” adherence.
  • Nudge used an opt-out consent approach where CC4H used an opt-in consent approach. In the former, the research team noted, patients who identified as Black, Hispanic, and primary Spanish speakers were more likely to remain in the study. An opt-out approach in the appropriate context may be a way to diversify clinical trial populations and improve external validity of results.
  • The use of AI chatbots allows users to generate questions in their own words and the system to retrieve a response from a closed, curated library.
  • Message engagement is key to text messaging interventions. Participants in the Nudge study who were randomized to optimized texts had more questions. Questions were related to medications, refill logistics, and costs. The study team hypothesizes that the optimized texts may have led to greater patient engagement, and therefore more questions about their medications.
  • Over 12 months, the Nudge study found no significant difference in the rates of prescription refills, between the 3 intervention arms and usual care. CC4H is ongoing, and will send a higher volume of messages in an effort to engage patients and change patient behavior.
  • So far, the top 5 topics in messages initiated by C4HH participants have been healthy eating, physical activity, managing cholesterol, quitting smoking, and medication management.

Discussion Themes

The study team had to be very careful to ensure that patient health data, including cell phone numbers and the messages sent, were encrypted. Vendors and phone carriers were not able to access this data and it was not stored on their servers.

One of the challenges they encountered was that their systems weren’t integrated into the health care organizations’ pharmacies or electronic health records. The integration piece will be key to any future sustainability.

As technology evolves significantly over the course of, say, a 5-year study, developing the skillset to utilize interactive interventions or a SMART design could be helpful for investigators interested in conducting research in this area.

Grand Rounds November 15, 2024: Pragmatic Randomized Trial of Smartphone-Based Nudges to Reduce Distracted Driving Among US Auto Insurance Customers (M. Kit Delgado, MD, MS)

Speaker:

M. Kit Delgado, MD, MS
Associate Professor of Emergency Medicine and Epidemiology
Faculty Director, Penn Medicine Nudge Unit

Title: Pragmatic Randomized Trial of Smartphone-Based Nudges to Reduce Distracted Driving Among US Auto Insurance Customers

Date: Friday, November 15, 2024, 1:00-2:00 p.m. ET

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