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Abstract
Background A variety of small mobile phone text-messaging interventions have indicated improvement in risk factors for cardiovascular disease (CVD). Yet the extent of this improvement and whether it impacts multiple risk factors together is uncertain. We aimed to conduct a systematic review and individual patient data (IPD) meta-analysis to investigate the effects of text-messaging interventions for CVD prevention.
Methods Electronic databases were searched to identify trials investigating a text-messaging intervention focusing on CVD prevention with the potential to modify at least two CVD risk factors in adults. The main outcome was blood pressure (BP). We conducted standard and IPD meta-analysis on pooled data. We accounted for clustering of patients within studies and the primary analysis used random-effects models. Sensitivity and subgroup analyses were performed.
Results Nine trials were included in the systematic review involving 3779 participants and 5 (n=2612) contributed data to the IPD meta-analysis. Standard meta-analysis showed that the weighted mean differences are as follows: systolic blood pressure (SBP), −4.13 mm Hg (95% CI −11.07 to 2.81, p<0.0001); diastolic blood pressure (DBP), −1.11 mm Hg (−1.91 to −0.31, p=0.002); and body mass index (BMI), −0.32 (−0.49 to −0.16, p=0.000). In the IPD meta-analysis, the mean difference are as follows: SBP, −1.3 mm Hg (−5.4 to 2.7, p=0.5236); DBP, −0.8 mm Hg (−2.5 to 1.0, p=0.3912); and BMI, −0.2 (−0.8 to 0.4, p=0.5200) in the random-effects model. The impact on other risk factors is described, but there were insufficient data to conduct meta-analyses.
Conclusion Mobile phone text-messaging interventions have modest impacts on BP and BMI. Simultaneous but small impacts on multiple risk factors are likely to be clinically relevant and improve outcome, but there are currently insufficient data in pooled analyses to examine the extent to which simultaneous reduction in multiple risk factors occurs.
PROSPERO registration number CRD42016033236.
- cardiovascular diseases
- diabetes
- short message service
- mobile phones
- mHealth
- cardiovascular risk factors
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Collaborators Text2PreventCVD Trial Collaborator Group: current membership of the Group: study institutes and investigators: 1. Cardiovascular Division, The George Institute for Global Health, Sydney, Australia (Secretariat) and University of Sydney, Sydney, Australia: Clara Chow, Julie Redfern, Anthony Rodgers, Shariful Islam and Aravinda Thiagalingam (TEXT ME41). 2. University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK/Chronic Disease Initiative for Africa, Division of Diabetes and Endocrinology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa South Africa: Kirsty Bobrow and Andrew Farmer (StAR42). 3. CenterCentre for International Health, Ludwig-Maximilians University, Munich, Germany/ Liverpool School of Tropical Medicine, UK, and Non-Communicable Diseases Initiative, International Center for Diarrhoeal Diseases, Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh: Andreas Lechner, Louis Niessen and Shariful Islam (MPID43). 4. National Institute for Health Innovation, The University of Auckland, New Zealand: Ralph Maddison, Robyn Whittaker and Leila Pfaeffli Dale (HEART26 and Text4Heart44). 5. Deakin University, Melbourne, Australia: Ralph Maddision and Shariful Islam. 6. Simon Fraser University and St. Paul's Hospital, Vancouver, BC, Canada: Scott Lear. 7. Duke University, USA: Zubin Eapen.
Contributors SMSI contributed to conception, drafted the protocol and data collection forms, conducted search, data abstraction and data checking as first reviewer, led the statistical analysis, and drafted and revised the paper. CKC contributed to the conception, drafted the protocol, data collection forms, supervised research staff working on the project, contributed to the review of the data analysis and the manuscript. KS conducted search, data abstraction and data checking as second reviewer. SS guided on the statistical analysis, contributed to the review of the data analysis and review of the manuscript. All authors reviewed the draft paper and contributed scientifically to improve the manuscript. SMSI and CKC are the guarantors.
Funding SMSI was funded by a senior research fellowship from the Institute for Physical Activity and Nutrition, Deakin University, and was a recipient of The George Institute for Global Health postdoctorate fellowship and early career transition grant from the High Blood Pressure Research Council of Australia. AF is a National Institute for Health Research (NIHR) senior investigator and received support from NIHR Oxford Biomedical Research Centre. JR was funded by a Career Development and Future Leader Fellowship cofunded by the National Health and Medical Research Council and the National Heart Foundation (APP1061793). AR has a NHMRC Principal Fellowship. CKC is funded by Career Development Fellowship cofunded by the National Health and Medical Research Council and the National Heart Foundation and the Sydney Medical Foundation Chapman Fellowship (1033478). KS is funded by a University of Sydney International Postgraduate Research Scholarship.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
Data availability statement Data are available upon reasonable request.
Author note All authors satisfied the four ICMJE Recommendations 2013 criteria for authorship.