A text messaging intervention to improve heart failure self-management after hospital discharge in a largely African-American population: before-after study.
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Date
2013-03-12
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Abstract
BACKGROUND There is increasing interest in finding novel approaches to reduce health disparities in readmissions for acute decompensated heart failure ADHF Text messaging is a promising platform for improving chronic disease self management in low income populations yet is largely unexplored in ADHF OBJECTIVE The purpose of this pre post study was to assess the feasibility and acceptability of a text message based SMS short message service intervention in a largely African American population with ADHF and explore its effects on self management METHODS Hospitalized patients with ADHF were enrolled in an automated text message based heart failure program for 30 days following discharge Messages provided self care reminders and patient education on diet symptom recognition and health care navigation Demographic and cell phone usage data were collected on enrollment and an exit survey was administered on completion The Self Care of Heart Failure Index SCHFI was administered preintervention and postintervention and compared using sample t tests composite and Wilcoxon rank sum tests individual Clinical data were collected through chart abstraction RESULTS Of 51 patients approached for recruitment 27 agreed to participate and 15 were enrolled 14 African American 1 White Barriers to enrollment included not owning a personal cell phone n 12 failing the Mini Mental exam n 3 needing a proxy n 2 hard of hearing n 1 and refusal n 3 Another 3 participants left the study for health reasons and 3 others had technology issues A total of 6 patients 5 African American 1 White completed the postintervention surveys The mean age was 50 years range 23 69 and over half had Medicaid or were uninsured 60 9 15 The mean ejection fraction for those with systolic dysfunction was 22 and at least two thirds had a prior hospitalization in the past year Participants strongly agreed that the program was easy to use 83 reduced pills missed 66 and decreased salt intake 66 Maintenance mean composite score 49 to 78 P 003 and management 57 to 86 P 002 improved at 4 weeks whereas confidence did not change 57 to 75 P 11 Of the 6 SCHFI items that showed a statistically significant improvement 5 were specifically targeted by the texting intervention CONCLUSIONS Over half of ADHF patients in an urban largely African American community were eligible and interested in participating in a text messaging program following discharge Access to mobile phones was a significant barrier that should be addressed in future interventions Among the participants who completed the study we observed a high rate of satisfaction and preliminary evidence of improvements in heart failure self management