Texting Can Save Your Life (Seriously)

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This comes via Dr. Aaron Carroll, who headlines his post, “Texting people actually gets them to improve their modifiable risk factors.” I decided on a punchier version. Was I justified? You be the judge.

Here’s the background: A team of 15 researchers recruited a group of 710 patients with coronary heart disease. Half of the patients got the usual treatment. The other half got the usual treatment plus one other thing: four text messages each week reminding them to exercise, eat right, quit smoking, etc. That’s it. Patients did not respond to the messages. They just received them.

Common sense and all previous research suggests that this would have almost no effect, even with a highly motivated population like this. Here’s Carroll:

Let’s take a pause here. If you had asked me to bet, I would have put all the money in my pocket on this being a negative trial. I mean, random text messages? That’s all? One-way communication? No way this would make a difference.

I was wrong. LDL cholesterol was 5 points lower in those in the intervention (79 mg/dL versus 84), and it started higher in the intervention group. Systolic blood pressure was 8 points lower (128 mm Hg versus 136). BMI was 1.3 points lower (28 versus 30.3). Physical activity was way up (936 metabolic equivalent task minutes per week versus 643), and the percentage of people smoking was way down (26% versus 43%).

These results are so spectacular that they cry out for replication. Offhand, I’d note two possible reasons for tentative skepticism:

  • This was a group of people already highly primed to change their lifestyles. How well would this work on people who weren’t staring death in the face?
  • The trial lasted only six months. It’s one thing for an intervention to get people motivated for a short period. It’s quite another to keep them motivated when their enthusiasm flags and the text messages start to become routine and therefore mostly ignored.

Nonetheless, this is pretty interesting. I’m honestly not sure that I want to give the medical establishment yet another medium they can use to bombard me with well-meaning advice, but then, I’m a grouch. If this stuff improves outcomes even modestly when done right, then it’s worth doing. And Republican presidential candidates take note: it costs next to nothing. Put it in your next healthcare white paper!

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