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Early Cardiovascular Health Outreach SMS (ECHOS): A Preventive Health Text Messaging Program Pilot Study

Context: Early adoption of healthy habits has shown reduced cardiovascular morbidity and mortality later in life. Providing heart-healthy information while encouraging positive lifestyle changes in adolescents and young adults is challenging but important preventive health goal.

Objective: We hypothesized text messaging may be an effective method of increasing preventive health knowledge among young people. Early Cardiovascular Health Outreach SMS (ECHOS) evaluated the effectiveness and feasibility of text messaging to promote awareness and encourage positive lifestyle behaviours using elements of “nudge theory.”

Design: We performed a prospective cohort study in 3 phases.

Setting: Community-based.

Participants: Individuals between 13 and 25 years of age.

Intervention: Over periods of 30 to 90 days, participants received daily to weekly text messages educating them on cardiovascular health and encouraging engagement in various heart-healthy behaviours.

Main outcome measures: Knowledge about heart health and health behaviours were assessed pre- and post- intervention using 5-point Likert scales.

Results: In Phase 1 the ECHOS program resulted in both increased knowledge about heart health and self-efficacy surrounding preventive health behaviours. Phase 2 addressed sleep quantity and quality and we observed improvement in both parameters. Phase 3 focused on stress management. Results showed improvement within certain lifestyle domains associated with stress but lack of improvement in others.

Conclusion: These data suggest that text messaging interventions based on “nudge theory” are a feasible and scalable mode of communication promoting heart health among adolescents and young adults. Positive feedback and high satisfaction from ECHOS participants suggest that similar digital health interventions may be an effective approach to improving cardiovascular health in this population.


Katherine E Makaroff AB, Jennifer P Woo, Kimberly Uehisa BS, Kaya Branche, Marcella Press, Tamara Horwich and Karol E Watson

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