A Text Message Intervention to Promote Health Behaviors in Cardiac Risk Conditions
A Text Message Intervention to Promote Health Behaviors in Cardiac Risk Conditions
This is a randomized pilot trial to examine the feasibility, acceptability, and preliminary
 efficacy of an adaptive text message intervention (TMI) to promote well-being and health
 behavior adherence in 60 patients with two or more cardiac risk conditions (hypertension,
 type 2 diabetes, or hyperlipidemia).
The investigators have developed an adaptive text message intervention (TMI) that uses
 participant feedback for individual messages and progress towards health goals to deliver
 increasingly personalized positive psychology (PP) and health behavior text messages over
 time. The investigators aim to examine its feasibility, acceptability, and preliminary
 efficacy in a randomized, controlled pilot trial in 60 adults with two or more cardiac risk
 conditions (hypertension, type 2 diabetes, or hyperlipidemia).
Inclusion Criteria:

 -  Cardiac risk conditions. Participants will have two or more of hypertension, type-2
 diabetes, and hyperlipidemia. Patients will have met 2+ of 2017 AHA-ACC criteria for
 hypertension (SBP ≥130, DBP ≥80), 2018 ADA criteria for type-2 diabetes (e.g., A1C
 ≥6.5%), and 2013 AHA-ACC criteria for hyperlipidemia (e.g., LDL cholesterol ≥190), via
 medical record review, with confirmation by healthcare providers as needed.

 -  Low physical activity or elevated sedentary leisure time (SLT). Low activity will be
 defined as ≤150 minutes/week of moderate to vigorous activity (MVPA), which is an
 ADA-recommended level of MVPA; elevated SLT will be ≥120 min/day, which is linked to
 adverse medical health. As initial screens for both MVPA and SLT, we will use the
 International Physical Activity Questionnaire (IPAQ). Patients reporting ≤150 min/week
 of MVPA or ≥120 min/day of SLT will wear accelerometers for 10 days to confirm low
 MVPA/high SLT (patients will indicate their leisure time hours to allow assessment of
 SLT during those hours).

 -  Suboptimal diet. Participants must also report either fewer than 5 daily servings of
 fruit/vegetables (measured by the Behavioral Risk Factor Surveillance System's [BRFSS]
 Fruit and Vegetable Consumption Module) or have a score of ≥70 on the MEDFICTS scale
 for fat/cholesterol intake, representing high risk. We will require diet and activity
 deficits to ensure that a broad range of messages will be relevant to every
 participant as we explore the utility of individual messages and patterns of message
 selection in this initial study.

 -  Ability to receive text messages. Participants must have a cellular phone that
 receives texts and that they use at least daily. We will remunerate them the cost of
 receiving the messages as needed.

 -  Ability to read in English or Spanish. Text messages will be available in English and
 Spanish.

 Exclusion Criteria:

 -  Existing coronary artery disease (CAD; diagnosed via cardiac catheterization using
 standard coronary artery stenosis definitions or prior ACS).

 -  An unrelated condition limiting physical activity.

 -  Participation in programs focused on cardiac prevention or well-being (e.g., cardiac
 rehabilitation).

 -  A cognitive disturbance precluding participation or informed consent, assessed using a
 six-item screen designed to assess suitability for research participation.