Technical Requirements, Design, and Automation Process for a Statewide Registry-Based Tailored Text Messaging System: The Heart Health Messages Program (Preprint)

BACKGROUND Tailored text messaging is a low-cost mobile health intervention approach shown to effectively improve self-care behaviors and clinical outcomes for patients with chronic cardiometabolic conditions. Given the ubiquitous nature of mobile phones, text messages have the potential to reach a large audience. However, automating and disseminating tailored text messages to large populations at low cost presents major logistical challenges that serve as barriers to implementation. OBJECTIVE This study describes an innovative approach for automating and disseminating personalized and tailored text messages to large populations at risk of cardiovascular events at a low cost using a registry-based tailored text messaging system known as the Heart Health Messages (HHM) program. We discuss the technical requirements, architectural design, automation process, and challenges associated with program implementation. METHODS Patients at high risk of cardiovascular diseases were identified using a statewide population health registry known as the Tennessee Population Data Network (TN-POPnet). Tailored invitation messages and enrollment surveys were sent to eligible patients via Twilio. Upon completion of the consent and enrollment forms, participants receive tailored text messages from a library of generic messages based on participant-selected frequency of message delivery (daily or every other day). Additionally, participants receive monthly text-based check-in survey messages designed to assess intervention adherence and improvement in self-care. Participants are also sent quarterly follow-up surveys to update enrollment information and preferences. All enrolled participants receive tailored text messages for a 12-month intervention period. RESULTS A total of 18,914 patients from two major health systems met the inclusion criteria and were eligible for the HHM program. Three phases of HHM 1.0 have been implemented so far, reaching 225 eligible patients in phase 1, 5,228 patients in phase 2, and 13,461 patients in phase 3, with enrollment of approximately 2%, 3%, and 3%, respectively, in each phase using recruitment through text message invitation alone. Efforts are underway to implement strategies in collaboration with the health systems to enhance the HHM program rollout and patient participation. The estimated cost of sending a tailored text message per patient per year via Twilio ranges from $1.70 to $3.42. CONCLUSIONS The HHM program is a low-cost tailored text messaging intervention set for broader dissemination and potentials for replication. The program has the capacity to improve outcomes for people with chronic medical conditions. CLINICALTRIAL N/A