The HeartHealth Program: A Mixed Methods Study of a Community-Based Text Messaging Support Program for Patients With Cardiovascular Disease From 2020 to 2024

BACKGROUND: The HeartHealth program is a six-month SMS message-based support program offered to patients with a recent cardiovascular hospitalisation or recent cardiovascular clinic visit in Western Sydney, Australia. Its customised content focuses on cardiovascular risk factors, lifestyle, treatments and general heart health information. OBJECTIVE: To evaluate the implementation of the HeartHealth program. METHODS: A mixed-methods study was conducted assessing program reach, effectiveness, implementation and maintenance using program data, participant feedback surveys and staff focus-group discussions. Consecutive adult patients who had attended cardiology clinics or had been discharged from cardiology hospitalisation at Westmead Hospital, between April 2020 and April 2024, were included in the analysis. Content analysis was utilised to interpret the qualitative data. RESULTS: A total of 23095 patients were invited, 8804 (38.1%; 8804/23095) enrolled into the program, and 7964 (90.5%; 7964/8804) completed the six-month duration. Participants enrolled into the HeartHealth program had a mean age of 58.6 years, 60.3% were male, and 62.4% were recruited from an outpatient clinic setting. A total of 851058 SMS messages were sent, with 99.41% delivered successfully. 3533 (44.4% of program completers) participants completed the post-intervention survey, and four HeartHealth staff members participated in a focus group discussion. Among the participants who completed the survey, 60.5% reported that the program improved the healthiness of their diet, 53.6% reported improved physical activity levels, and 56.1% reported that it helped remind them to take their medications. Content analysis of participant feedback identified that the program was effective in prompting participants to change their diet, providing emotional support, reminding them of the importance of behaviour change, improving their confidence in managing their health, and keeping participants focused. Key barriers included limited personalisation, language options, and SMS scheduling flexibility. Recommended adaptations focused on enhancing personalisation, greater engagement by local clinical teams and expanding program dissemination. CONCLUSIONS: The program had a broad reach, translated to improved patient-reported health behaviours, provided participants with needed support at low cost and low resource requirements. This analysis highlights the successful implementation and scalability of the HeartHealth program and provides key learnings for health systems who are looking to implement similar programs in the future.