Accepted for/Published in: JMIR Research Protocols
Date Submitted: Apr 7, 2021
Date Accepted: Sep 13, 2021
Date Submitted to PubMed: Dec 2, 2021
Developing a behavioral support texting protocol for hypertension incorporating African American Veterans’ success stories
ABSTRACT
Background:
Peer narratives engage listeners through personally relevant content and have been shown to promote lifestyle change and effective self-management among patients with hypertension. Incorporating key quotations from these stories into follow-up text messages (mHealth) is a novel way to ‘continue the conversation,’ providing reinforcement of health behaviors within patients’ daily lives.
Objective:
In our previous work, we developed and tested videos in which African American Veterans shared stories of challenges and success strategies related to their hypertension self-management. We now describe the process by which we developed a text-messaging protocol, intended for use after viewing videos that incorporate the voices of these Veterans.
Methods:
We used a multi-step process, transforming video-recorded story excerpts from five Veterans into 160-character texts. We then integrated these into comprehensive 6-month texting protocols. We began with iterative review of story transcripts to identify vernacular features and key self-management concepts emphasized by each storyteller. We worked with two Veteran consultants who guided our ‘narrative text message’ development in substantive ways, as we sought to craft culturally sensitive content for texts. Informed by Veteran input on timing and integration, supplementary educational and 2-way interactive assessment text messages were also developed.
Results:
Within the Veterans Administration (VA) texting system (‘Annie’), we programmed five 6-month text-messaging protocols that included cycles of three text message types: narrative messages, non-narrative educational messages, and two-way interactive messages assessing self-efficacy and behavior related to hypertension self-management. Each of the protocols corresponds to a single Veteran storyteller, allowing Veterans to choose the story that most resonates with their own life experience.
Conclusions:
We crafted a culturally sensitive text-messaging protocol using narrative content referenced in Veteran stories, aimed at supporting effective hypertension self-management. Leveraging mHealth provides additional tools to continue conversations and cues for behavior change. Clinical Trial: NCT03970590
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