Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 5, 2022
Date Accepted: Dec 1, 2022
Increasing engagement in the Electronic Framingham Heart Study (eFHS): a factorial randomized controlled trial.
ABSTRACT
Background:
Smartphone apps and mHealth devices offer innovative ways to collect longitudinal cardiovascular data. Randomized evidence regarding effective strategies to maintain longitudinal engagement is limited.
Objective:
To evaluate smartphone messaging interventions on remote transmission of blood pressure (BP) and heart rate (HR) data.
Methods:
We conducted a 2x2x2 factorial blinded randomized trial with randomization implemented centrally to ensure allocation concealment. (Trial registration: ClinicalTrials.gov NCT03516019). We invited participants from the eFHS, an e-cohort embedded in the Framingham Heart Study and asked participants to measure their BP (Withings digital cuff) weekly and wear their smartwatch daily. We assessed 3 weekly notification strategies to promote adherence: personalized vs. standard; weekend vs. weekday; and morning vs. evening. Personalized notifications included the participant’s name and were tailored to whether or not data from the prior week were transmitted to the research team. Intervention notification messages were delivered weekly automatically via the eFHS app. We assessed if participants transmitted at least one BP or HR measurement within 7 days of each notification after randomization. Outcomes were adherence to BP and HR transmission at 3-months, primary and 6-months, secondary.
Results:
Of 791 FHS participants, 655 (82.8%) were eligible and randomized (mean age 53±9 years, 60% women, 91% white). For the personalized vs. standard notifications, 38.9% vs. 28.8% participants sent BP data at 3 months (difference, 10.1%, 95%CI 2.9-17.4; P=0.006), but no significant differences were observed for HR data transmission (65.4% vs. 63.9%, P=0.69). Personalized notifications were associated with increased BP and HR data transmission vs. standard at 6 months (BP: 36.8% vs. 22.4%, difference 14.4%, 7.1- 21.7, P=0.0002; HR: 66.2% vs. 56.2%, difference 10.0%, 95%CI 2.0-18.0; P=0.02). For BP and HR primary or secondary outcomes, there was no evidence of differences in data transmission for notifications sent on weekend vs. weekday, or morning vs. evening.
Conclusions:
Personalized notifications increased longitudinal adherence to BP and HR transmission from mobile and digital devices among eFHS participants. Our results suggest that personalized messaging is a powerful tool to promote adherence to mHealth systems in cardiovascular research. Clinical Trial: ClinicalTrials.gov NCT03516019
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