Health Education Using Text Messaging Prevents Hypertension in High Risk People

Study Overview
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Brief Summary
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Prehypertension is a predisposing condition for morbidity inhypertension and cardiovascular diseases. Health education via electronic pathways such as mobile text messaging or virtual communities may provide more availability and adherence than printed media. Regarding lower costs of such electronic resources and continuity of interventions through these ways, assessing their effectiveness compared to a printed material may help health educators to choose proper methods for improve their educational attempts. Therefore, the current study aims to compare different tools for health education about healthy lifestyle in people with prehypertension. For this, educational interventions with similar content among 3 groups of people will be conducted (i.e., first group via mobile text messaging, second group using virtual communities, and third group by brochures as a printed media). A control group also will be considered without any intervention. Several phases are considered in the study. In phase 1 using health centers located in Qazvin city, people would be invited to a free screening program of prehypertension. Then, an eligible sample will be divided in three groups using a random allocation process (each one including 100-150 people with prehypertension). The blood pressure and health promotion lifestyle profile II (HPLP II) will be measured before intervention. A standard educational content using approaches of lifestyle promotion defined in HPLP II would be available for intervention groups during a time period of 1 month concurrently. At final phase, one month after termination of intervention blood pressure as primary outcome and lifestyle changes along with self-efficacy for lifestyle modification as secondary outcomes will be measured. This study may suggest effective ways for health education which is applicable by health care professionals to promote health status among peopleat risk of hypertension.

Detailed Description
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Prehypertension is a predisposing condition for morbidity in hypertension and cardiovascular diseases. This has been defined as a systolic pressure from 120 to 139 mmHg or a diastolic pressure of 80-89 mm hg. The prevalence of this condition estimated to be at least 2 times higher than hypertension and those who have prehypertension 4 times more likely to progress to hypertension than normotensive people. Although, hypertension is a multi-factorial disease, lifestyle is associated mainly to its development. According to information, lifestyle changes may prevent more than 70% of primary hypertension and health education is a key strategy to promote lifestyle modification. Health education via electronic pathways such as mobile text messaging or virtual communities may provide more availability and adherence than printed media. Regarding lower costs of such electronic resources and continuity of interventions through these ways, assessing their effectiveness compared to a printed material may help health educators to choose proper methods for improve their educational attempts. Therefore, the current study aims to compare different tools for health education about healthy lifestyle in people with prehypertension. For this, educational interventions with similar content among 3 groups of people will be conducted (i.e., first group via mobile text messaging, second group using virtual communities, and third group by brochures as a printed media). A control group also will be considered without any intervention. Several phases are considered in the study. In phase 1 using health centers located in Qazvin city, people would be invited to a free screening program of prehypertension. Then, an eligible sample will be divided in three groups using a random allocation process (each one including 100-150 people with prehypertension). The blood pressure and health promotion lifestyle profile II (HPLP II) will be measured before intervention. A standard educational content using approaches of lifestyle promotion defined in HPLP II would be available for intervention groups during a time period of 1 month concurrently. At final phase, one month after termination of intervention blood pressure as primary outcome and lifestyle changes along with self-efficacy for lifestyle modification as secondary outcomes will be measured. This study may suggest effective ways for health education which is applicable by health care professionals to promote health status among people at risk of hypertension.

Official Title
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Health Education Using Text Messaging Prevents Hypertension in High Risk People: a Comparison Between Effectiveness of Electronic Text Messaging and Printed Material

Conditions
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Hypertension, Cardiovascular Diseases

Intervention / Treatment
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* Behavioral: mobile text messages
* Behavioral: virtual community
* Behavioral: brochures
* Other: Usual care
* Device: mobile phone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: be >18 years have a diagnosis of prehypertension based on definition own a cell phone capable of receiving and sending text messages be a member of virtual communities Persian speaking willing to attend two data collection visits in Qazvin Exclusion Criteria: admits to planning to terminate cell phone contract or excite form virtual communities during the next one month education less than primary school other major health problems (e.g., terminal stage of cancer, advanced liver disease)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: mobile text messaging<br>Patients will receive some SMS in a regular interval. | Behavioral: mobile text messages<br> <br> Device: mobile phone<br> <br> |
| Experimental: virtual communities<br>Patients will receive some messages by a virtual community in a regular interval. | Behavioral: virtual community<br> <br> |
| Experimental: brochures<br>Patients will receive some messages by as a printed media | Behavioral: brochures<br> <br> |
| Active Comparator: Control<br>control group will be included without any intervention | Other: Usual care<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood pressure |  | Changes from baseline and 1 Months after the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| changes in self-reported physical activity | Physical activity will be measured using a self-reported scale examining participants' self- reported physical activity for the past seven days. Six items | Changes from baseline and 1 Months after the intervention | 
| Changes in self-reported healthy eating | Healthy eating behavior will be measured using the Diet Guidelines Index (DGI). The DGI is a food-based dietary index that measures adherence to healthy eating recommendations over the previous month. It consists of 15 items that reflect current dietary guidelines,including consumption of vegetable and legumes, fruit, total cereals, meat, total dairy, beverages, sodium, saturated fat, alcoholic beverages, and added sugars. A diet quality score is obtained by summing the indicators of wholegrain cereals, lean meat, low-fat dairy, and dietary variety, and is informed by age- and sex-specific recommendations. Scores range from 0 to 150, with higher scores representing higher levels of healthy eating. Serving portions are described in the questionnaire, and participants were directed to refer to the healthy eating guidelines26 provided for further details. | Changes from baseline and 1 Months after the intervention | 
| Changes in self-reported Self-efficacy | Self-efficacy will be measured using the Medication Adherence Self-Efficacy Scale (MASES).he MASES is a patient-centered and self-administered questionnaire that consists of 26 items. The patient were asked to rate their confidence of taking antihypertensive medications in different conditions using a three-point scale | Changes from baseline and 1 Months after the intervention |