# An adaptive personalized text message intervention for cardiac prevention

> **NIH NIH R21** · MASSACHUSETTS GENERAL HOSPITAL · 2021 · $210,000

## Abstract

The majority of patients at risk for heart disease are unable to adhere to key health behaviors, including
regular physical activity and healthy eating. This is a major public health problem, as heart disease is the
leading cause of death in the U.S., yet could be prevented in many cases through greater participation in these
behaviors. Existing programs to promote health behaviors and prevent heart disease can be effective but have
several limitations. First, they are costly, intensive, and attended by relatively few patients (with especially low
attendance among minorities). In addition, these programs have not included positive psychology (PP)
activities, which promote constructs (e.g., positive affect) that are independently linked to healthy behaviors
and superior cardiac health. Finally, they are not designed to meet patients’ individual preferences and needs.
 Text message interventions (TMIs) may address many of the shortcomings of existing programs. TMIs
are simple, low-burden, customizable, and highly accessible, and they have thus far shown promise in
promoting health behaviors. Simple PP activities are well-suited to TMIs, and a TMI delivering both PP and
health behavior messages could be a powerful approach to improving health and reducing cardiac risk, as
combined psychological-behavioral interventions appear to have greater effects than either approach alone.
 A TMI that utilizes an adaptive algorithm to choose messages could be highly effective. As opposed to
a single fixed set of messages, a flexible program that is deeply personalized for each individual could greatly
improve engagement and impact. We have developed a novel adaptive TMI that delivers PP and health
behavior text messages in English and Spanish. Based on a participant’s adherence gaps and feedback about
the utility of prior messages, the program uses a dynamic, patient-specific algorithm to select new messages
via multiple message-specific attributes (e.g., PP vs. health behavior-focused). Over time, the adaptive TMI
increasingly delivers message content that matches the individual’s specific preferences and needs.
 Consistent with PA-18-389 focused on mHealth interventions for self-management, we propose a
randomized pilot trial of this adaptive 12-week TMI (with daily text messages from the adaptive algorithm,
twice-weekly goal-focused messages, and two brief phone check-ins to provide support) plus provision of a
step counter. The TMI will be compared to enhanced usual care (step counter alone) in 60 patients with 2+
cardiac risk conditions (hypertension, type 2 diabetes, hyperlipidemia) and suboptimal physical activity and
diet. The primary outcome of this R21 trial is feasibility and acceptability, measured via rates of text message
feedback and participants’ ratings of message utility. As a key secondary aim, we will compare between-group
differences in improvements in psychological, behavioral, and health-related outcomes at 12 and 24 weeks. If
the interven...

## Key facts

- **NIH application ID:** 10141304
- **Project number:** 5R21NR018738-02
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Jeff C Huffman
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $210,000
- **Award type:** 5
- **Project period:** 2020-04-08 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10141304

## Citation

> US National Institutes of Health, RePORTER application 10141304, An adaptive personalized text message intervention for cardiac prevention (5R21NR018738-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10141304. Licensed CC0.

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