TY  - JOUR
AU  - Trinquart, Ludovic
AU  - Liu, Chunyu
AU  - McManus, David D
AU  - Nowak, Christopher
AU  - Lin, Honghuang
AU  - Spartano, Nicole L
AU  - Borrelli, Belinda
AU  - Benjamin, Emelia J
AU  - Murabito, Joanne M
PY  - 2023
DA  - 2023/1/20
TI  - Increasing Engagement in the Electronic Framingham Heart Study: Factorial Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e40784
VL  - 25
KW  - smartphone notifications
KW  - digital device use
KW  - randomized trial
KW  - smartphone
KW  - apps
KW  - mobile health
KW  - mHealth
KW  - devices
KW  - cardiovascular
KW  - data
KW  - intervention
KW  - blood pressure
KW  - heart rate
KW  - digital
KW  - tool
KW  - notification
KW  - messaging
KW  - prompt
KW  - nudge
KW  - behavior change
KW  - self-monitoring
KW  - self care
KW  - cardiology
AB  - Background: Smartphone apps and mobile health devices offer innovative ways to collect longitudinal cardiovascular data. Randomized evidence regarding effective strategies to maintain longitudinal engagement is limited. Objective: This study aimed to evaluate smartphone messaging interventions on remote transmission of blood pressure (BP) and heart rate (HR) data. Methods: We conducted a 2 × 2 × 2 factorial blinded randomized trial with randomization implemented centrally to ensure allocation concealment. We invited participants from the Electronic Framingham Heart Study (eFHS), an e-cohort embedded in the FHS, 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 versus standard; weekend versus weekday; and morning versus 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 the 791 FHS participants, 655 (82.8%) were eligible and randomized (mean age 53, SD 9 years; 392/655, 59.8% women; 596/655, 91% White). For the personalized versus standard notifications, 38.9% (126/324) versus 28.8% (94/327) participants sent BP data at 3 months (difference=10.1%, 95% CI 2.9%-17.4%; P=.006), but no significant differences were observed for HR data transmission (212/324, 65.4% vs 209/327, 63.9%; P=.69). Personalized notifications were associated with increased BP and HR data transmission versus standard at 6 months (BP: 107/291, 36.8% vs 66/295, 22.4%; difference=14.4%, 95% CI 7.1- 21.7%; P<.001; HR: 186/281, 66.2% vs 158/281, 56.2%; difference=10%, 95% CI 2%-18%; P=.02). For BP and HR primary or secondary outcomes, there was no evidence of differences in data transmission for notifications sent on weekend versus weekday or morning versus 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 mobile health systems in cardiovascular research. Trial Registration: ClinicalTrials.gov NCT03516019; https://clinicaltrials.gov/ct2/show/NCT03516019 
SN  - 1438-8871
UR  - https://www.jmir.org/2023/1/e40784
UR  - https://doi.org/10.2196/40784
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36662544
DO  - 10.2196/40784
ID  - info:doi/10.2196/40784
ER  -