Abstract P067: A Co-Design Approach to Validate a Text Message Bank for Use With Older Adults at Risk of Cardiovascular Disease

Abstract

Purpose/Aims: To describe the design and validation of a text message bank that will be used for an mHealth behavioral change intervention -- Fitness Intensive Therapy ( Get FIT+ ) in order to improve healthy eating and enhance physical activity in a sample of older adults (≥ 60 years) at risk for cardiovascular disease. Background: Short message service (SMS) has been widely used in patient follow-up and disease management, showing improvements in medication adherence, symptom monitoring, appointment attendance and satisfaction with health services. However, most studies usually focus on the effectiveness of SMS and lack information regarding the development and validation of their content to guarantee adequate understanding and appeal of SMS strategies by end users. Methods: An initial bank of 68 SMS text messages was developed to focus on healthy eating, physical activity and provide motivational feedback through an extant literature review for promoting behavior change to engage in healthy lifestyles. The messages were organized into three subsets [e.g., healthy eating (24 messages), physical activity (24 messages), other goals and compliance (20 messages)] for field validation. An expert panel (N = 5) evaluated each subset of SMS text messages. Consistent with the Get FIT+ project that will utilize the text messages, additional validation was conducted with 5 older adults (≥ 60 years old) from diverse ethnic backgrounds representative of the population in Orange County. Two to three people evaluated each of the three SMS text message subsets (N = 5, 40% male). User demographics, phone literacy, understanding and appeal of each SMS text message was assessed using a 27-item questionnaire. Results: The text message content included educational, motivational and goal progress feedback on the topics of nutrition, physical activity and compliance/other goals. Overall, the three SMS datasets received a total of 10 evaluations each. All evaluations—10 out of 10 (100%) valid responses—revealed an adequate understanding of the key idea contained in the SMS text message. The older adults’ average appeal score of the three datasets was 9.0 (SD±0.2) of 10 points. Participants did not make significant suggestions to change the wording of the messages, but provided excellent and useful feedback to optimize the messaging. Implications: The final set of SMS text messages produced had very high rates of understanding and appeal among an expert panel and older adults who represented the potential recipient. This study highlights the importance of developing and validating a database of simple, feedback-oriented SMS text messages, grounded in evidence and theory, with an expert panel and active engagement of potential end users.