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2023 HSR&D/QUERI National Conference Abstract

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4042 — Participant engagement in a virtual RCT: Who responds to ANNIE texts in a RCT of self-management for African American Veterans with hypertension?

Lead/Presenter: Ece Bal ,  Philadelphia VAMC
All Authors: DeLaughter KL (Center for Healthcare Organization and Implementation Research, Bedford), McDannold, SE (Center for Healthcare Organization and Implementation Research, Bedford) Fix GM (Center for Healthcare Organization and Implementation Research, Bedford; Boston University School of Medicine) Shimada SL (Center for Healthcare Organization and Implementation Research, Bedford; Population and Quantitative Health Sciences, University of Massachusetts Medical School) Pope C (Research and Development (and Nursing), Ralph H Johnson VA Medical Center, Charleston, SC; College of Medicine, Medical University of South Carolina) Bokhour BG (Center for Healthcare Organization and Implementation Research, Bedford; Boston University School of Medicine) Smith, BM (Center of Innovation for Complex Chronic Healthcare (CINCCH); Edward J. Hines, Jr. VA Hospital) Brown G (Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare) DeFelice D (Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia) Vargas-Correa J (Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare) Bal E (Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia) Gardner J (Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare) Calloway R (Center for Healthcare Organization and Implementation Research, Bedford) Stroupe KT (Center of Innovation for Complex Chronic Healthcare (CINCCH); Edward J. Hines, Jr. VA Hospital) Gordon HS (Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare; Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago) Long JA (Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia; Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania) Cutrona SL (Center for Healthcare Organization and Implementation Research, Bedford; Population and Quantitative Health Sciences, University of Massachusetts Medical School)

Objectives:
Disparities in hypertension control persist in the Veterans Health Administration (VA). African American Veterans in some Medical Centers experience suboptimal blood pressure control which can lead to adverse cardiovascular outcomes. Engaging Veterans with hypertension in a texting intervention designed to encourage healthy behaviors can expend the reach of these supportive messages and enhance self-care motivation. Narrative-informed text messages offer an innovative approach to promoting behavior change for marginalized Veterans. We sought to understand engagement of African American Veterans in a narrative-informed texting intervention to improve uncontrolled hypertension.

Methods:
Our RCT is currently enrolling at 2 VA medical centers, with the goal of recruiting 600 African American Veterans with diagnosis of hypertension. We created a 6-month protocol, and pilot-tested for feasibility and acceptability. Trial participants were randomly assigned to either Intervention or Control. Intervention patients watched 5 videos in which African American Veterans shared their stories of challenges and successes in managing their hypertension. Participants were then asked to select a ‘favorite’ storyteller and received text messages that were excerpted from their chosen storyteller in addition to educational texts. Participants enrolled in our virtual randomized controlled trial were sent texts based on a protocol designed in Aim 1 of our study that sent up to 4 content texts per week. One of these weekly texts was an assessment designed to elicit response. We recorded Veteran replies to these assessments, to determine the rate of response. We assessed engagement with the narrative-based text messaging intervention that uses the Veteran Affairs (VA)’s ANNIE texting system by gathering data on frequency of responses to assessment texts over the course of the trial. Our results describe engagement at 1 month, 3 months and 6 months, as well as patient characteristics associated with engagement (age, gender, rural/urban residency, education, and income).

Results:
As our study is ongoing, preliminary results of 282 participants are as follows: Average age of participants is 63.1 years, 24.8% are female, 41.8% are married or in long-term relationship, 29.1% reported living alone, 72.3% reported having some college or higher education degree and 43.3% reported household income < $40,000. Of eligible participants, 253 (90%) respondents replied to at least one message. Females responded more than males (75.2% vs. 56.8% average 61.4% P < 0.001 chi-square) to all message types. Response rates declined over time, though not significantly. Response rates at each of three time points: 1) 1mo. 170/268 (63.4%), 2) 3mo. 159/264 (60.2%), and 3) 6mo. 154/262 (58.8%). Participants responded more frequently to questions about their self-management confidence (2323/3721, 62.43%) than their current behaviors (3341/5568, 60.0%). There was no significant difference in completion rate based on the two types of questions.

Implications:
Our RCT has demonstrated the potential of narrative-informed text messaging to yield significant participant engagement, as assessed by response to assessment texts, over an extended period.

Impacts:
The majority of African American Veterans living with hypertension in the RCT engaged with the text-based self-management support intervention by responding to messages they received. There is potential to leverage texts to continue engaging patients between visits.