Increasing Engagement in the Electronic Framingham Heart Study: Factorial Randomized Controlled Trial

Area of Science:

• Cardiovascular research
• Digital health interventions
• Mobile health (mHealth)

Background:

• Smartphone apps and mHealth devices enable collection of long-term cardiovascular data.
• Limited randomized evidence exists on effective strategies for maintaining long-term participant engagement in digital health studies.

Purpose of the Study:

• To evaluate the effectiveness of smartphone messaging interventions in promoting remote transmission of blood pressure (BP) and heart rate (HR) data.

Main Methods:

• A 2x2x2 factorial blinded randomized trial was conducted with participants from the Electronic Framingham Heart Study (eFHS).
• Three weekly notification strategies were assessed: personalized vs. standard, weekend vs. weekday, and morning vs. evening.
• Adherence to BP and HR data transmission was measured at 3 and 6 months.

Main Results:

• Personalized notifications significantly increased BP data transmission at 3 months compared to standard notifications (38.9% vs. 28.8%, P=.006).
• At 6 months, personalized notifications showed increased BP and HR data transmission versus standard (BP: 36.8% vs. 22.4%, P<.001; HR: 66.2% vs. 56.2%, P=.02).
• No significant differences in data transmission were observed based on notification timing (weekend vs. weekday, morning vs. evening).

Conclusions:

• Personalized messaging effectively enhanced longitudinal adherence to BP and HR data transmission using mobile and digital devices.
• Personalized messaging is a potent strategy for improving adherence in mHealth systems for cardiovascular research.