Development of a Health Text Message System to Support Stroke Prevention: A Component of the Love Your Brain Digital...

Globally, stroke is a common cause of death and disability. More than 80% of strokes are reported to be preventable through effective management of modifiable risk factors. Text messages can encourage changes in health behaviour. The Love Your Brain project involves the development and evaluation of a digital health platform for stroke prevention in Australia. In this study, we aimed to develop a text message system and content for this digital platform.

The first phase involved reviewing a repository of existing health promotion messages from prior research on stroke. The second phase included co-designing the content and delivery of the messaging system with community members (n = 12) and health knowledge experts (n = 10) through 16 focus groups. New messages were then developed and formatted. These messages were reviewed by subject matter experts, then adjusted for reading age ≤ Grade 10. The final phase included the development of the messaging platform.

Among 1500+ pre-existing messages reviewed for suitability, ≈10% were adapted for primary prevention. Focus group participants reported that receiving messages on weekdays was preferred and 'having a choice' was beneficial. No consensus was reached regarding message frequency. Weblinks and shorteners were felt to be untrustworthy by participants; therefore, a Love Your Brain website using one hyperlink was developed. New messages were co-designed and personalised with greetings and sign-offs to increase engagement. All messages were revised by at least three of eight experts. After editing, 98% were readable at ≤ Grade 10 reading age and 79% at ≤ Grade 8. A REDCap message platform was built to enable personalisation at any time regarding the selection of 'healthy choices' relevant to participants' risk factors and preferences for the number of messages per week.

Integrating prior research and co-design enriched the text message platform, including content and delivery. This system can be adapted for other conditions and cultural needs to deliver relevant health information.

People with lived experience of stroke including family/caregivers. and members of the public, actively participated in the co-design focus groups. The Love Your Brain Management Committee includes people with lived experience of stroke who work in partnership with researchers and clinicians to provide oversight of all stages of the study and the preparation of this manuscript.