Impact of integrated text messaging (ITM) on the efficacy of rehabilitation programs for chronic respiratory and cardiovascular disease.

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Over 7 million Australians are living with a chronic conditions that cause more than half of all preventable hospital admissions. Once people leave hospital only about 50% adhere to prescribed medicines and at best 30% achieve lifestyle change. Simple strategies to improve ‘out-of-hospital’ management and support are needed. Text messaging has been shown to be effective and simple and is supported by quantitative and qualitative evidence led by CIs who have developed text message programs that promote lifestyle change. At the same time, Sydney Local Health District (LHD) has a text message system for contacting and following-up patients with chronic disease. However, these programs are not linked and in this research we will expand, refine and integrate our existing message programs then test and examine implementation. We propose a 3 phase project combining implementation science, a pragmatic trial, qualitative research and stakeholder engagement with appropriate ethical approval and following CONSORT guidelines. Phase 1 will see expansion of existing software and message content. Phase 2 is a pragmatic randomised implementation trial (n=310) with clinical and cost-effectiveness outcomes coupled with a process evaluation to inform scalability and implementation across settings. Phase 3 is a post-implementation assessment of success and challenges: to enable refinement of program content and features so as to maximise future success and ensure scalability.