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Texting your way to heart health? NPR thoroughly examines the evidence

Rating

5 Star

Text Reminders Help People Lower Cholesterol, Blood Pressure

Our Review Summary

iStock_000004992558_SmallThe story focuses on a JAMA study that found coronary heart disease patients who received four health-related text messages per week for six months were more likely to take steps to reduce their risk of heart-related health problems — and saw corresponding improvements in cholesterol and blood pressure. The story does a nice job of describing the study and is careful to note the study’s limitations, but could have done more to explain the extent to which patients benefited from the intervention.

 

Why This Matters

According to the CDC, heart disease is the leading cause of death in the United States for both men and women, and coronary heart disease is the most common form of heart disease — killing more than 370,000 people annually. In short, the odds are good that just about everyone knows someone who has been affected by coronary heart disease. In addition, the disease has an enormous economic impact. For example, the estimated burden of cardiovascular disease in the U.S. in 2010 was $444 billion. Behavior change is an important piece of reducing heart disease risk, and lifestyle changes such as exercise are associated with other positive health outcomes as well, including reduced risk of stroke, better mental health outcomes (depression and anxiety), and lower extremity arthritis.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

This is a tricky one. The story does not explicitly address cost, except to call text messaging “a scalable and affordable approach.” For many (or most) patients, the cost of receiving four text messages a week would likely be negligible — covered by an individual’s phone plan or by nominal text rates. However, not everyone owns a mobile phone, a fact that makes access (and cost) a more significant issue. However, the story does deliver on this point. The story discusses both the number of U.S. adults who own mobile phones (90 percent) and the fact that text messages are more accessible than other forms of mobile health communication (such as apps, which require patients to own smartphones or other smart devices). So, while we’d prefer a more in-depth discussion here, we’ll award a Satisfactory rating for the story’s nod in this direction.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story addresses the range of benefits reported in the study, such as reduced cholesterol and blood pressure, but doesn’t quantify that information or offer readers any context. For example, while the story says “patients who had received the text messages had reduced their cholesterol,” the JAMA paper reports that patients who received the text messages had a “mean difference [of] −5 mg/dL” in “LDL-C.” In other words, the information in the paper, while quantified, probably isn’t very useful to many readers outside the health industry. Is “a mean difference of −5 mg/dL in LDL-C” good? Bad? Irrelevant?

This is where reporters have an opportunity to shine. If a news story can take those numbers and translate them into language that is accessible to non-experts, it provides a very real service. It would have been great to see that here.

Does the story adequately explain/quantify the harms of the intervention?

Not Applicable

As long as people aren’t driving and checking their cell phones, there don’t appear to be any harms associated with receiving well-meaning text messages four times a week, so we’ll mark this one “not applicable.”

Does the story seem to grasp the quality of the evidence?

Satisfactory

This is a strong suit. The story not only offers a concise, but good, summary of the study — but it also goes out of its way to address the study’s limitations. For example, the study notes that the study “can’t tell us whether text messaging could eventually lead to fewer subsequent heart attacks among the patients receiving those messages or whether the positive health outcomes would continue past the six-month study window.” Good points, and we’re glad the story includes them.

Does the story commit disease-mongering?

Satisfactory

No disease mongering here.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story includes input from an outside expert who was not involved with the research.  The story clearly meets our bar here, although it would have been stronger if it had reached out to at least one more independent source — preferably one who hadn’t written an editorial that ran in conjunction with the paper in JAMA. Yes, the editorial was independent and provides some insightful commentary. But it also means we already knew where this source stood on the issue. Finding another reputable expert, who hadn’t already weighed in publicly on the work, would have been great.

Does the story compare the new approach with existing alternatives?

Satisfactory

The focus of the story is not so much on how the text message intervention directly reduced heart disease risk, but on the extent to which it resulted in patients taking steps to reduce their own risk — such as by exercising more, smoking less, making dietary changes, or taking prescription drugs on a regular basis. The story does discuss other “mobile health interventions,” such as smartphone apps — but notes that there don’t appear to be many mobile health projects that rely simply on text messages. The story also looks at how the text messages helped patients pursue lifestyle changes — like exercising more and smoking less — that reduced their risk.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

It was fairly clear from the story that this was a clinical trial, and that this particular service doesn’t seem to be available to offer customized, encouraging text messages for heart disease patients.

Does the story establish the true novelty of the approach?

Satisfactory

From the start, the story frames this research in the context of the much larger “mobile health” field. For example, the story notes that “While there are more than 100,000 health-related apps on the market, the evidence to date is lacking as to whether many of those apps are safe or effective.”

Does the story appear to rely solely or largely on a news release?

Satisfactory

Since the story includes quotes from an interview, we can be fairly certain it went beyond the related JAMA news release.

Total Score: 8 of 9 Satisfactory

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