Lung Support Service: Implementation of a Nationwide Text Message Support Program for People with Chronic Respiratory Disease during the COVID-19 Pandemic

Rebecca Raeside; Anna C Singleton; Allyson Todd; Stephanie R Partridge; Karice K Hyun; Helen Kulas; Sally L Wootton; Marita T Dale; Jennifer A Alison; Zoe McKeough; Renae J McNamara; Lissa Spencer; Christine Jenkins; Julie Redfern

doi:10.3390/ijerph192417073

Lung Support Service: Implementation of a Nationwide Text Message Support Program for People with Chronic Respiratory Disease during the COVID-19 Pandemic

Int J Environ Res Public Health. 2022 Dec 19;19(24):17073. doi: 10.3390/ijerph192417073.

Authors

Rebecca Raeside¹, Anna C Singleton¹, Allyson Todd¹, Stephanie R Partridge¹, Karice K Hyun^{1

2}, Helen Kulas³, Sally L Wootton^{4

5}, Marita T Dale⁵, Jennifer A Alison^{5

6}, Zoe McKeough⁵, Renae J McNamara^{5

7

8}, Lissa Spencer⁹, Christine Jenkins¹⁰, Julie Redfern^{1

11}

Affiliations

¹ Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia.
² Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW 2137, Australia.
³ NSW Agency for Clinical Innovation, Sydney, NSW 2065, Australia.
⁴ Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, NSW 2103, Australia.
⁵ Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia.
⁶ Allied Health Research and Education Unit, Sydney Local Health District, Sydney, NSW 2050, Australia.
⁷ Department of Physiotherapy, Prince of Wales Hospital, Sydney, NSW 2031, Australia.
⁸ Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia.
⁹ Department of Physiotherapy, Sydney Local Health District, Sydney, NSW 2050, Australia.
¹⁰ Institute of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
¹¹ The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia.

Abstract

Background: COVID-19 pandemic lockdowns led to the closure of most in-person pulmonary rehabilitation programs in Australia. Text message programs are effective for delivering health support to aid the self-management of people with chronic diseases. This study aimed to evaluate the implementation of a six-month pre-post text message support program (Texting for Wellness: Lung Support Service), and the enablers and barriers to its adoption and implementation.

Methods: This mixed-methods pre-post study used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the Texting for Wellness: Lung Support Service, which is an automated six-month text message support program that included evidence-based lifestyle, disease-self management and COVID-19-related information. Reach was measured by the proportion of participant enrolments and demographic characteristics. Adoption enablers and barriers were measured using text message response data and a user feedback survey (five-point Likert scale questions and free-text responses). Implementation was evaluated to determine fidelity including text message delivery data, opt-outs, and intervention costs to promote and deliver the program.

Results: In total, 707/1940 (36.4%) participants enrolled and provided e-consent, with a mean age (±standard deviation) of 67.9 (±9.2) years old (range: 23-87 years). Of participants who provided feedback, (326/707) most 'agreed' or 'strongly agreed' that the text messages were easy to understand (98.5%), helpful them to feel supported (92.3%) and helped them to manage their health (88.0%). Factors influencing engagement included a feeling of support and reducing loneliness, and its usefulness for health self-management. Messages were delivered as planned (93.7% successfully delivered) with minimal participant dropouts (92.2% retention rate) and low cost ($AUD24.48/participant for six months). A total of 2263 text message replies were received from 496 unique participants. There were no reported adverse events.

Conclusion: Texting for Wellness: Lung Support Service was implemented quickly, had a broad reach, with high retention and acceptability among participants. The program was low cost and required minimal staff oversight, which may facilitate future implementation. Further research is needed to evaluate the efficacy of text messaging for the improvement of lung health outcomes and strategies for long-term pulmonary rehabilitation program maintenance.

Keywords: COVID-19; chronic respiratory disease; digital health; implementation science; public health; pulmonary rehabilitation; text messaging.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
COVID-19* / epidemiology
Communicable Disease Control
Humans
Lung
Middle Aged
Pandemics
Respiration Disorders*
Text Messaging*
Young Adult

Grants and funding

ACS’s stipend was provided by the University of Sydney’s Australian Government Research Training Program Scholarship and a Supplementary Postgraduate Research Scholarship in Breast Cancer. SRP was supported by a National Health and Medical Research Council Early Career Fellowship (APP1157438) and National Heart Foundation Postdoctoral Fellowship (HF102164). KKH was suported by an NHMRC Investigator Grant (Emerging Leadership 1) (APP1196724). JR was supported by a National Health and Medical Research Council Career Investigator Grant Fellowship [GNT2007946].