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Many times we assume that hard problems require complex solutions. This post is about how the simplest of technology can affect dramatic change.

Recently, JAMA published a randomized clinical trial showing that lifestyle focused text messages caused a significant reduction of LDL cholesterol in patients diagnosed with coronary heart disease.

Patients were enrolled in the Tobacco, Exercise and Diet Messages (TEXT ME) program. These patients were on average 58 years old and had either had a heart attack or had an angiogram proving heart disease.

In addition to normal care & medication, patients in the intervention group received 4 texts a week covering general heart health, diet, exercise or smoking cessation.

The results were pretty dramatic- after 6 months researchers observed significant drops in LDL cholesterol, blood pressure, BMI and smoking. Additionally they saw significant increases in physical activity and +90% of subjects liking the program.

How could this be? Why is it that patients are able to achieve significant change just by getting texts?

Text messaging is core to our platform, so we have been thinking about texting and health for a while. In this post we will share why we think it works and how one way texts can be made even better.

People engage with texts far more than health

We love this graph from Flurry. It is based on an analysis done of apps collectively opened 1.7 billion times per week.

wake up

Health and fitness apps are some of the poorest performers in retention and frequency. This happens for the same reason that ~70% of gym memberships go unused– people get really motivated to make change and that motivation wanes. This lack of persistence is because (1) health habits are deeply ingrained and (2) many conditions don’t have tight feedback loops- meaning you can get away with bad habits for a long time.

On the other hand, communication apps are the clear leader in both retention and frequency. They are easy to use and they have large, stable user bases. The utility of texting is paid off instantly (messages sent and received) vs. after months of slogging at the gym. Additionally, phone operating systems are very text friendly- texts are often the most prominent notifications a user will receive on a daily basis. These factors combined with the low rate of spam delivered through text gives it a staggering 98% open rate absolutely demolishing other methods of reaching a user.

We built our technology on these principles. Want to learn more?

Small changes can make a big impact

report from the University of Bristol shows that each cigarette shortens your life by 11 minutes. That means each cigarette counts for something. So why can’t small positive changes extend your life?

The answer is they do. A study from the Lancet looked at almost 10,000 patients from 40 countries. They saw people walking 4,000 more steps a day had a 16-20% reduction of cardiovascular events. (Btw: Heart attacks and strokes are cardiovascular events).

Similarly, a cut in daily sugar intake from 25% to less than 10% reduces your risk of dying of a heart attack by half according to this study in JAMA.

How PeerWell uses texts

It’s hard to completely change your life overnight. It’s much easier to make a small change today. And another small change tomorrow. And over time these small changes add up to a big effect.

PeerWell’s chronic disease programs include regular small & easy texts that help people make small daily change. Our nudges are must meet two criteria: (1) they must be good in the immediate term (2) they must add up to a big, evidence based effect on chronic disease.

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