JMIR Mhealth Uhealth. 2026 Nov 6;14:e64502. doi: 10.2196/64502.
ABSTRACT
BACKGROUND: Mobile health interventions have the potential to motivate healthy behaviors. Optimal strategies for engaging patients in cardiac rehabilitation (CR) through mobile health interventions remain unclear.
OBJECTIVE: This study aimed to examine patient engagement in a mobile app platform for CR across patient characteristics and by the method of delivery of nudge messages over the 12 weeks of CR.
METHODS: The authors analyzed data from the ERA-Nudge (Enhancing Rehabilitation Adherence Through Optimized Nudge) study, a pragmatic randomized trial conducted at an urban safety-net hospital testing nudges (short messages designed using behavioral economics to elicit behavior change) to enhance CR adherence and log healthy activity. Trial patients were given access to a smartphone-based app. Nudges were initially sent as app notifications. Later in the study, patients received nudges as text messages. We assessed patient characteristics associated with app engagement, and we compared time spent in the CR app among patients receiving nudges as app notifications vs text messages. The trial enrolled patients who could engage with messages in either English or Spanish at an urban safety-net hospital with a qualifying CR diagnosis and a smartphone from May 2019 to May 2023. We describe minutes spent in the app across patient characteristics and by type of nudge delivery, and we compare the 2 approaches using unadjusted and multivariate negative binomial regression over the 12 weeks of CR.
RESULTS: In total, 223 patients received nudges: 74 via app notification and 149 via text message. Overall, patients spent an average of 219 (SD 328) minutes in the app, and 3 (1.3%) patients used the app for zero minutes. Patients receiving only app nudges spent a mean of 167 (SD 365) minutes in the app, and patients receiving text messages and app nudges spent 245 (SD 306) minutes in the app (unadjusted ratio 1.5, 95% CI 1.1-2.0; P=.02). After adjusting for age category, sex, primary language, CR location (hospital vs home), and highest education achieved, Spanish-preferring patients, patients with some college education, and patients receiving text messages spent more time in the app. Patients receiving nudges as text messages and app notifications spent an adjusted ratio of 1.8 (95% CI 1.2-2.5; P=.002) times as many minutes in the app compared to those getting nudges as app notifications.
CONCLUSIONS: Among an urban safety-net population, text message nudges were associated with greater time in the app compared to nudges delivered as app notifications. These findings suggest that text messages may result in greater patient engagement for mobile health interventions.
PMID:43006932 | DOI:10.2196/64502
