Using Social Media and Text Messages to Promote Health in African-Americans: #HeartHealthyandCancerFree

Purpose:   African Americans suffer disparity from both cancer and cardiovascular disease. For example, the prevalence of hypertension among African Americans is the highest of any ethnic group in the world, and African Americans have the highest mortality rate of any racial or ethnic group in America for all cancers combined and for most major cancers. They are vulnerable to both cardiovascular disease (CVD) and cancer by virtue of having extremely high rates of risk factors, with the risk factors for these diseases being intricately connected. Use of social media and mobile phones to send health related text messages is an innovative strategy, presenting researchers with new opportunities to reach this vulnerable population with information and strategies to reduce these risk factors. The purpose of this study was to test the impact and feasibility of a social media and text messaging intervention that promotes self-care resulting in the reduction of multiple CVD and cancer risk factors in African Americans. 

Methods: We developed a library of intervention text messages, a message delivery protocol, Facebook page and blog that were culturally tailored and targeted for African Americans at risk for CVD and cancer. We conducted a one group, pre/post test intervention study with 39 African Americans over the age of 40 who were at risk for CVD and/or cancer as evidenced by having one or more modifiable risk factors (e.g. weight, blood pressure, cholesterol). We also conducted small group interviews post intervention to assess satisfaction with the intervention, and obtain usability and feasibility data. Participants were recruited from the community using a lay health worker.  Data collection occurred at baseline and at three months post baseline and included: height, weight, waist circumference, blood pressure, body mass index, heart rate, HgA1c, total cholesterol, LDL, HDL, triglycerides, comorbidities, current medications, heart health and heart disease knowledge, depression, quality of life, fatalism, and cancer screening activities.  

Results: Study participants were primarily female (69%), aged 58  5 years, who were married (59%) and worked full time (56%). One third of the participants reported they were financially comfortable (36%). Roughly 77% had private/commercial insurance. Almost 13% of participants reported being current smokers. The majority of participants felt they were in “Good” health (44%). Post intervention, participants experienced significant decreases in waist circumference (41 ± 5 in vs 40  5 in, p = 0.002), systolic blood pressure (147 ± 24 vs 138  20, p = 0.009), diastolic blood pressure (84, interquartile range [IQR] 79-93 vs 82, IQR 77-90, p = 0.02), total cholesterol (194 ± 35 vs 173 ± 31, p < 0.001), LDL levels (100 ± 31 vs 86 ± 29, p = 0.015), and HDL levels (51, IQR 35-71, vs 46, IQR 39-57, p = 0.006). Participants also reported increased heart healthy knowledge. In addition, five participants had colorectal cancer screening, two had prostate cancer screening, and four women had mammograms.

Conclusion: Innovative methods are necessary to reduce cancer and cardiovascular risks, and to promote cancer screening and heart healthy activities in the African American population. The social media and text messaging intervention used in this study led to significant reductions in several risk areas, and promoted cancer screening. Future studies should incorporate these innovative strategies in promoting health in vulnerable populations.