The current clinical trial (IRCT20160914029817N7) was conducted on cases with ACS admitted to the cardiac ward of Afshar Hospital in Yazd, Iran, during 2018-2019. The sample size was calculated to be 40 individuals per group, with 80% power and 95% confidence interval. Because of the possibility of dropout, 96 individuals were evaluated. They were randomly assigned to two the intervention (group A) and control (group B) groups. They were allocated to the groups via permuted block randomization. Two homogeneous blocks were considered with respect to confounding variables, such as age and gender. Allocation was performed double-blinded, that is, neither the allocator nor the patient knew the type of intervention.
The inclusion criteria for the patients were as follows: diagnosis of ACS by a cardiologist [7]; age >21 years [12]; having access to a personal or family mobile phone; and being able to read, write, and speak Farsi [7]. In addition, the inclusion criteria for the patient's family were as follows: having access to a third person who could read the text messages for them; being able to do daily activities [5]; having access to a personal or family mobile phone; and being able to read, write, and speak Farsi. In contrast, the exclusion criteria included change of mobile phone number and not informing the researcher [8]; having a known mental, intellectual, or motor disability; and having a physical or mental problem, resulting in disability at any stage of the research [13, 7]. Also, the exclusion criteria for the patient's family included disability at old age [7] and inability to read and write in Farsi language [12].
Data were collected from two groups of patients before and three months after the intervention. The research tool had two sections. The former included questions about the demographic characteristics and information about the disease (e.g., age, gender, education, and history of hospitalization). The latter consisted of Walker’s Lifestyle Questionnaire with six dimensions: nutrition, physical activity, stress management, interpersonal relationship, health responsibility, and self‑realization. The tool was ranked on a four-point Likert scale (1= never, 2= sometimes, 3= often, and 4= always); the minimum score is 52, and the maximum score is 208 [7, 14, 15]. The reliability and validity of this questionnaire have been determined in Iran. Its total reliability was estimated at 91%, and reliability of the dimensions, including nutrition, physical activity, stress management, interpersonal relationships, health responsibility, and self‑realization was 0.89, 0.75, 0.78, 0.80, 0.78, and 0.71, respectively [14].
First, the research objectives were explained for the subjects followed by collecting the informed consent. Next, the investigator’s colleague completed the questionnaire through interviews with the patients, without providing any information about the groups or purpose of the study. After primary data collection, the patients’ mobile phone numbers were obtained. Lastly, cases were randomly assigned to two groups. The intervention group received educational text and video messages according to the Walker’s Lifestyle Questionnaire dimensions.
Time table: Content of text messages in the intervention group
Days of the week
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Subject of messages sent
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Saturday
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Nutrition
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Sunday
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Physical activity
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Monday
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Stress management
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Wednesday
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Interpersonal relationships
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Thursday
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Self‑realization
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