Feasibility and preliminary effects of a culturally adapted short message service intervention for non-communicable disease prevention in older adults: a pilot study

Abstract

Background Among low- and middle-income countries, noncommunicable diseases (NCDs) are a significant health burden among the elderly. Mobile health interventions provide resource-constrained health education that is scalable. Aims Determine the viability, acceptability, and preliminary effects of culturally adapted Short Message Service (SMS)-based nutrition and lifestyle change on the knowledge, attitudes, and practices (KAP) of older adults in Jordan towards prevention of noncommunicable diseases (NCDs). Method and Materials A total of 79 older adults (mean age 57.33 ± 9.37 years) with NCDs received 30 culturally tailored SMS messages daily for one month. Messages were based on Social Cognitive Theory and addressed dietary habits, physical activity, and NCD risk reduction. A validated Arabic-adapted KAP questionnaire was administered pre- and post-intervention. Statistical Analysis Paired-samples t-tests were used to compare pre- and post-KAPs. Effect sizes were calculated using Cohen’s d. Sociodemographic factors associated with KAP improvement were examined through multiple linear regression (p ≤ 0.05). Results Significant improvements occurred in knowledge (mean difference = 40.62, p ≤ 0.001; Cohen’s d = 3.29) and attitudes (mean difference = 24.43, p ≤ 0.001; Cohen’s d = 1.77). There was no significant change in practice scores (p = 0.175). Overall KAP improved significantly (p ≤ 0.001; Cohen’s d = 2.15), driven primarily by gains in knowledge and attitudes; practice scores did not change significantly. Greater improvement in KAP was associated with higher education (β = 0.379, p ≤ 0.001), younger age (β = − 0.646, p ≤ 0.001), female sex (β = − 0.067, p = 0.007), and living alone (β = 0.150, p = 0.031). Conclusions The pilot study indicates that culturally adapted SMS messaging among older adults with NCDs is feasible and acceptable in Jordan, and its early impacts on knowledge and attitudes are promising. These results provide preliminary evidence and effect size estimates needed to design a fully powered randomized controlled trial to determine effectiveness.