Feasibility and preliminary effects of a culturally adapted short message service intervention for non-communicable disease prevention in older adults: a pilot study.
Culturally adapted SMS messaging among older adults with NCDs is feasible and acceptable in Jordan, with significant early impacts on knowledge and attitudes but no significant change in practice scores.
Key Findings
Results
Knowledge scores improved significantly following the one-month SMS intervention.
Mean difference in knowledge scores = 40.62, p ≤ 0.001
Effect size was large: Cohen's d = 3.29
79 older adults with NCDs participated (mean age 57.33 ± 9.37 years)
Participants received 30 culturally tailored SMS messages daily for one month
Pre- and post-intervention comparison used paired-samples t-tests
Results
Attitude scores improved significantly following the SMS intervention.
Mean difference in attitude scores = 24.43, p ≤ 0.001
Effect size was large: Cohen's d = 1.77
Messages were based on Social Cognitive Theory and addressed dietary habits, physical activity, and NCD risk reduction
A validated Arabic-adapted KAP questionnaire was used to measure outcomes
Results
Practice scores did not change significantly after the intervention.
p = 0.175 for practice score change, which was not statistically significant
Despite significant improvements in knowledge and attitudes, behavioral practice was unchanged
The authors note the one-month intervention duration may have been insufficient to produce behavioral change
Overall KAP improved significantly (p ≤ 0.001; Cohen's d = 2.15), driven primarily by knowledge and attitude gains
Results
Overall KAP scores improved significantly, driven primarily by gains in knowledge and attitudes.
Overall KAP improvement: p ≤ 0.001, Cohen's d = 2.15
Effect sizes indicate large practical significance for knowledge and attitudes
Practice scores did not contribute meaningfully to overall KAP improvement
Sample size was 79 older adults in Jordan
Results
Higher education level was significantly associated with greater KAP improvement.
β = 0.379, p ≤ 0.001 for education level in multiple linear regression
Sociodemographic factors were examined through multiple linear regression with p ≤ 0.05 significance threshold
This suggests SMS-based interventions may be differentially effective depending on participants' educational background
Results
Younger age within the older adult sample was associated with greater KAP improvement.
β = -0.646, p ≤ 0.001 for age in multiple linear regression
The negative beta coefficient indicates that lower age was associated with greater improvement
Mean participant age was 57.33 ± 9.37 years
Examined alongside other sociodemographic predictors including sex, education, and living situation
Results
Female sex was associated with greater KAP improvement.
β = -0.067, p = 0.007 for sex in multiple linear regression
The negative beta coefficient indicates females showed greater improvement
This was one of four sociodemographic factors significantly associated with KAP improvement
Results
Living alone was associated with greater KAP improvement.
β = 0.150, p = 0.031 for living alone in multiple linear regression
Living situation was a statistically significant predictor of KAP improvement
This finding may have implications for targeting SMS interventions to socially isolated older adults
Conclusions
The SMS intervention was found to be feasible and acceptable among older adults with NCDs in Jordan.
79 older adults completed the pilot study
Messages were culturally adapted and written in Arabic
30 messages were delivered daily for one month
The pilot study design aimed to determine viability and acceptability as primary feasibility outcomes
Authors conclude results provide preliminary evidence and effect size estimates needed to design a fully powered randomized controlled trial
Methods
The SMS messages were designed using Social Cognitive Theory and addressed multiple NCD-related lifestyle domains.
Messages were grounded in Social Cognitive Theory
Content addressed dietary habits, physical activity, and NCD risk reduction
Messages were culturally tailored for a Jordanian older adult population
A total of 30 messages were delivered per day over one month
What This Means
This research suggests that sending culturally adapted health text messages to older adults in Jordan can meaningfully improve what they know and how they feel about preventing noncommunicable diseases (NCDs) like diabetes and heart disease. In this pilot study, 79 older adults with existing NCDs received 30 text messages per day for one month. The messages were written in Arabic, tailored to the local culture, and covered topics like healthy eating, physical activity, and reducing disease risk. After the month was over, participants showed very large improvements in their knowledge about NCDs and in their attitudes toward healthier behaviors.
However, this research also suggests that knowledge and attitude gains alone did not translate into actual behavioral change within the one-month study period. Scores measuring what participants actually did — their practices — did not improve significantly. This gap between knowing and doing is a common challenge in health behavior change and may require longer interventions or additional support strategies to bridge. The study also found that younger participants, women, those with higher education, and those living alone tended to benefit more from the messages.
This was a small pilot study without a control group, so it cannot definitively prove that the text messages caused the improvements. The authors frame their findings as preliminary evidence to help design a larger, more rigorous randomized controlled trial. Still, the results indicate that mobile phone-based health education can reach older adults in resource-limited settings and may be a practical, low-cost tool for public health efforts in countries like Jordan where NCDs are a growing concern.
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Elsahoryi N, Milhem F. (2026). Feasibility and preliminary effects of a culturally adapted short message service intervention for non-communicable disease prevention in older adults: a pilot study.. PeerJ. https://doi.org/10.7717/peerj.21643