Understanding Preferences for Lifestyle-Focused Visual Text Messages in Patients With Cardiovascular and Chronic Respiratory Disease: Discrete Choice Experiment

Michael Choi, Rebecca Raeside, Karice Hyun, Stephanie R Partridge, Aravinda Thiagalingam, Julie Redfern*

*Corresponding author for this work

Research output: Other contributionDiscipline Preprint RepositoryResearch



Supporting healthy lifestyle change is a key aim of cardiovascular and pulmonary rehabilitation programs. Text messaging programs have demonstrated effectiveness in cardiovascular disease risk reduction, weight loss, increasing physical activity and smoking cessation. Optimisation of text message programs may deliver greater population benefits as mobile phone usage becomes ubiquitous. Visual messaging (i.e. image-based messages) has the potential to communicate health messages via digital technology with enhanced engagement.


To determine and understand patient preferences for lifestyle-focused visual text messages that support cardiovascular and pulmonary rehabilitation


A discrete choice experiment was conducted in a four-stage iterative process to elicit patient preferences for features of visual messages. Attribute and level development yielded three attributes: purpose, image type and web address and 16 choice sets were subsequently constructed according to a full factorial design. Patients participating in cardiovascular and pulmonary rehabilitation were surveyed (online) for their preferences regarding the visual message choice sets. Respondents were asked to choose between 16 pairs of visual messages regarding key lifestyle behaviours, namely, physical activity and nutrition. Data were analysed by using a conditional logit model.


There was a total of 1728 observations from 54 unique respondents. Two factors that were associated with the patient preference were gain-framed purpose compared to no purpose (OR 1.93, 95% CI 1.40 – 2.65) and real images compared to cartoon images (OR 1.26, 95% CI 1.04 – 1.54). A loss-framed purpose was less preferred than no purpose (OR 0.55, 95% CI 0.42 - 0.74). Overall, patients preferred positive images that were colourful and engaging with text that supported the image with a preference for images of real people rather than cartoons.


A discrete choice experiment is a scientific method to elicit patient preferences for a visual messaging intervention designed to support change to lifestyle behaviours. Text messaging programs which utilise visual aids may find greater patient satisfaction by employing a gain-frame, using real images and avoiding a loss-frame. Further research is needed to explore feasibility of implementation and health and behavioural outcomes associated with such visual messaging programs.
Original languageEnglish
PublisherJMIR Preprints
Number of pages31
Publication statusSubmitted - 7 Dec 2020
Externally publishedYes


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