Comparing the Effectiveness of Group Discussion and SMS-Based Education on Nutritional Status, Physical Activity, and Blood Cholesterol Levels in Women with Elevated Cholesterol: A Randomized Controlled Trial

Abstract

Background: Given the significant contribution of dyslipidemia to cardiovascular disease (CVD) risk in women, effective educational interventions targeting lifestyle modifications are crucial for disease prevention and management. Objectives: The present study was conducted with the aim of comparing the effectiveness of group discussion and short message service (SMS)-based education in improving nutrition, physical activity, and cholesterol levels in women with high blood cholesterol. Methods: A randomized trial was conducted with 165 women aged 30 - 59, recruited from two urban health centers in Kermanshah, Iran. The study included participants with borderline high cholesterol levels (200 - 239 mg/dL) who were randomly assigned to one of three groups (n = 55 each): An SMS-based education group receiving text messages on nutrition and physical activity, a group discussion intervention with facilitated sessions on lifestyle modification, or a control group that received standard care without additional educational components. Participants were randomly assigned to one of three groups using permuted block randomization [block sizes of (e.g. 6, 9)], with allocation concealment ensured by sealed, opaque envelopes. With a statistical power of 80% and a confidence level of 95%, the minimum required sample size was calculated. Questionnaires were administered to evaluate dietary and physical activity habits before and three months after the interventions. Blood samples were also obtained at these time points. Statistical analysis was performed using SPSS version 16. The chi-square, Wilcoxon signed-rank, and Kruskal-Wallis tests were used for baseline, within-group, and between-group comparisons, respectively. A P-value of less than 0.05 was considered statistically significant. Results: The two intervention groups showed a statistically significant increase in the mean score of nutritional status and physical activity and a decrease in the level of blood cholesterol after the intervention, compared to the control group (P < 0.001). There was no significant difference between the SMS and discussion groups in terms of physical activity and cholesterol levels, but the nutritional status score in the discussion group was significantly higher than in the SMS group. Conclusions: Both group discussion and SMS interventions can be effective strategies for promoting healthy lifestyle changes in women with high cholesterol. Group discussions appear to have a broader impact, as they also improve nutritional status. Healthcare providers can consider incorporating these methods into their interventions to help women manage their cholesterol levels and improve their overall health.