Effect of a digitally augmented general health promotion intervention on abstinence from health-risk behaviors among emergency department discharge patients: A randomized controlled trial
- 1The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- 2School of Nursing, Sun Yat-Sen University, Guangzhou, China
- 3United Christian Hospital, Kowloon, Hong Kong SAR, China
Abstract
Background: Noncommunicable diseases (NCDs) are the leading global cause of death and are driven by modifiable behaviors, such as tobacco use, harmful alcohol consumption, unhealthy diet, and physical inactivity. Recognizing that emergency department (ED) visits represent a unique opportunity to promote behavior change, this trial evaluated a digitally augmented, theory based general health promotion approach, combining a brief telephone-based intervention with mobile instant messaging support, to help discharged ED patients abstain from health risk behaviors. Methods and findings: This assessor-blinded randomized controlled trial was conducted in a major public hospital ED in Hong Kong. Adults (18–65 years) triaged as semi-urgent or non-urgent and with ≥1 health-risk behavior and smartphone access were randomized to receive a digitally augmented, theory‑based general health‑promotion intervention consisting of a brief telephone‑based AWARD‑model intervention (Ask, Warn, Advise, Refer, and Do-it-again) followed by weekly WhatsApp or WeChat messages for 6 months, or to a control group receiving brief telephone advice only. The primary outcome was self-report abstinence from ≥1 health-risk behavior at 6 months; secondary outcomes included the proportion of participants who achieved self-reported abstinence from ≥1 health-risk behavior at 12 months and reduction in the number of behaviors at 6 and 12 months. Of the 2,134 screened patients, 572 were enrolled (286 per group). At 6 months, 30.1% of the intervention participants versus 19.9% of the controls achieved self-reported abstinence (RR = 1.51; 95% CI, 1.13–2.02; P = 0.006). The intervention also significantly increased the likelihood of fewer risky behaviors at 6 (RR = 1.54; P = 0.01) and 12 (RR = 1.48; P = 0.02) months. Physical inactivity showed the greatest improvement at 6 months (31.7% versus 16.2%; P < 0.001). The effects attenuated after cessation of booster messaging. Limitations include reliance on self-reported outcomes, the single-center study design, and loss to follow-up, which may have affected the generalizability of the results. Conclusions: A digitally augmented, theory-based general health promotion strategy delivered at ED discharge through brief telephone intervention and mobile instant messaging support demonstrated short-term benefits in promoting self-reported abstinence and reducing health-risk behaviors at 6 months. However, the absence of a sustained effect at 12 months suggests that extended support or maintenance strategies may be required to maintain these improvements over time. Multicenter trials with longer follow-up are warranted to evaluate long-term effectiveness. Clinical trial registration: ClinicalTrials.gov (Registration No: NCT06077565). Why was this study done?: What did the researchers do and find?: What do these findings mean?: Ho Cheung William Li and colleagues conduct a randomized controlled trial to assess the effects of a health-promotion intervention delivered by telephone, with weekly digital reminders and initiated at hospital discharge, that aims to improve abstinence from health risk behaviors.
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BibTeX
@article{li2026effect,
title = {{Effect of a digitally augmented general health promotion intervention on abstinence from health-risk behaviors among emergency department discharge patients: A randomized controlled trial}},
author = {Ho Cheung William Li and Wei Xia and Joanna Yeung and Laurie Long Kwan Ho and Tan Ankie Cheung and Kai Yeung Cheung and Yiu Cheung Chan and Wai Yee Chan and Chin Wai Lui and Hong Chen},
journal = {PLOS Medicine},
year = {2026},
month = sep,
doi = {10.1371/journal.pmed.1004916},
url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004916},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effect of a digitally augmented general health promotion intervention on abstinence from health-risk behaviors among emergency department discharge patients: A randomized controlled trial
AU - Ho Cheung William Li
AU - Wei Xia
AU - Joanna Yeung
AU - Laurie Long Kwan Ho
AU - Tan Ankie Cheung
AU - Kai Yeung Cheung
AU - Yiu Cheung Chan
AU - Wai Yee Chan
AU - Chin Wai Lui
AU - Hong Chen
PY - 2026
DA - 2026/09/08
JO - PLOS Medicine
DO - 10.1371/journal.pmed.1004916
UR - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004916
AB - Background: Noncommunicable diseases (NCDs) are the leading global cause of death and are driven by modifiable behaviors, such as tobacco use, harmful alcohol consumption, unhealthy diet, and physical inactivity. Recognizing that emergency department (ED) visits represent a unique opportunity to promote behavior change, this trial evaluated a digitally augmented, theory based general health promotion approach, combining a brief telephone-based intervention with mobile instant messaging support, to help discharged ED patients abstain from health risk behaviors. Methods and findings: This assessor-blinded randomized controlled trial was conducted in a major public hospital ED in Hong Kong. Adults (18–65 years) triaged as semi-urgent or non-urgent and with ≥1 health-risk behavior and smartphone access were randomized to receive a digitally augmented, theory‑based general health‑promotion intervention consisting of a brief telephone‑based AWARD‑model intervention (Ask, Warn, Advise, Refer, and Do-it-again) followed by weekly WhatsApp or WeChat messages for 6 months, or to a control group receiving brief telephone advice only. The primary outcome was self-report abstinence from ≥1 health-risk behavior at 6 months; secondary outcomes included the proportion of participants who achieved self-reported abstinence from ≥1 health-risk behavior at 12 months and reduction in the number of behaviors at 6 and 12 months. Of the 2,134 screened patients, 572 were enrolled (286 per group). At 6 months, 30.1% of the intervention participants versus 19.9% of the controls achieved self-reported abstinence (RR = 1.51; 95% CI, 1.13–2.02; P = 0.006). The intervention also significantly increased the likelihood of fewer risky behaviors at 6 (RR = 1.54; P = 0.01) and 12 (RR = 1.48; P = 0.02) months. Physical inactivity showed the greatest improvement at 6 months (31.7% versus 16.2%; P < 0.001). The effects attenuated after cessation of booster messaging. Limitations include reliance on self-reported outcomes, the single-center study design, and loss to follow-up, which may have affected the generalizability of the results. Conclusions: A digitally augmented, theory-based general health promotion strategy delivered at ED discharge through brief telephone intervention and mobile instant messaging support demonstrated short-term benefits in promoting self-reported abstinence and reducing health-risk behaviors at 6 months. However, the absence of a sustained effect at 12 months suggests that extended support or maintenance strategies may be required to maintain these improvements over time. Multicenter trials with longer follow-up are warranted to evaluate long-term effectiveness. Clinical trial registration: ClinicalTrials.gov (Registration No: NCT06077565). Why was this study done?: What did the researchers do and find?: What do these findings mean?: Ho Cheung William Li and colleagues conduct a randomized controlled trial to assess the effects of a health-promotion intervention delivered by telephone, with weekly digital reminders and initiated at hospital discharge, that aims to improve abstinence from health risk behaviors.
SN - 1549-1676
ER -