Integrating Cardiovascular Prevention Into Psoriasis Care Using Text Messaging: Insights From the <scp>TEXTME PSO</scp> Trial

Cardiovascular disease (CVD) is the leading cause of mortality in individuals with psoriasis, driven by shared inflammatory pathways and modifiable risk factors [1]. Given this heightened risk, lifestyle-based prevention and patient activation are essential. Mobile health (mHealth) strategies such as text messaging (TM) have proven effective in chronic disease management, but their role in psoriasis remains underexplored. User feedback is critical to ensure acceptability, engagement and impact. While guidelines now recommend routine CVD risk assessment in this population [2], uptake in clinical practice remains inconsistent [3], compounded by variable clinician awareness of the psoriasis–CVD link [3]. Furthermore, in the absence of definitive evidence demonstrating that highly effective biologic therapies mitigate cardiovascular risk, a renewed focus on primary prevention and novel patient-centred ways to achieve this must be explored [4]. While mobile health (mHealth) tools such as text messaging have demonstrated value in chronic disease prevention, their role in psoriasis is largely underexplored [5-7]. The International Psoriasis Council released a statement in 2021 recommending the integration of digital models of care into routine practice [8]. This single-centre randomised controlled trial evaluated a text messaging (TM) intervention designed to enhance patient activation and support cardiovascular disease (CVD) prevention in psoriasis. Participants were randomised 1:1 to receive either standard care or a six-month TM programme delivering behaviourally framed, evidence-based messages. At study end, participants completed a structured survey comprising Likert-scale and free-text items assessing message utility, engagement and behavioural impact; controls completed matched questions on lifestyle change. The trial was conducted at a tertiary referral hospital in Sydney, Australia, from February 2024 to January 2025 (HREC 2020/ETH02033; ACTRN12621000141831). Primary and other secondary outcomes are reported separately [9]. This analysis focusses on user feedback to assess feasibility, engagement and acceptability of the intervention. A total of 111 participants were enrolled (mean age 51.8 ± 13.2 years; 65.1% male); 55 were randomised to the intervention. Most had early-onset psoriasis (83.8%), 74.8% were receiving biologics, and 49.5% had ≥ 1 cardiovascular risk factor. Structured user feedback was completed by 35 of 55 intervention participants (63.6%) and 34 of 56 controls (60.7%), with both groups answering matched behavioural questions on motivation, physical activity, diet and medication adherence. Free-text responses were collected from both groups; thematic analysis focussed on responses from the intervention arm. The text messaging intervention was well-received, with high engagement and self-reported improvements in diet, physical activity and motivation. Control participants reported lower motivation and smaller improvements in lifestyle behaviours. Among survey respondents, a significantly greater proportion of intervention participants compared with controls reported improvements in physical activity (Intervention 71.4% vs. Control 44.1%; p = 0.015), diet (74.3% vs. 52.9%; p = 0.056) and medication adherence (62.9% vs. 38.2%; p = 0.038); motivation was also higher (74.3% vs. 55.9%; p = 0.101), though not significant. Outcomes were assessed using 5-point Likert items. Proportions were compared using Chi-squared tests; mean scores using independent-sample t-tests. Physical activity improvement was significantly greater in the intervention group (mean difference = −0.68; p = 0.003), with non-significant trends in motivation (p = 0.060) and diet (p = 0.169). Participants described the programme as supportive, motivating and aligned with their communication preferences. In free-text responses, many requested that the messaging continue and noted that the format helped normalise preventive health conversations and provided information they were either unaware of or would not have sought during routine care. Representative examples of intervention messages are provided in Table S1. This study provides real-world evidence supporting the feasibility and acceptability of a mobile health (mHealth) intervention in a psoriasis cohort. Participants who received text messages reported high engagement and greater improvements in lifestyle behaviours—including physical activity, diet and medication adherence—compared with controls. High satisfaction and uptake highlight the potential of behavioural text messaging as a low-cost adjunct to psoriasis care. Such interventions may help extend support beyond the clinic, complement systemic therapies and contribute to more holistic, empowering and CVD–preventative dermatology practice. These findings should be interpreted in the context of study limitations, including self-reported outcomes, six-month follow-up and potential response bias. Longer term trials are required to assess sustained engagement and cardiovascular outcomes. TEXTME PSO is a novel intervention that uses behavioural text messages to specifically target cardiovascular prevention in psoriasis. Our findings suggest that simple, structured digital communication can support lifestyle change and empower patients. The TEXTME PSO intervention provides a practical and scalable template for low-cost digital prevention—helping to place the heart, not just the skin, at the centre of psoriasis care. We thank the staff at the Westmead Applied Research Centre and Westmead Dermatology for their support in conducting the TEXTME PSO trial. We thank the patients who participated in this study. Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians. Approved by the Western Sydney Local Health District Human Research Ethics Committee (PID00988/2021/ETH8001|Version 1.4), in accordance with the Helsinki Declaration (1964) and its later amendments. Informed consent was obtained from all participants prior to enrolment. The authors declare no conflicts of interest. Deidentified participant quotes used in this article are drawn from previously published and submitted studies. Full datasets, including raw qualitative data and participant transcripts, will not be made publicly available due to ethical constraints and lack of participant consent for broad data sharing. Researchers may contact the corresponding author to discuss potential data access on a case-by-case basis, subject to institutional approval. Table S1: Examples of text messages delivered in the TEXTME PSO intervention. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.