Effects of a Digital SMS-Based Knowledge and Implementation Intention Intervention on Patient Activation

This study investigates whether a brief digital intervention can increase patient activation in adults receiving care for musculoskeletal complaints in an outpatient setting, including chiropractic care, physiotherapy, and medical massage. Patient activation refers to a patient’s knowledge, skills, and confidence to actively manage their health. Higher levels of patient activation are associated with improved self-management and more active engagement in care (Hibbard et al., 2007). However, many patients with musculoskeletal complaints tend to hold passive treatment expectations and show limited engagement in self-initiated health behaviors (Darlow et al., 2013). Digital interventions offer a scalable opportunity to support patient engagement beyond face-to-face consultations, which are often time-limited in outpatient care (Du et al., 2019; Irving et al., 2017). In the present study, the digital intervention is delivered via SMS messages containing links to a dedicated website. The website provides educational video content and written instructions. The intervention period lasts approximately three weeks. Both intervention groups receive identical educational video content addressing musculoskeletal complaints, recovery, and the importance of movement. The two intervention conditions differ in the accompanying written content provided on the website. In the knowledge intervention condition, the written text summarizes and reinforces the key informational content from the videos, focusing on knowledge transmission and understanding of the condition and its management. In the implementation intention condition, the written content guides participants in formulating a personalized if–then plan related to their health behavior (e.g., movement initiation). Implementation intentions are a self-regulatory strategy designed to reduce the intention–behavior gap by linking situational cues to goal-directed actions (Gollwitzer, 1999). This plan is integrated into the website content and revisited in subsequent weeks within the same digital environment. The study follows a 2 (Time: T0 vs T1) x 3 (Group : control vs. knowledge vs. implementation intention) mixed design. Participants will be randomly assigned to one of three conditions: (1) control group (usual care without additional digital content), (2) knowledge intervention (educational videos plus knowledge-focused written summaries), or (3) implementation intention intervention (educational videos plus structured guidance to formulate and revisit a personalized if–then plan). Patient activation will be measured at baseline (T0) and three weeks later (T1) using the German version of the PAM-13 (Brenk-Franz et al., 2013).