Using the behavior change wheel to develop text messages intervention (MedText-PCI) to promote medication adherence in patients after PCI

Abstract Background Percutaneous coronary intervention (PCI) has significantly improved survival among patients with coronary heart disease (CHD). However, many post-PCI patients continue to struggle with suboptimal medication adherence, which increases the risk of recurrent cardiovascular events and hospital readmissions. Text message-based interventions offer a promising, low-cost strategy to support adherence, yet defining the most effective content to achieve meaningful behavioral change remains challenging. This study aimed to apply the Behavior Change Wheel (BCW) framework to design a text message intervention (MedText-PCI) to improve medication adherence in post-PCI patients. Methods An intervention development study was conducted using the BCW framework to guide the design of MedText-PCI. A detailed behavioral diagnosis identified barriers and facilitators to medication adherence, which were mapped onto COM-B components. Intervention functions and behavior change techniques (BCTs) were systematically selected using the APEASE criteria. Based on the chosen BCTs, text messages were collaboratively developed by medical experts and a communication specialist. All messages were refined to a junior high school reading level to ensure clarity and accessibility, and fidelity coding was conducted to verify alignment with the intended BCTs. Results The final intervention consisted of 115 theory-informed messages incorporating 15 distinct BCTs, covering domains such as treatment benefits, consequences of non-adherence, action planning, and motivational reinforcement. Iterative expert review ensured clinical accuracy and accessibility. The program is currently undergoing pilot testing to assess feasibility and acceptability in a tertiary hospital setting. Conclusion This study demonstrates the feasibility and systematic approach of using the BCW framework to develop MedText-PCI for improving medication adherence after PCI. The rigorous design process supports reproducibility and provides a solid foundation for future evaluation. If proven effective, MedText-PCI could serve as a powerful tool to cut cardiovascular events and readmissions after PCI. It may even inspire broader use in other chronic diseases needing lifelong medication adherence. Trial registration Not applicable.