{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:07:12Z","timestamp":1789153632169,"version":"build-2803163510"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004916","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000}}],"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Fund for Evidence-based Practice Improvement Collaborative Projects by the Nethersole Evidence-based Nursing Practice Unit \u2013 Nethersole Group Hospitals"}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods and findings<\/jats:title>\n \n This assessor-blinded randomized controlled trial was conducted in a major public hospital ED in Hong Kong. Adults (18\u201365 years) triaged as semi-urgent or non-urgent and with \u22651 health-risk behavior and smartphone access were randomized to receive a digitally augmented, theory\u2011based general health\u2011promotion intervention consisting of a brief telephone\u2011based AWARD\u2011model 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 \u22651 health-risk behavior at 6 months; secondary outcomes included the proportion of participants who achieved self-reported abstinence from \u22651 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\u2009=\u20091.51; 95% CI, 1.13\u20132.02;\n P<\/jats:italic>\n \u2009=\u20090.006). The intervention also significantly increased the likelihood of fewer risky behaviors at 6 (RR\u2009=\u20091.54;\n P<\/jats:italic>\n \u2009=\u20090.01) and 12 (RR\u2009=\u20091.48;\n P<\/jats:italic>\n \u2009=\u20090.02) months. Physical inactivity showed the greatest improvement at 6 months (31.7% versus 16.2%;\n P<\/jats:italic>\n \u2009<\u20090.001). 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Clinical trial registration<\/jats:title>\n \n ClinicalTrials.gov (Registration No:\n NCT06077565<\/jats:ext-link>\n ).\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004916","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:51:58Z","timestamp":1788889918000},"page":"e1004916","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":0,"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"],"prefix":"10.1371","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2562-769X","authenticated-orcid":true,"given":"Ho Cheung William","family":"Li","sequence":"first","affiliation":[{"name":"The Chinese University of Hong Kong","place":["Shatin, China"],"department":["The Nethersole School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Xia","sequence":"additional","affiliation":[{"name":"Sun Yat-Sen University","place":["Guangzhou, China"],"department":["School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0061-4905","authenticated-orcid":true,"given":"Joanna","family":"Yeung","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong","place":["Shatin, China"],"department":["The Nethersole School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0852-6299","authenticated-orcid":true,"given":"Laurie Long Kwan","family":"Ho","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong","place":["Shatin, China"],"department":["The Nethersole School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6498-0314","authenticated-orcid":true,"given":"Tan Ankie","family":"Cheung","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong","place":["Shatin, China"],"department":["The Nethersole School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai Yeung","family":"Cheung","sequence":"additional","affiliation":[{"name":"United Christian Hospital","place":["Kowloon, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2139-2886","authenticated-orcid":true,"given":"Yiu Cheung","family":"Chan","sequence":"additional","affiliation":[{"name":"United Christian Hospital","place":["Kowloon, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Yee","family":"Chan","sequence":"additional","affiliation":[{"name":"United Christian Hospital","place":["Kowloon, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin Wai","family":"Lui","sequence":"additional","affiliation":[{"name":"United Christian Hospital","place":["Kowloon, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2606-0039","authenticated-orcid":true,"given":"Hong","family":"Chen","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong","place":["Shatin, China"],"department":["The Nethersole School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"pmed.1004916.ref001","unstructured":"World Health Organization. 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