Text message-based health interventions

Text messaging interventions provide patients with reminders, education, or self-management assistance for health conditions. Interventions are most frequently used as part of broader health promotion efforts or to help individuals manage chronic diseases. Text messaging is a low-cost platform which can be combined with other approaches or delivered as part of a stepped care or progressive intervention that is tailored to patients’ needs, beginning with the least intensive treatment and moving to more intensive, and often expensive, treatments as needed (). Text message software and smartphone apps can be integrated into electronic health records (EHRs) to send alerts and reminders to patients (Perri-Moore 2016).

Expected Beneficial Outcomes (Rated)

  • Increased healthy behaviors

  • Improved health outcomes

  • Improved weight outcomes

Other Potential Beneficial Outcomes

  • Increased medication adherence

  • Increased tobacco cessation

  • Reduced tobacco use

  • Reduced drug and alcohol use

  • Increased vaccination

Evidence of Effectiveness

There is strong evidence that text message-based health interventions improve health (Arambepola 2016, Poorman 2015, , , , , ) and weight outcomes (, , Liu 2015a, Poorman 2015, ), and increase healthy behaviors (, , Poorman 2015, ). However, additional evidence is needed to confirm long-term effects.

Text message-based health interventions improve health outcomes for adolescents with chronic conditions (Badawy 2017a) and improve health outcomes in diabetics (Arambepola 2016), including improved blood glucose levels (Poorman 2015, ). Text messaging appears to be as effective as, and in some cases better than, usual care in the self-management of long-term illnesses such as hypertension and diabetes (), and can improve asthma self-management (). For prediabetics, interventions can increase weight loss and improve blood glucose levels, especially for Spanish language speakers (). Text message-based health interventions improve weight loss (, Poorman 2015, Liu 2015a, , ) and reduce body mass index (BMI) for overweight or obese participants (Liu 2015a).

Text messaging, alone or with an internet-based component, has been shown to change health behaviors in the short-term (, , ) and may also have longer-term effects (, , Poorman 2015, ). Text messaging interventions have been shown to increase vaccinations (, Poorman 2015, Badawy 2017), including human papillomavirus (HPV) vaccines for adolescents (, Rand 2015), and flu vaccines for Latino families () and mothers with low incomes (). Such interventions also increase tobacco cessation (, Poorman 2015) and reduce tobacco (, Mason 2015a, ), alcohol (Mason 2015a, , , , Gonzales 2016), and drug use (, Gonzales 2016), including methamphetamines and opioids (). Text interventions aimed at teenagers appear to reduce risky sexual behavior (, ), increase testing and treatment for STIs, and increase knowledge of sexual and reproductive health for teens of various races and genders ().

An Anchorage-based study suggests that text messaging interventions increase colorectal cancer screening among Alaska Native and American Indian populations (Muller 2017). International studies suggest text messaging interventions increase breast and cervical cancer screenings (Uy 2017). Interventions may also increase completion of outpatient cardiovascular rehabilitation (). Text messaging appears to be as effective as telephone reminders at promoting appointment attendance ().

Text messaging interventions can increase medication adherence (, , Hamine 2015, , ), including adherence for chronic conditions such as asthma (Hall 2015, ), diabetes (Hall 2015), and HIV (Hall 2015, ) for adults () and adolescents (Badawy 2017a). However, a study of schizophrenic patients suggests daily text message prompts added to standard care may not increase medication adherence more than standard care alone for this population ().

Programs which use individualized coaching through smartphone texts can increase daily step counts and physical activity (Martin 2015a). Customized text support can also improve oral health and increase sun safety knowledge among adolescents (Badawy 2017).

In some cases, two-way text communication can be more effective than one sided reminders (Vargas 2017). Tailoring messages and using participants’ preferred language may contribute to participant satisfaction with text message-based health interventions ().

Impact on Disparities

No impact on disparities likely

Implementation Examples

One example of a text messaging service, Text 2 Survive in Illinois, allows minority youth and young adults to receive HIV/AIDS information and testing, including lists of nearby sites that offer free services, health events, and health tips (AHRQ HCIE-Halloway).

Another example, Text4baby, is a free national health text messaging service and smartphone app for expectant and new moms. Texts are available in English and Spanish and include appointment reminders, information on baby milestones, nutrition, breastfeeding, labor, etc. (Text4baby, Mathematica-Text4baby 2015).

The Healthcare Information and Management Systems Society’s (HIMSS’s) mHealth Roadmap provides guidance to hospitals and health care providers on implementing mobile and mHealth methods (HIMSS Mobile Health Roadmap).

Implementation Resources

Handel 2011 - Handel MJ. mHealth (mobile health)-using apps for health and wellness. EXPLORE: The Journal of Science and Healing. 2011;7(4):256–61.

HIMSS Mobile Health Roadmap - Health Information and Management Systems Society (HIMSS). Mobile Health Roadmap.

Text4baby - Text4baby. Free text messages to keep you and your baby healthy. Wellpass healthcare messaging platform.

Citations - Evidence

* Journal subscription may be required for access.

Cochrane-Whittaker 2016* - Whittaker R, McRobbie H, Bullen C, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Systematic Reviews. 2016;(4):CD006611.

Buhi 2013* - Buhi ER, Trudnak TE, Martinasek MP, et al. Mobile phone-based behavioural interventions for health: A systematic review. Health Education Journal. 2013;72(5):564–83.

Cochrane-de Jongh 2012* - de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database of Systematic Reviews. 2012;(12):CD007459.

Cochrane-Gurol-Urganci 2013* - Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database of Systematic Reviews. 2013;(12):CD007458.

Cochrane-Horvath 2012* - Horvath T, Azman H, Kennedy GE, Rutherford GW. Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database of Systematic Reviews. 2012;(3):CD009756.

Cochrane-Kauppi 2014* - Kauppi K, Välimäki M, Hätönen H, Kuosmanen L, Warwick-Smith K, Adams C. Information and communication technology based prompting for treatment compliance for people with serious mental illness. Cochrane Database of Systematic Reviews. 2014;(6):CD009960.

Cochrane-Vodopivec-Jamsek 2012* - Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, Atun R, Car J. Mobile phone messaging for preventive health care. Cochrane Database of Systematic Reviews. 2012;(12):CD007457.

Fjeldsoe 2009* - Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. American Journal of Preventive Medicine. 2009;36(2):165–73.

Head 2013a* - Head KJ, Noar SM, Iannarino NT, Grant Harrington N. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Social Science & Medicine. 2013;97:41-8.

Scott-Sheldon 2016* - Scott-Sheldon LAJ, Lantini R, Jennings EG, et al. Text messaging-based interventions for smoking cessation: A systematic review and meta-analysis. JMIR mHealth and uHealth. 2016;4(2):e49.

Job 2018* - Job JR, Fjeldsoe BS, Eakin EG, Reeves MM. Effectiveness of extended contact interventions for weight management delivered via text messaging: A systematic review and meta-analysis. Obesity Reviews. 2018;19(4):538-549.

Arambepola 2016 - Arambepola C, Ricci-Cabello I, Manikavasagam P, et al. The impact of automated brief messages promoting lifestyle changes delivered via mobile devices to people with type 2 diabetes: A systematic literature review and meta-analysis of controlled trials. Journal of Medical Internet Research. 2016;18(4):e86.

Thakkar 2016* - Thakkar J, Kurup R, Laba TL, et al. Mobile telephone text messaging for medication adherence in chronic disease: A meta-analysis. JAMA Internal Medicine. 2016;176(3):340-349.

Liu 2015a - Liu F, Kong X, Cao J, et al. Mobile phone intervention and weight loss among overweight and obese adults: A meta-analysis of randomized controlled trials. American Journal of Epidemiology. 2015;181(5):337-348.

Armanasco 2017* - Armanasco AA, Miller YD, Fjeldsoe BS, Marshall AL. Preventive health behavior change text message interventions: A meta-analysis. American Journal of Preventive Medicine. 2017;52(3):391-402.

Mason 2015a - Mason M, Ola B, Zaharakis N, Zhang J. Text messaging interventions for adolescent and young adult substance use: A meta-analysis. Prevention Science. 2015;16(2):181-188.

Badawy 2017 - Badawy SM, Kuhns LM. Texting and mobile phone app interventions for improving adherence to preventive behavior in adolescents: A systematic review. JMIR mHealth and uHealth. 2017;5(4):e50.

L’Engle 2016* - L’Engle KL, Mangone ER, Parcesepe AM, Agarwal S, Ippoliti NB. Mobile phone interventions for adolescent sexual and reproductive health: A systematic review. Pediatrics. 2016;138(3):e20160884.

O’Rourke 2016* - O’Rourke L, Humphris G, Baldacchino A. Electronic communication based interventions for hazardous young drinkers: A systematic review. Neuroscience & Biobehavioral Reviews. 2016;68:880-890.

Hamine 2015 - Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: A systematic review. Journal of Medical Internet Research. 2015;17(2):e52.

Vargas 2017 - Vargas G, Cajita MI, Whitehouse E, Han H-R. Use of short messaging service for hypertension management: A systematic review. The Journal of Cardiovascular Nursing. 2017;32(3):260-270.

Hall 2015 - Hall AK, Cole-Lewis H, Bernhardt JM. Mobile text messaging for health: A systematic review of reviews. Annual Review of Public Health. 2015;36:393-415.

Park 2014* - Park LG, Howie-Esquivel J, Dracup K. A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence. Journal of Advanced Nursing. 2014;70(9):1932-1953.

Poorman 2015 - Poorman E, Gazmararian J, Parker RM, Yang B, Elon L. Use of text messaging for maternal and infant health: A systematic review of the literature. Maternal and Child Health Journal. 2015;19(5):969-989.

Siopsis 2015* - Siopis G, Chey T, Allman-Farinelli M. A systematic review and meta-analysis of interventions for weight management using text messaging. Journal of Human Nutrition and Dietetics. 2015;28(s2):1-15.

Loescher 2018* - Loescher LJ, Rains SA, Kramer SS, Akers C, Moussa R. A systematic review of interventions to enhance healthy lifestyle behaviors in adolescents delivered via mobile phone text messaging. American Journal of Health Promotion. 2018;32(4):865-879.

Uy 2017 - Uy C, Lopez J, Trinh-Shevrin C, et al. Text messaging interventions on cancer screening rates: A systematic review. Journal of Medical Internet Research. 2017;19(8):e296.

Tofighi 2017* - Tofighi B, Nicholson JM, McNeely J, Muench F, Lee JD. Mobile phone messaging for illicit drug and alcohol dependence: A systematic review of the literature. Drug and Alcohol Review. 2017;36(4):477-491.

Badawy 2017a - Badawy SM, Barrera L, Sinno MG, et al. Text messaging and mobile phone apps as interventions to improve adherence in adolescents with chronic health conditions: A systematic review. JMIR mHealth and uHealth. 2017;5(5):e66.

Rand 2017* - Rand CM, Vincelli P, Goldstein NPN, Blumkin A, Szilagyi PG. Effects of phone and text message reminders on completion of the human papillomavirus vaccine series. Journal of Adolescent Health. 2017;60(1):113-119.

Rand 2015 - Rand CM, Brill H, Albertin C, et al. Effectiveness of centralized text message reminders on human papillomavirus immunization coverage for publicly insured adolescents. Journal of Adolescent Health. 2015;56(5 Suppl):S17-S20.

Stockwell 2015* - Stockwell MS, Hofstetter AM, DuRivage N, et al. Text message reminders for second dose of influenza vaccine: A randomized controlled trial. Pediatrics. 2015;135(1):e83-e91.

Fischer 2016* - Fischer HH, Fischer IP, Pereira RI, et al. Text message support for weight loss in patients with prediabetes: A randomized clinical trial. Diabetes Care. 2016;39(8):1364-1370.

Muller 2017 - Muller CJ, Robinson RF, Smith JJ, et al. Text message reminders increased colorectal cancer screening in a randomized trial with Alaska Native and American Indian people. Cancer. 2017;123(8):1382-1389.

Martin 2015a - Martin SS, Feldman DI, Blumenthal RS, et al. mActive: A randomized clinical trial of an automated mHealth intervention for physical activity promotion. Journal of the American Heart Association. 2015;4(11):e002239.

Jordan 2015* - Jordan ET, Bushar JA, Kendrick JS, Johnson P, Wang J. Encouraging influenza vaccination among Text4baby pregnant women and mothers. American Journal of Preventive Medicine. 2015;49(4):563-572.

Gonzales 2016 - Gonzales R, Hernandez M, Murphy DA, Ang A. Youth recovery outcomes at 6 and 9 months following participation in a mobile texting recovery support aftercare pilot study. The American Journal on Addictions. 2016;25(1):62-68.

Lounsbury 2015* - Lounsbury P, Elokda AS, Gylten D, et al. Text-messaging program improves outcomes in outpatient cardiovascular rehabilitation. IJC Heart & Vasculature. 2015;7:170-175.

Citations - Implementation Examples

* Journal subscription may be required for access.

AHRQ HCIE-Halloway - Halloway V. Texting service enhances minority youth access to HIV/AIDS information and testing. Rockville: AHRQ Health Care Innovations Exchange.

HIMSS Mobile Health Roadmap - Health Information and Management Systems Society (HIMSS). Mobile Health Roadmap.

Mathematica-Text4baby 2015 - Promoting maternal and child health through health text messaging: An evaluation of the Text4baby Program— summary of key findings. Princeton: Mathematica Policy Research for the Health Resources and Services Administration, US Department of Health and Human Services (US DHHS); 2015.

Text4baby - Text4baby. Free text messages to keep you and your baby healthy. Wellpass healthcare messaging platform.

Date Last Updated

Jun 25, 2018