Text message-based health interventions
Text message-based health interventions provide patients with reminders, education, or self-management assistance for a broad spectrum of health conditions. Interventions are most frequently used as a part of broader health promotion efforts or to help individuals manage chronic diseases1. Text messages may be standardized or tailored to specific patients and sent at varied frequencies based on the intervention2. Text messaging 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 needed1. Text message software and smartphone apps can be integrated into electronic health records (EHRs) to send alerts and reminders to patients3.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Improved health outcomes
Improved weight outcomes
Increased healthy behaviors
Improved chronic disease management
Increased tobacco cessation
Reduced tobacco use
Reduced drug and alcohol use
Increased vaccination
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased medication adherence
What does the research say about effectiveness?
There is strong evidence that text message-based health interventions improve health4, 5, 6, 7, 8, 9, 10 and weight outcomes5, 6, 7, 11, 12, 13, and increase healthy behaviors2, 5, 6, 14, 15, 16, 17 for a variety of populations and in diverse settings. However, additional evidence is needed to confirm long-term effects.
Text message-based health interventions improve health outcomes for adolescents with chronic conditions18 and appear to be as effective as, and in some cases better than, usual care in the self-management of chronic illnesses such as hypertension8, and can improve asthma self-management7. Such interventions improve health outcomes in diabetics4, 8, including improved blood glucose levels5, 7. For prediabetics, interventions can increase weight loss and improve blood glucose levels, especially for Spanish language speakers19. Text message-based health interventions improve weight loss5, 7, 11, 12, 13 and reduce body mass index (BMI) for overweight or obese participants12.
Text messaging, alone or with an internet-based component, has been shown to change health behaviors in the short-term7, 20, 21 and in some cases has longer-term effects5, 15, 16, 17. Such interventions increase tobacco cessation5, 22 and reduce tobacco15, 23, 24, alcohol1, 15, 24, 25, 26, and drug use15, 26, including methamphetamines and opioids1. Text messaging interventions aimed at teenagers appear to reduce risky sexual behavior15, 17, increase testing and treatment for sexually transmitted infections (STIs), and increase knowledge of sexual and reproductive health for teens of various races and genders17.
Text messaging interventions increase vaccinations5, 14, 17, 27, including human papillomavirus (HPV) vaccines for adolescents28, 29, and flu vaccines for Latino families30 and mothers with low incomes31. An Anchorage-based study suggests that text messaging interventions increase colorectal cancer screening among Alaska Native and American Indian populations32 and international studies suggest they increase breast and cervical cancer screenings33. Interventions may also increase completion of outpatient cardiovascular rehabilitation34. Text message reminders increase appointment attendance14 and appear to be as effective as telephone reminders35.
Text messaging interventions can increase medication adherence1, 2, 14, 17, 36, including adherence by adults37 and adolescents18 with chronic conditions such as asthma6, 15, diabetes6, and HIV6, 9. 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 population38.
Programs which use individualized coaching through smartphone texts can increase daily step counts and physical activity39. Customized text support can also improve oral health and increase sun safety knowledge among adolescents27.
In some cases, two-way text communication can be more effective than one-sided reminders40. Tailoring messages and using participants’ preferred language may contribute to participant satisfaction with text message-based health interventions41. The intervention characteristics that are most beneficial will vary based on the specifics of the health condition addressed and population served6, 14, 15, 16.
Implementation Examples
Text message-based health interventions are available at the national, state, and local level42. One example is Text4baby, 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.43, 44. The U.S. Department of Veterans Affairs (VA) offers VEText, a text message service to remind veterans of upcoming appointments; reminders are sent seven days and then two days prior to an appointment45.
The University of Utah Health offers text message reminders for outpatient appointments42, as does CHI Franciscan health care system in the Seattle and Tacoma areas of Washington46. 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 methods47.
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.
Footnotes
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1 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.
2 Orr 2015 - Orr JA, King RJ. Mobile phone SMS messages can enhance healthy behaviour: A meta-analysis of randomised controlled trials. Health Psychology Review. 2015;9(4):397-416.
3 Perri-Moore 2016 - Perri-Moore S, Kapsandoy S, Doyon K, et al. Automated alerts and reminders targeting patients: A review of the literature. Patient Education and Counseling. 2016;99(6):953-959.
4 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.
5 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.
6 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.
7 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.
8 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.
9 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.
10 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.
11 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.
12 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.
13 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.
14 Schwebel 2018 - Schwebel FJ, Larimer ME. Using text message reminders in health care services: A narrative literature review. Internet Interventions. 2018;13:82-104.
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.
16 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.
17 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.
18 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.
19 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.
20 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.
21 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.
22 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.
23 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.
24 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.
25 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.
26 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.
27 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.
28 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.
29 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.
30 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.
31 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.
32 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.
33 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.
34 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.
35 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.
36 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.
37 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.
38 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.
39 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.
40 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.
41 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.
42 U of U Health - University of Utah Health (U of U Health). Patient and family services: Text message reminders for your appointment.
43 Text4baby - Text4baby. Free text messages to keep you and your baby healthy. Wellpass healthcare messaging platform.
44 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, U.S. Department of Health and Human Services (U.S. DHHS); 2015.
45 US VA-VEText - U.S. Department of Veterans Affairs (U.S. VA). VEText: An interactive mobile solution to remind veterans of upcoming appointments.
46 CHI Franciscan - CHI Franciscan. Appointment reminders. Seattle and Tacoma, Washington.
47 HIMSS Mobile Health Roadmap - Health Information and Management Systems Society (HIMSS). Mobile Health Roadmap.
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