Text message interventions work best when they're tailored

By Aditi Pai
03:49 am
Columbia University's Frederick Muench Columbia University's Frederick Muench

Text messages have been proven several times to be a positive medium for improving health outcomes. Text message intervention studies for smoking cessation, medication adherence and weight loss have all come back with positive results. Although companies have begun developing more and more apps, tailored text messages that speak to a specific audience still have a different and relevant impact, according to Boston University Research Scientist Keith McInnes, Columbia University Assistant Professor Frederick Muench and Partners Healthcare Research Coordinator Meaghan Doherty, in a panel moderated by MobiHealthNews Associate Editor Jonah Comstock.

Muench and his team at Columbia recently completed a study of 277 participants that looked at how to design text messages for specific audiences. He found that tailoring the tone and structure of a message would increase receptivity, memory for message content and relevance of the message.

After each participant contributed personal goals, Muench separated participants into 22 different groups and then began the trial.

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Overall, participants preferred smiley emoticons to sad-faced emoticons. They liked proper english rather than an abbreviated form that Muench called "textese" and the groups liked benefit-oriented text messages more than consequence-oriented ones.

Although the group was slightly more female than male, 71.9 percent preferred receiving a quote from a man to one from a woman. Muench made a distinction between people being polite, which 86.5 percent preferred, to being direct instead of passive, which 82.3 percent preferred.

When categorized by different demographics, female participants were more likely than male participants to prefer correct grammar, older individuals were more likely than younger individuals to prefer declarative statements to questions and "you" statements to "we" statements. Looking at education, Muench found participants with less than a college degree were more likely than those with a college degree or greater level of education to prefer directions to passive suggestions and short messages to long messages.

Muench's study will be published in the Journal of Medical Internet Research in a few months.

Doherty's research at Partner's Healthcare was more specific. Her group looked at activity tracking with motivational text messaging to promote physical activity among teenagers. Doherty's group studied 33 10th graders over 12 weeks and within that time sent over 60 text messages. After the study, Doherty found there was a 41 percent higher step count for adherent participants. The participants also showed a majority interest, 77 percent, in participating in the program in the future.

Finally, McInnes's intervention targeted homeless veterans, of which 40 to 60 percent had mobile phones, and looked at if sending text messages helped them keep their doctors' appointments.

The intervention of 21 veterans from Providence, Rhode Island VA Medical Center was 8 weeks long and excluded daily visits, home care visits or anything else on a very regular basis. The study did include primary care appointments, speciality care appointments, social work visits and mental health appointments. While most veterans didn't have service problems, one veteran lost service for three weeks.

After the intervention, McInnes found patient cancellations dropped from 53 to 37, no shows dropped from 31 to 25, and ER visits dropped from 15 to 5. The challenges he saw were some participants never completed follow-up interviews, he didn't know if text messages were opened and read, and he had to manually edit the text messages. McInnes concluded that for next time, he would need a larger study to confirm there are changes in behavior and utilization, determine how large the changes are, and evaluate whether they would diminish over time.

While all of the studies focused on tailoring messages, the researchers agreed that a good next step for texting studies is a three-way texting system, which is helpful to adding an even more human element to the intervention.

"In other studies that we’ve done we’ve created three-way messages, send out, come back in and receive a tailored message based on your response," Doherty said. "And we found that patients sometimes think that it’s their doctor texting back. So we’ve used it as a communication tool, to really think that they’re being cared about."


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