research on text messaging

It's Complicated: Our Relationship With Texting

• Parenting, Families, Relationships
• Social Media and Internet

From sexting to breaking up, texting can bring us close or drive us apart, studies find

SAN FRANCISCO — Texting has the power to both help and hinder our relationships, whether we’re tapping our fingers to stay in touch or using our smartphones to avoid difficult situations, according to research on texting and sexting presented at the annual convention of the American Psychological Association.

For instance, couples with similar texting habits tend to be happier and more fulfilled, according to one study.

Researchers surveyed 205 adults between the ages of 18 and 29 who were in romantic relationships. Questions focused on emotional security, texting habits and relationship satisfaction.

Results showed that people who described their partner as having a similar texting style to themselves reported greater relationship satisfaction. In other words, couples who were more in sync with the kind of texts they sent to each other were more satisfied with their partner, regardless of whether the messages they sent were love notes or complaints about an issue in the relationship.

“How couples texted was more important to the satisfaction of the relationship than how frequently they texted,” said Leora Trub, PhD, of Pace University, who presented the findings.

Previous research has shown that couples who communicate similarly in any medium are happier in their relationships. This research extended those findings to text-based communication, according to Trub.

A second study, also presented by Trub, found that texting can bring people closer to others or create distance, depending on the motivations underlying its use.

“We text to check in with our spouse during the work day and to stay connected with friends far away, but we also text to avoid dealing with relatives at the family party and to break up with someone,” said Trub.

Trub and her colleagues developed a survey to measure people’s motivation for texting. They administered the survey to 982 adults between the ages of 18 to 29. Questions focused on possible addictive behaviors with mobile phones, levels of social anxiety and shyness and general personality traits.

Aside from finding texting functional, people also text to escape their present situation, because they’re bored, or because they feel it is a better way to express themselves than talking on the phone or in person, the researchers found.

They noted the potential implications of texting as a form of escape.

“Texting can become a crutch and eventually become a barrier to creating meaningful interactions,” said Trub. “Texting all the time can also come from being lonely or bored, and that can lead to isolation and alienation.”

Trub and her colleagues noted that psychologists and counselors may be interested in their findings if they have clients who engage in unhealthy texting behaviors that may be damaging to their relationships.

On the steamier side of the spectrum, another study found that people who sexted several times a week (“frequent sexters”) and those who sexted every day or multiple times per day (“hyper sexters”) were more likely to experience conflict and ambivalence in their relationships, as well as engage in infidelity-related behaviors on social media and view more pornography.

The study included 615 adults from the U.S. and Canada who were then in committed relationships. The survey asked questions about sexting behaviors, self-esteem, relationship satisfaction, commitment, conflict and pornography use, among other topics.

People who did not sext made up the largest group in the study and were just as happy with their partners as people who did sext, the study found. Sexters did, however, report more sexual satisfaction than the nonsexting group.

The researchers also found that a greater percentage of people in same-sex relationships were frequent or hyper sexters.

“Sexting may help couples with intimacy and to spice things up, but we definitely did see the negative side of too much of a good thing,” said Michelle Drouin, PhD, of Purdue University Fort Wayne, who presented the findings during the symposium “An Update on Sexting and Future Research.”

Session 1205

• “ Sexting: Are Adults Really Doing It? And What Are the Dark Sides? ” 

Symposium, Thursday, Aug. 9, 12 p.m. PDT, Room 3008, Level Three-West Building, Moscone Center, 747 Howard St., San Francisco.

Session: 3138

• “Getting Close From Far Away and Feeling Far While Being Close: Texting to Manage Closeness and Distance” 

Poster session, Saturday, Aug. 11, 10 a.m. PDT, Halls ABC Exhibition Level-South Building, Moscone Center.

• Leora Trub, PhD
• Michelle Drouin, PhD

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes nearly 115,700 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.

Kaitlin Luna

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Evaluating the Utility of Using Text Messages to Communicate With Patients During the COVID-19 Pandemic

Campbell, Kevin J. MD; Blackburn, Brenna E. PhD; Erickson, Jill A. PA-C; Pelt, Christopher E. MD; Anderson, Lucas A. MD; Peters, Christopher L. MD; Gililland, Jeremy M. MD

From the Orthopedic & Sports Institute of the Fox Valley, Appleton, Wisconsin (Dr. Campbell), and the Department of Orthopedics, University of Utah, Salt Lake City, Utah (Dr. Campbell, Dr. Blackburn, Ms. Erickson, Dr. Pelt, Dr. Anderson, Dr. Peters, and Dr. Gililland).

Correspondence to Dr. Campbell: [email protected]

Dr. Campbell or an immediate family member has stock or stock options held in STREAMD. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Blackburn, Erickson, Dr. Pelt, Dr. Anderson, Dr. Peters, and Dr. Gililland.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction: 

We evaluated the use of text messages to communicate information to patients whose surgeries were postponed because of the COVID-19 restriction on elective surgeries. Our hypothesis was that text messaging would be an effective way to convey updates.

Methods: 

In this observational study, 295 patients received text messaging alerts. Eligibility included patients who had their surgery postponed and had a cell phone that received text messages. Engagement rates were determined using embedded smart links. Patient survey responses were collected.

Results: 

A total of 3,032 texts were delivered. Engagement rates averaged 90%. Survey responses (n = 111) demonstrated that 98.2% of patients liked the text messages and 95.5% said that they felt more connected to their care team; 91.9% of patients agreed that the text updates helped them avoid calling the office. Patients with higher pain levels reported more frustration with their surgery delay (5.3 versus 2.8 on 1 to 10 scale, P value < 0.01). More frustrated patients wished they received more text messages (24.4% versus 4.6%, P value = 0.04) and found the content less helpful (8.2 versus 9.2 on 1 to 10 scale, P value = 0.01).

Conclusion: 

Text messaging updates are an efficient way to communicate with patients during the COVID-19 pandemic.

On March 16, 2020, the State Department of Health issued a 6-week ban on nonurgent surgeries in an attempt to preserve essential healthcare resources and prepare for COVID-19 surge conditions. This ban, along with the persistent presence of the virus within our community, brought many changes to our academic joint arthroplasty practice, including the widespread cancellation of elective surgery and the rapid adoption of telehealth services. A particular challenge for our group was keeping a growing cohort of patients, whose elective joint arthroplasty surgeries were either delayed or canceled because of this ban, informed and updated because our office navigated the dynamic conditions of the pandemic.

In our group, which consists of four high-volume hip and knee arthroplasty specialists, the surgical dates for 295 patients were either directly or indirectly affected by the 6-week nonurgent surgery ban at its outset. It became apparent to us that we needed a way to keep them engaged with our office for a number of reasons. First, understanding that our patients were facing many unknowns regarding their surgery, we wanted to keep them informed about scheduling updates (or lack thereof) and help manage their expectations in a thoughtful and timely manner. Second, it was important to ensure that our patients did not experience an additional decline in their health status or mobility because they awaited surgery. We wanted to reiterate the importance of healthy habits, such as smoking cessation, weight management, and management of comorbid medical conditions. Third, we wanted to distribute reputable information to them about COVID-19 because it relates to their orthopaedic condition (eg, American Academy of Hip and Knee Surgeons [AAHKS] patient education materials). Fourth, we wanted to maintain the patient-physician relationship so that they would continue to rely on us for their orthopaedic care when elective surgeries resumed. Finally, we wanted to convey a sense of empathy although we were not able to accommodate in-person clinical visits or connect with all of these patients individually on a regular basis. Ideally, we wanted to attain these goals without overburdening clinical staff and resources.

Just before the COVID-19 shutdown, we had started using a text messaging patient engagement program to help our patients prepare for and recover from surgery. Based on our conversations with patients, we found that traditional text messaging (short message service, SMS) is a convenient and simple way for them to receive information. Although the standard use case for the text program is the automation of perioperative communication through the automatic delivery of informative text messages, we adopted a novel use for it by sending text updates to our patients whose surgeries were either postponed or canceled because of COVID-19. The content and timing of the messages included a breadth of topics, such as relevant updates from our office, information for nonsurgical arthritis care, patient education materials from our department as well as the AAHKS (AAHKS Patient Education Portal), and personalized video messages from our attending surgeons, physician assistants, and physical therapists.

The purpose of this study was to evaluate the use of text messages to communicate updates and information to our patients whose surgeries had been postponed during the COVID-19 pandemic. Our hypothesis was that text messages during the COVID-19 pandemic would be regarded by our patients as an easy way to receive information and would not overly burden our staff or strain clinical resources.

In this IRB exempt study, we prospectively sent text message updates to our patients whose elective surgeries were postponed because of the COVID-19 pandemic. A total of 338 patients were initially affected by the restriction. Of those, 295 (87% enrollment rate) signed up and consented to receive the text updates. The number of patients receiving the text alerts grew to approximately 350 throughout the study period because more cases were postponed. Text message updates commenced on April 3 and continued to May 27, at which time our institution transitioned to the yellow “low-risk” phase, and elective surgeries resumed. The text messaging service was provided by STREAMD.

During the 8-week study period, patients received 3,032 text updates, approximately 10 messages per patient. The content of the messages included relevant updates from our office, information for nonsurgical arthritis care, patient education material from our department as well as the AAHKS (AAHKS Patient Education Portal), and personalized video messages from our attending surgeons, physician assistants, and physical therapists. To measure engagement, text messages that included a web address were embedded with a “smart” URL link (Bitly) capable of tracking the number of times the patients clicked on the URL. Responses from patients into the system were not encouraged. An automatic reply directing patients to call the office with questions was programmed to respond to inbound messages from patients. After the final text was delivered, we collected survey responses (Appendix 1, https://links.lww.com/JG9/A143 ) to gauge patients' satisfaction with the text alerts. Overall responses were calculated and stratified by age, sex, pain level, and frustration level. Descriptive statistics, including chi-square and t -tests, were used for these comparisons.

A total of 3,032 texts were delivered (∼10 per patient). Nine patients unenrolled themselves in the text messaging service (one had manipulation under anesthesia during the study period, three had surgery at another facility that was offering elective surgery despite the directive during the study period, and five canceled and did not want to reschedule their surgery). Engagement rates averaged 90%. This calculation is based on the average percent viewership of the embedded “smart” URL links in the text messages. Overall, 111 patients completed the survey, totalling a response rate of 32% (111/350). The average age of respondents was 64.3 years (range = 19 to 86), with most being female (70.3%) ( Table 1 ). Survey responses demonstrated that 98.2% of patients liked the text messages and 95.5% said that they felt more connected to their care team ( Table 2 ); 91.9% of patients agreed that the text updates helped them avoid calling the office; and 85.6% of patients preferred text updates compared with e-mail, phone calls, or patient portal messages.

A total of 84.7% of patients rated the frequency of the updates as just right; 91.0% of patients rated ‘scheduling updates' as the most valuable content. Patients with higher pain levels reported more frustration with their surgery delay (5.3 versus 2.8 on 1 to 10 scale, P value < 0.01). More frustrated patients wished they received more text messages (24.4% versus 4.6%, P value = 0.04) and found the content less helpful (8.2 versus 9.2 on 1 to 10 scale, P value = 0.01).

Of the seven text messages that included embedded destination URLs, the links with the highest patient engagement included video messages from attending surgeons (eg, Dr. #3 and Dr. #2 video message viewed 139% and 129%, respectively). The link with the third highest engagement (109%) directed patients to the AAHKS portal, 1 which provides patients with peer-reviewed education resources written by surgeon members of the AAHKS Patient Education Committee. The lowest engagement rates were observed with links directed to the COVID-19 section of the State Department of Health website (24%) and a video message about home pain control modalities (34%). The engagement rates for the embedded links are shown in Table 3 .

In this study, we sent our patients, whose surgery had been delayed because of the COVID-19 elective surgery restriction, text messages in an attempt to keep them informed, educated, and engaged to our office when we awaited the resumption of surgery. The most notable result from this study is that the patients found that text updates are a helpful and convenient way for them to receive general information from the office because their surgeries were postponed because of COVID-19. Because of the COVID-19 effect on our health system, surgical cancelations and postponements lasted for 8 weeks, and we still have not been able to return to pre-COVID surgical case levels. We learned rather quickly that our patients who were awaiting surgery desired some sort of connection to our office to help them cope with the anxiety regarding the uncertainty of COVID-19 and how it would affect their individual care.

To maintain communication with our patients whose surgery had been delayed, we searched internally for an appropriate communication platform. We considered e-mail, MyChart messages (EPIC Health System) and phone calls but realized there were specific limitations with each that made them unusable for this particular use case. For e-mail, it did not feel personal enough, and our experience has been that our patients are not reading their e-mails regularly. Our health system discouraged us from sending mass MyChart messages for the specific purpose in this study because they suspected it could be confusing to patients who also have internal medicine physicians and other specialists using the same MyChart portal as well. We also did not want to burden our patients by having them log into MyChart to read their messages. Finally, although phone calls seemed like the most personable way to connect, we have routinely had limited success getting our patients to answer their phone, given how ubiquitous robocalling has become. Our medical assistants get into a vicious cycle where they leave voicemails and then when patients return their calls, the assistants are already on another patient call, forcing the patient to leave a voicemail and wait for a callback. Moreover, calls tend to take quite a bit of time because patients start to have conversations with our staff about other unrelated topics. Ultimately, calling 300 + patients for each update we wanted to provide was not feasible for our staff.

Texting has increased in popularity year-after-year and has been adopted by every age group. It is reported that Gen X'ers (45 to 54 years) send and receive about 33 text messages per day and baby boomers (56 to 76 years) send and receive about 16 text messages per day. 2 The benefits of texting a group of patients are the speed and the highly interactive nature of SMS. Texting is a native feature to every cell phone, and by mass texting, we were able to reach our patients quickly. In total, 90% of SMS marketing messages are opened within three minutes, and 99% are opened within 20 minutes. 3 This is in stark contrast to e-mail message open rates, which have been reported to be 20%. 4 Today, most patients are used to sending and receiving text messages, so by meeting them where they already are, we felt we were more likely to engage them. We did not feel this type of efficiency, and engagement could be found with any other communication channels.

In this study, we were not able to capture read rates for each individual text message, but we were able to gain insight into engagement because we tracked the click rates for the embedded URLs. We found click rates over 100% (meaning some patients clicked on the links more than one time) for the physician video messages and the AAHKS COVID-19 patient education portal. We were surprised by this finding, but feel strongly that physicians can have a strong calming effect for patients, especially during this time. These engagement rates suggest that text messaging is an acceptable and engaging communication platform. The average open rate for health and fitness e-mail campaigns is reported to be 21.48%, with click rates of only 2.69%. 5 Although 97% of secure portal messages (eg, MyChart) are read by patients, it is reported that most hospitals (62%) see fewer than 25% of their patients activate their patient portal. 6

Our study is not without limitations. This study was completed at a single academic center and may not be wholly representative of the patient population in other geographic areas. Moreover, this study is observational in nature, consisting of only a single cohort of patients who elected to receive text messages during the COVID-19 shutdown. We do not have a comparative cohort of patients who did not receive the messages. In addition, there is some selection bias at play because the only patients eligible were those who had access to a cell phone. In addition, we were unable to conceal patient allocation by blinding the participants. This has previously been reported to exaggerate the estimate of effect size of interventions. 7 Finally, the patient self-reported data within our study are also subject to response bias, introspective ability, and the inherent limitations of rating scales and questionnaires.

The restriction on elective surgeries presented our group with a unique challenge because we managed a growing list of patients whose surgeries were postponed or canceled. We sent text message alerts to our patients to keep them informed, educated, and engaged to our office because we navigated the pandemic. Patients reported high satisfaction and ease of use with this communication medium. We will continue to study the benefits of this technology going forward because we ramp up and return to a new sense of normalcy.

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• v.13; 2018 Sep

Using text message reminders in health care services: A narrative literature review

Frank j. schwebel.

a University of Washington, Department of Psychology, 119A Guthrie Hall Box 351525, Seattle, WA 98195-1525, United States of America

Mary E. Larimer

b University of Washington, Department of Psychiatry and Behavioral Sciences, 1100 NE 45th, Suite 300, Office 312, Box 354944, Seattle, WA 98105, United States of America

Introduction

Despite the extensive use of mHealth behavior change interventions, questions remain about the use of technology-based reminders in delivering health care services. Text messaging, or short message service (SMS), is one reminder method that has been extensively researched. Most SMS-reminder research is distributed across a range of health care outcomes. The aim of this article is to systematically review the aggregate impact of these reminders on overall health care outcomes.

A systematic literature review was conducted and yielded 2316 articles. Studies were included if they used SMS reminders to support patient health care outcomes. Study methodology was aligned with the PRISMA guidelines for systematic reviews.

Following screening, 162 articles met inclusion criteria. Of these studies, 93 investigated medical compliance reminders and 56 investigated appointment reminders. The review found that nearly all the SMS-reminder studies helped improve patient medical compliance and appointment reminders. Additionally, researchers reported numerous benefits from using SMS reminders, including ease of use, relative inexpensiveness, and rapid and automated message delivery. Minimal risks were reported and most participants found the reminders to be acceptable.

Text messages appear to be an effective reminder mechanism to promote improved patient appointment and medical compliance. Reminders should continue to be evaluated and improved to determine the most effective timing and frequency of messages for improving outcomes.

• • A systematic review of SMS reminders in health care delivery was conducted.
• • SMS reminders helped increase appointment attendance and medication adherence.
• • SMS reminders helpful in shaping behavior across spectrum of health care issues
• • SMS reminders may help promote healthy behaviors.

1. Introduction

In 2017, there were an estimated 7.7 billion mobile phones used, approximately one phone per person on the planet ( International Telecommunication Union, 2017 ). Mobile phones, and more recently smartphones, have quickly changed the way people communicate and the way treatment providers think about service delivery ( Atun and Sittampalam, 2006 ). Mobile phones are used in a variety of settings for various purposes, including in impoverished countries where mobile phones offer a relatively inexpensive method of communication ( Ben-Zeev et al., 2015 ; Free et al., 2010 ); for treating individuals with psychological problems ( Thomas et al., 2017 ); and for routine communication among individuals of all ages ( Center for Substance Abuse Treatment, 2009 ; Global Attitudes Project, 2012 ). Due to the ubiquity of text messaging (short message service, SMS) ( Gatwood et al., 2016 ), customizability (e.g., Downer et al., 2005 ), relative low cost (e.g., Rohman et al., 2015 ), rapid and automated delivery (e.g., Chung et al., 2015 ), and acceptability ( Garofalo et al., 2016 ), SMS has become a focus of researchers in the health care field and is recommended for use by leading organizations in various health care fields (e.g., American Medical Association, 2016 ; World Health Organization, 2012 ). Nevertheless, SMS is a relatively nascent technology. Using it in research requires continuous researcher education on ever-changing SMS treatment guidelines and implementation methods, and frequent training of research staff that help implement the rapidly evolving interventions.

Research on SMS in health care services has been focused on two main areas: behavior change interventions and reminders. Mobile Health (mHealth) is defined as the use of mobile computing and communication technologies in health care and public health ( Berrouiguet et al., 2016 ; Free et al., 2010 ). Behavior change interventions and reminders both fall under the umbrella of mHealth. Although mHealth reminder research has primarily focused on outcomes such as appointment attendance and medication adherence ( Berrouiguet et al., 2016 ; Kannisto et al., 2014 ), SMS reminders can also play an important role in behavior change. As proposed in the transtheoretical model of change, reminders can serve as coaching or prompts to help facilitate behavior change ( Prochaska et al., 1994 ). They are likened to stop signs at a busy intersection—reminding us how to respond next. Reminders can be used to enhance prospective memory, which is remembering to complete an activity in the future ( Guynn et al., 1998 ; McDaniel et al., 2004 ).

Before the cell phone era, Prochaska et al. (1994) highlighted the utility of alarm clocks, calendars, and timers as tools for delivering personal reminders. These tools are now easily and frequently accessed from one source: the mobile phone ( Madden et al., 2013 ; Nelson and Nelson, 2010 ). Mobile phones can receive automated SMS reminders or notifications that remind the user to do (or not to do) a specific behavior. For example, if an individual is attempting to decrease their substance use, they can receive an automated SMS that reminds them of their goal at certain high-risk times; and if an individual is attempting to lose weight, they can receive a reminder not to snack between meals. Recently, some research has begun to investigate the impact of adjunct reminders (i.e., mHealth reminders as an adjunct to a behavior change intervention) (e.g., Aguilera et al., 2017 ). Due to the paucity of research on adjunct reminders at this time, they will not be included as part of the systematic review. However, this topic is covered in the Discussion section. The current review will address the following questions about the use of mHealth reminders in health care: What specific uses mHealth reminders been applied to in health care? How has the impact of mHealth reminders been assessed? What have we learned about designing reminders for health care? The review methodology has been aligned with the PRISMA guidelines for systematic reviews ( Moher et al., 2009 ).

2.1. Objective

The objective of this study is to provide a systematic narrative review of the application of SMS reminders in health care services. All studies were categorized using a two-step process. First, all the titles and abstracts were reviewed for relevance to the topic and to see if they met inclusion criteria. Second, the studies were read and categorized by methodology, treatment goal, and target health condition.

2.2. Search strategy

An extensive literature search was conducted in April 2018 using the PsychINFO, CINAHL, PubMed, and Web of Science electronic databases. The search terms used were selected to broadly examine the impact of text message reminders on health care outcomes (see Fig. 1 ). Titles, abstracts, and reference lists of the selected studies were also reviewed to check for other potentially relevant studies.

PRISMA flowchart of primary study selection.

2.3. Selection criteria

The review was limited to peer-reviewed articles published in English between 2003 and 2018, with an abstract available online. The starting date of the search was selected for three reasons: (1) the majority of mHealth research has occurred after 2003, (2) the rate of text messaging and cell phone ownership has greatly increased since 2003 ( International Telecommunication Union, 2017 ; Kannisto et al., 2014 ), and (3) 2003 is a typical beginning date for mHealth literature reviews ( Berrouiguet et al., 2016 ; Kannisto et al., 2014 ). The review was limited to studies of SMS reminders used to support patient health care. While the majority of studies sent SMS directly to the patients, some health care needs necessitate the reminders be sent to guardians or caretakers rather than the patient. There was no limitation on patient population, age, or diagnosis. Excluded from this review were: articles that assessed patients' feelings toward SMS for non-clinical purposes (e.g., to create a list of SMS messages or assess expected acceptability of receiving messages), theoretical papers, statistical reviews, dissertations, editorials, letters, and study protocols. Both randomized control trials (RCTs) and non-RCTs (e.g., feasibility studies, before-and-after studies, cross-sectional studies, cohort studies) were included.

3.1. Study selection

The steps illustrating the literature search and article review process are shown in Fig. 1 . The initial search produced 2316 articles. An additional 62 articles were found by looking at the reference list of each article. After checking for duplicates as well as screening titles and abstracts for relevance to the topic, 196 potential full-text articles were obtained, with 162 articles ultimately meeting inclusion criteria after full-text review.

3.2. Characteristics of studies reviewed

Author, year, country, research setting, type of study, patient group, sample size, and message dose (i.e., timing of messages, frequency of messages, total number of messages) were extracted to describe the characteristics of the study. These results have been summarized in Table 1 . The number of articles published on this topic has gradually increased over time, peaking in 2015 (35/162; 22%). Approximately one-third of the studies reviewed were conducted in the United States (60/162; 37%).

Basic study information with review of messaging details and outcomes.

RCT – randomized control trial.

Nearly two-thirds (111/162; 68%) of the studies reviewed were randomized control trials (RCTs), with a marked increase in RCTs after 2013. Non-RCTs were recorded as quasi-experimental. Additional descriptive characteristics of the studies are presented in more detail in Table 1 .

3.3. Purposes of text message reminders in health care treatment

The reported purpose of the study, description of the intervention, and dose of the intervention were extracted to describe the most commonly studied application of mHealth reminders in health care. SMS reminders were primarily used to remind patients to comply with a medical practice (e.g., taking medication on time, following non-medical treatment guidelines, and completing vaccinations) (93/162; 57%) or attend a clinical appointment (56/162; 35%). Reminders for appointment attendance were generally used as a method to increase clinical appointment attendance and the rate of advance cancellations (as opposed to not showing up). Various studies assessed the impact of SMS reminders on decreasing the rate of missed appointments across a variety of settings, including first-time psychotherapy appointments ( Clough and Casey, 2014 ), recurring medical appointments ( Branson et al., 2013 ; Tolonen et al., 2014 ), and completing vaccinations ( Stockwell et al., 2014 ).

In a majority of studies (140/162; 86%), SMS reminders were the only intervention used. The remaining studies used a secondary or complimentary component in conjunction with the SMS reminder. These include educational or informational messages about the treatment target (e.g., Stockwell et al., 2014 ), links to additional educational information (e.g., Kodama et al., 2016 ), phone call reminders and/or mailed reminders (e.g., Baker et al., 2015 ), and motivational or supportive messages (e.g., Celik et al., 2015 ).

3.4. Message dosage and timing

Across the studies, it was most common that the dose (number) and timing of messages were individually customized based on the patients' medication or treatment schedule, or scheduled appointments. Other studies used researcher-selected dosing ( Belton et al., 2013 ; Odeny et al., 2014 ). Many studies sent daily or weekly messages, however, not all studies reported details about message timing. Some studies set message dosage based solely on patient preference (e.g., Spohr et al., 2015 ), and others reported the total amount of reminders sent rather than when they were sent (e.g., Celik et al., 2015 ).

Specific timing of reminders varied across studies. Detailed timing (e.g., a specific time or time frame) was reported in 75 of 162 (46%) of the studies reviewed. Medication reminders typically were sent near the scheduled medication time (e.g., Mao et al., 2008 ). Specific appointment reminder time was reported in 86% (49/57) of studies. These reminders occurred between two weeks ( Kunigiri et al., 2014 ) and the morning of ( Prasad and Anand, 2012 ) a scheduled appointment. Additionally, studies reminding individuals to complete a medical follow-up exam sent a reminder message up to six months after initial contact ( Van Ryswyk et al., 2015 ).

3.5. Appointment reminders

Of the studies reviewed, 56 of 162 (35%) used SMS appointment reminders. Some of these studies targeted increased appointment attendance ( Thomas et al., 2017 ), while others targeted decreased missed appointments ( Altuwaijri et al., 2012 ) or increased cancellations ahead of time (rather than not showing up) ( Farmer et al., 2014 ). The study of appointment reminders has occurred in a variety of settings, including primary care ( Steiner et al., 2016 ), dental care ( Perry, 2011 ), and psychotherapy clinics ( Delgadillo et al., 2015 ). Appointment attendance reminders were found to either increase the rate of appointment attendance, increase the rate of appointments cancelled ahead of time, or decrease the rate of missed appointments in 48 of the 56 studies (86%) ( Altuwaijri et al., 2012 ; Arora et al., 2015 ; Berenson et al., 2016 ; Bourne et al., 2011 ; Brannan et al., 2011 ; Branson et al., 2013 ; Chen et al., 2008 ; da Costa et al., 2010 ; Deng et al., 2015 ; Downer et al., 2005 ; Fairhurst and Sheikh, 2008 ; Farmer et al., 2014 ; Foley and O'Neill, 2009 ; Geraghty et al., 2008 ; Hofstetter et al., 2015a , Hofstetter et al., 2015b ; Kerrison et al., 2015 ; Koshy et al., 2008 ; Leong et al., 2006 ; Liew et al., 2009 ; Lin et al., 2012 ; Liu et al., 2017 ; Lund et al., 2012 ; Lund et al., 2014 ; McInnes et al., 2014 ; Milne, 2010 ; Muller et al., 2017 ; Murray et al., 2015 ; Narring et al., 2013 ; Nundy et al., 2013a , Nundy et al., 2013b ; Nyatsanza et al., 2016 ; Odeny et al., 2012 ; Perry, 2011 ; Pijnenborg et al., 2007 ; Prasad and Anand, 2012 ; Pratap et al., 2015 ; Rohman et al., 2015 ; Sims et al., 2012 ; Sly et al., 2014 ; Steiner et al., 2016 ; Taylor et al., 2012 ; Thomas et al., 2017 ; Ting et al., 2012 ; Tolonen et al., 2014 ; Trent et al., 2015 ; Van Ryswyk et al., 2015 ; Vidal et al., 2014 ; Wolff et al., 2016 ; Yang et al., 2016 ).

Six of the eight studies that did not find improved outcomes for individuals receiving SMS reminders reported neutral results. Of the six studies, one reported being underpowered to assess appointment attendance differences ( Fischer et al., 2012 ); two found no significant difference between a phone call, mailed, and SMS reminder ( Bos et al., 2005 ; Kunigiri et al., 2014 ); one found no significant difference between a mailed reminder and a mailed reminder in addition to a SMS reminder ( Delgadillo et al., 2015 ); one found no significant difference between a SMS reminder and no SMS reminder ( Bellucci et al., 2017 ); and one found no significant difference between a telephone call and a SMS reminder ( Junod Perron et al., 2013 ). The seventh study ( Clough and Casey, 2014 ), found SMS appointment reminders were not significantly more effective than the control group at increasing intake appointment attendance at an outpatient training clinic. The results trended toward more participants receiving reminders dropping out before their intake appointment. Despite this, the authors still suggest that with further research SMS may prove to be a viable appointment reminder system. The eighth study ( Nelson et al., 2011 ) found that phone reminders were more effective than SMS reminders at increasing pediatric dental appointment attendance. Despite this, the authors suggested continuing to investigate the effectiveness of messages based on patient preference (i.e., sending text messages to individuals that prefer them as a reminder method). Kunigiri et al. (2014) found SMS reminders were not statistically significantly more effective than calls or mailed reminders. Yet, they suggest continuing to use SMS messages as an appointment reminder mechanism due to its ease and relative inexpensiveness.

3.6. Medication, treatment, and vaccination adherence

Of the studies reviewed, the most common application of SMS reminders is for medical compliance reminders. The term medical compliance reminders is used in this review to encompass reminders to follow a medication regimen (e.g., taking anti-retroviral therapy medication on time), to follow a non-medication treatment guideline (e.g., returning for sexually transmitted infection re-testing), and to complete vaccinations (e.g., fully immunizing infants). Ninety-seven of the 162 studies reviewed (59%) assessed the impact of SMS reminders on medical compliance reminders. Medication regimen adherence was the intervention outcome for 52 of these studies, non-medication treatment adherence was the intervention outcome for 24, and vaccination adherence was the intervention outcome for 21. Medical compliance reminders were found to improve (e.g., taking medication at a scheduled time, completing non-medication follow-up treatment, completing a vaccination regimen) when using an SMS-reminder intervention in 85% (83/97) of studies ( Akhu-Zaheya and Shiyab, 2017 ; Anthony et al., 2015 ; Armstrong et al., 2009 ; Arora et al., 2012 ; Baker et al., 2015 ; Balato et al., 2013 ; Bangure et al., 2015 ; Berenson et al., 2016 ; Chow et al., 2015 ; Chung et al., 2015 ; Cocosila et al., 2009 ; da Costa et al., 2012 ; Davey et al., 2016 ; Dick et al., 2011 ; Downing et al., 2013 ; Dowshen et al., 2013 ; Fang and Deng, 2017 ; Ferguson et al., 2015 ; Foreman et al., 2012 ; Franklin et al., 2006 ; Garofalo et al., 2016 ; Gengiah et al., 2014 ; Georgette et al., 2017 ; Granholm et al., 2012 ; Gu et al., 2016 ; Guy et al., 2013 ; Haji et al., 2016 ; Hanauer et al., 2009 ; Hardy et al., 2011 ; Hirst et al., 2017 ; Hofstetter et al., 2015a ; Hofstetter et al., 2015b ; Huang et al., 2017 ; Huang et al., 2013 ; Johnson et al., 2016 ; Jordan et al., 2015 ; Kamal et al., 2015 ; Keränen and Liikkanen, 2013 ; Khorshid et al., 2014 ; Kollmann et al., 2007 ; Lewis et al., 2013 ; Ludlow et al., 2009 ; Lv et al., 2012 ; Maduka and Tobin-West, 2013 ; Mao et al., 2008 ; Matheson et al., 2014 ; Miloh et al., 2009 ; Miloh et al., 2017 ; Modrek et al., 2014 ; Montes et al., 2012 ; Moore et al., 2015 ; Morris et al., 2015 ; Nundy et al., 2013b ; Nundy et al., 2013a ; O'Leary et al., 2015 ; Orrell et al., 2015 ; Park et al., 2014 ; Park et al., 2015 ; Pena-Robichaux et al., 2010 ; Pijnenborg et al., 2007 ; Pop-Eleches et al., 2011 ; Raiff et al., 2016 ; Raifman et al., 2014 ; Rand et al., 2015 ; Rand et al., 2017 ; Regan et al., 2017 ; Smith et al., 2015 ; Stockwell et al., 2014 , Stockwell et al., 2015 ; Stockwell et al., 2012a ; Stockwell et al., 2012b ; Strandbygaard et al., 2010 ; Suffoletto et al., 2015 ; Sumari-de Boer et al., 2016 ; Thakkar et al., 2016 ; Thomsen et al., 2017 ; Vervloet et al., 2012 , Vervloet et al., 2014 ; Vilella et al., 2004 ; Wald et al., 2014 ; Wang et al., 2014 ; Yudin et al., 2017 ).

Of the 14 studies that did not find a positive improvement, all but one reported the intervention had a neutral effect on participants. Three of the studies found that despite the medical compliance reminders not being more effective than the control group, the reminders still had benefits, including increasing medical knowledge ( Richman et al., 2016 ), increasing self-efficacy in disease self-management ( Gatwood et al., 2016 ), and increasing the rate of consecutive days taking medication ( Stoner et al., 2015 ). Two of the studies reported being unpowered to find a statistically significant difference ( Boker et al., 2012 ; Buis et al., 2017 ). Niederhauser et al. (2015) reported that their experimental group had more barriers to immunization than control and hypothesized that with a larger trial they might expect to find statistically significant results. One study reported most of their control group used their own reminder, potentially confounding the non-significant outcomes ( Hou et al., 2010 ), and a second study hypothesized that many participants in the control group used their own reminder (although this was not formally assessed) ( Mbuagbaw et al., 2012 ). Another study found that a phone call reminder was more effective than a SMS reminder at increasing treatment follow-up appointment completion ( Porto-Ferreira et al., 2017 ). Two studies found both the treatment and control group had a significantly higher medication adherence and appointment attendance rate than typical ( Burton et al., 2014 ; Goldstein et al., 2014 ); and another hypothesized that due to the length of their study, the novelty and benefit of a medication reminder may have worn off ( Ting et al., 2012 ). Two studies did not find that SMS reminder helped increase rate of Hepatitis B and anti-retroviral therapy (ART) medication adherence and, in fact, displayed lower rates of adherence than no reminder or treatment as usual (respectively) ( Linnemayr et al., 2017 ; McIver et al., 2016 ). Lastly, all studies that included a measure of feasibility and/or acceptability found positive results (e.g., Garofalo et al., 2016 ; Gengiah et al., 2014 ; Park et al., 2014 ), even if the intervention was not found to be statistically significant (e.g., Buis et al., 2017 ; Richman et al., 2016 ).

3.7. Miscellaneous messages

The remaining studies (15/162; 9%) that did not meet inclusion criteria as either an appointment or medical compliance reminder are grouped below by intervention outcome and briefly described.

3.7.1. Exercise

All six studies assessing the impact of SMS reminders on exercise and weight loss found improvements in exercise frequency, exercise consistency, or weight lost for individuals receiving reminders ( Belton et al., 2013 ; Chen et al., 2017 ; Chen et al., 2016 ; Kim et al., 2015 ; Muller et al., 2016 ; Shaw et al., 2013 ). These studies targeted a range of demographics, including age, from middle school students (mean age: 12) ( Belton et al., 2013 ) to older adults (between 55 and 70 years old) ( Muller et al., 2016 ); and location, Ireland ( Belton et al., 2013 ), Malaysia ( Muller et al., 2016 ), Taiwan ( Chen et al., 2017 ; Chen et al., 2016 ), Korea ( Kim et al., 2015 ), and the United States ( Shaw et al., 2013 ). Four of the studies were randomized control trials (RCTs) ( Belton et al., 2013 ; Chen et al., 2017 ; Kim, 2017 ; Muller et al., 2016 ) and the rest were quasi-experimental studies ( Chen et al., 2016 ; Shaw et al., 2013 ).

3.7.2. Tooth brushing

Two studies assessed the impact of SMS reminders on the amount of plaque and level of oral hygiene. Bowen et al. (2015) found that SMS reminders helped adolescents and young adults (ages 11 to 18) decrease the amount of plaque on their teeth. Eppright et al. (2014) found that reminders helped adolescents and young adults (ages 11 to 19) improve their level of oral hygiene. Both studies were RCTs and were conducted at outpatient University clinics in the United States.

3.7.3. Diabetes

One study assessed the impact of reminders on perceived diabetes knowledge and injection skill among adults (ages 18 to 75) with diabetes mellitus in Turkey. The studies found reminders were effective at increasing patient-perceived diabetes knowledge and injection skill ( Celik et al., 2015 ).

3.7.4. Schizophrenia

Pijnenborg et al. (2010) found SMS reminders helped inpatients and outpatients at a University clinic in the Netherlands with schizophrenia achieve a higher percentage of goal-directed behaviors (e.g., carrying out leisure activities). The study was quasi-experimental and utilized a wait list control.

3.7.5. Traumatic brain injury (TBI)

Hart and Vaccaro (2017) found SMS reminders helped individuals nearing discharge from intensive outpatient brain injury treatment with a TBI in the United States to more effectively implement goal-directed behaviors (e.g., seeking out appropriate social interaction). The study was an RCT with the control group receiving treatment as usual (TAU).

3.7.6. Suicidal ideation

Kodama et al. (2016) found SMS messages with informational links to social welfare services made psychiatric outpatients with high levels of suicidal ideation in Japan more likely to seek help when experiencing suicidal ideation. The study was quasi-experimental.

3.7.7. Substance use

Spohr et al. (2015) found SMS reminders helped adults (ages 19 to 62) on probation in the United States maintain substance use abstinence and initiate substance use treatment while in a criminal justice setting. The study was a RCT with the control group receiving no reminders.

3.7.8. Adult circumcision

Odeny et al. (2014) used SMS reminders to deter adult males in Kenya from resuming sexual activity too soon after circumcision. This basic intervention was not successful in reducing early resumption of sexual activity. The researchers suggest further investigation of SMS reminders should be paired with a behavioral intervention, citing the high likelihood that participants may not have understand postoperative instructions.

3.7.9. Smoking cessation

Abroms et al. (2014) used SMS reminders to help adults (mean age: 35.7 years old) in the United States stop smoking. The study found that the interactive, personalized reminders helped individuals abstain from smoking statistically significantly more than the control group that received self-help TAU.

4. Discussion

The results of this literature review demonstrate SMS reminders can be effectively implemented worldwide (e.g., Chen et al., 2008 ) and in a variety of settings (e.g., Stockwell et al., 2014 ) to help improve health care services. SMS reminders show excellent promise as an automated support mechanism. The review found 86% (48/56) of appointment-reminder studies and 85% (83/97) of medical compliance reminder studies reported positive results associated with SMS messages. The reminders helped increase appointment attendance (e.g., Guy et al., 2013 ) and before-appointment cancellations (an unexpected outcome; e.g., Steiner et al., 2016 ), as well as decrease missed appointments (e.g., Altuwaijri et al., 2012 ). By decreasing missed appointments and increasing advance cancellations, health care providers can save time and money, maintain uninterrupted care, and allow other patients to receive needed treatment ( da Costa et al., 2010 ; Farmer et al., 2014 ; Rohman et al., 2015 ; Ting et al., 2012 ). SMS reminders also helped increase the rate of medication adherence (e.g., Montes et al., 2012 ), non-medication treatment adherence (e.g., Balato et al., 2013 ), and vaccination completion (e.g., Stockwell et al., 2014 ).

SMS reminders showed promising results in studies of various diseases and conditions, including HIV, diabetes, heart problems, schizophrenia, skin problems, asthma, IBS, Parkinson's disease, psychosis, stroke, Hepatitis A and B, and breast cancer. A minority of studies did not find positive results. However, even these authors suggested that potential limitations such as small sample size ( Fischer et al., 2012 ) or control group participants using their own reminders ( Hou et al., 2010 ; Mbuagbaw et al., 2012 ) may have confounded the results. The review found a single study investigating each of the following: IBS, Parkinson's disease, psychosis, stroke, breast cancer, and oral contraception. Given the lack of research in these areas, further research would be helpful to better understand the impact SMS reminders can have on these particular health care problems. However, given the composite effectiveness of SMS reminders for health care problems and the initial promising results described above, it seems probable SMS reminders are effective if implemented as a reminder mechanism.

4.1. Benefits of SMS reminders

SMS messages are relatively inexpensive, easily customized, automatically sent directly to individuals, and a part of many individuals' daily life. Given these attributes, it is not surprising many studies utilize SMS as a reminder to help improve health care services. SMS can function as a reminder both for recurring (e.g., daily medication adherence) and distal, one-time (e.g., to complete a follow-up vaccination two months after initial vaccination) behaviors. Clinics report major financial savings after implementing an automated, SMS-reminder system, and attribute the savings to the relative inexpensiveness of SMS reminders and the decreased rate of missed appointments (e.g., Pratap et al., 2015 ; Rohman et al., 2015 ). SMS messages may also help individuals who need additional support or structure to remember things or to engage in a behavior (e.g., individuals with schizophrenia or a TBI) ( Hart and Vaccaro, 2017 ; Pijnenborg et al., 2010 ).

Medical professionals can use technology to help guide their treatment. With technology, they can receive more accurate information about treatment adherence when they are treating patients whose recall and self-report may not be accurate (e.g., Boker et al., 2012 ).

4.2. Potential consequences, risks, and drawbacks of SMS reminders

Patient confidentiality is frequently cited as a risk of using SMS in health care treatment (e.g., Branson et al., 2013 ; Downer et al., 2005 ). While confidentiality is a risk, there are steps that can be taken to mitigate the concern. These steps include: sending generic reminders (e.g., “See you next Thursday at 5”); informing individuals to open messages in a private location and delete messages after reading them; and suggesting individuals use password protection on their phones. However, SMS is an inherently insecure system technology. Unless an encrypted messaging application is being used, there is a possibility that any message sent can be read by someone other than the intended recipient—a risk that most individuals take on a daily basis (willingly or unwittingly).

One drawback is individuals not reading the messages they've received. A potential strategy to mitigate the possibility of messages being ignored is to utilize interactive or two-way messaging that elicits a response from message recipients. Another drawback is the possibility that recipients may become annoyed at receiving multiple messages over time. Note that none of the studies reviewed found SMS reminders caused adverse iatrogenic results.

4.3. Future directions

SMS reminders show great promise for use across the broad scope of health care services. This review found SMS reminders are highly effective as both an appointment and medical compliance reminder. Additionally, SMS reminders were found to be effective at prompting a number of other health behaviors, including self-medical examinations, socialization, and goal-directed behaviors. As of now, it is unclear what is the most effective dose of SMS reminders (i.e., timing, frequency, and total number of messages) and under what conditions should dosage be changed over time. It is likely dosage varies between individuals and is impacted by the perceived importance of the reminder (e.g., is it for something crucial to your health or for changing a behavior you aren't particularly motivated to change?). Additionally, the underlying mechanism that makes SMS reminders effective and aid prospective memory is not understood. Further research on these topics can help inform future implementations of reminders.

There is an existing body of research on the use of SMS to deliver interventions (e.g., Haug et al., 2012 ). Some studies have also investigated using SMS reminders as an adjunct (e.g., receiving an appointment reminder to continue attending the main intervention) to therapy (e.g., Abroms et al., 2014 ). However, very few studies have investigated the effectiveness of using SMS as a supportive adjunct to behavioral health treatment. One such study ( Aguilera et al., 2017 ) used text messages not only as a reminder, but also as a support mechanism for racial/ethnic minority patients receiving cognitive-behavioral therapy (CBT) for depression. While the study did not find a statistically significant benefit of SMS, this is an area that may require further research to better understand how to implement reminders as a prompt to help support behavior change.

4.4. Limitations

While this review draws from many diverse sources, the data were synthesized using a narrative method rather than a meta-analysis, thus the findings cannot be used to recommend a preferred strategy for the use of SMS reminders in health care. The studies varied in methodological rigor, which may have impacted their results and biased the interpretation in this review. Studies were only selected from peer-reviewed, English-language journals, which may have restricted the findings.

5. Conclusion

The findings for the use of SMS reminders in health care treatment are very promising. A rapidly increasing body of literature on SMS reminders demonstrates the value of using SMS reminders. The results indicate SMS reminders provide an inexpensive, easily implemented, and automatable method to help increase medical compliance and improve appointment attendance. Additionally, these results suggest SMS reminders may be helpful in improving prospective memory and supplementing behavior change interventions by reminding recipients to engage (or not engage) with behaviors they wish to change.

Declaration of conflicting interests

The authors declare that there is no conflict of interest with respect to the research, authorship, and/or publication of this article.

This work was supported by the National Institute on Alcohol Abuse and Alcoholism [grant number 1F31AA025531-01].

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• Relationships

Why Are People Dependent on Texting?

Addicted to text messaging new research explains why..

Posted September 28, 2018

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A new study published in Computers in Human Behavior shows how attitudes about communicating online — such as whether a person believes texting will lead to miscommunication, is easier than face-to-face communication or is an important part of maintaining relationships — can explain “text intensity,” or how dependent that person is on text messaging.

According to Dr. Andrew Ledbetter , there are five attitudes people can hold about online communication. People vary on how much they hold each of these five attitudes. Those variations can come from the way a person grew up communicating with their family, or that person’s competence or skill at communicating with others.

1. The attitude of self-disclosure refers to the anxiety people may have about sharing personal and private information online.

2. The attitude of apprehension refers to feelings of dread or fear of communicating online.

3. The attitude of miscommunication refers to beliefs about how common misunderstandings and conflict are when communicating online, because online communication makes it difficult for people to understand one another.

4. The attitude of social connection refers to beliefs about how the ability of online communication facilitates a person’s social life , and how their social connections would suffer if they were no longer able to communicate online.

5. The attitude of ease refers to how people feel about the convenience and efficiency of communicating online. This attitude also captures whether people enjoy communicating online.

In a new study conducted by myself, Dr. Megan Kenny Feister at California State University Channel Islands, and Dr. Stephanie Tikkanen at Ohio University, we found that all five online communication attitudes were associated with how much a person depends on and integrates text messaging into their lives. People who believed sharing information about themselves was easier through texting than talking face-to-face were, perhaps unsurprisingly, more dependent on texting. People who said they would feel “out of the loop” with friends if they were not able to text also reported higher text dependence. People who felt awkward communicating through texts were, on the other hand, less dependent on texting.

The research study also looked at the effect of "self-monitoring" on those attitudes and dependency on texting. "Self-monitoring" refers to a person’s ability to adapt to a variety of social situations. A person is a high self-monitor if they can recognize that they should behave differently at work, at a dinner party, and at home with their children. Not only would a high self-monitor recognize that they should act differently, but they would actually change their behaviors for each occasion. By itself, the trait of self-monitoring leads people to depend less on texting, likely because people who are socially aware recognize the limitations of texting (like the lack of nonverbal cues) and choose other ways to communicate that allow them more control over their self-image .

For people who believe that communicating online allows them to connect with others socially, self-monitoring had the opposite effect. In other words, people who are high self-monitors and who strongly believe that online communication allows them to connect to others tended to experience more dependence on texting. The same pattern was true for people who did not feel much apprehension about texting. For those people, self-monitoring was related to more text dependency.

This study shows that attitudes about online communication matter, and can be useful in understanding why some people are so dependent on texting as a form of communication.

Dorrance Hall, E., Feister, M. K., & Tikkanen, S. (2018). A mixed-method analysis of the role of online communication attitudes in the relationship between self-monitoring and emerging adult text intensity. Computers in Human Behavior, 89, 269-278. doi: 10.1016/j.chb.2018.08.002

Ledbetter, A. M. (2009). Measuring online communication attitude: Instrument development and validation. Communication Monographs, 76, 463-486. doi: 10.1080/03637750903300262

Ledbetter, A. M. (2010). Family communication patterns and communication competence as predictors of online communication attitude: Evaluating a dual pathway model. Journal of Family Communication, 10, 99-115. doi: 10.1080/15267431003595462

Elizabeth Dorrance Hall, Ph.D. , is an Assistant Professor of Communication, Michigan State University and Director, Family Communication and Relationships Lab.

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Text-Messaging Prescreening Streamlines Treatment Visits and Care for ICI Toxicities

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Prescreening patients for immune-related adverse events during treatment with immune checkpoint inhibitors (ICIs) using text messaging may reduce the need for some in-person, preinfusion office visits, researchers reported in JAMA Network Open. The approach may help decrease the burden of cancer care for both patients and providers.

In a single-center, cross-sectional study, researchers compared use of a text message–based triage instrument to identify patient-reported ICI toxic effects to standard in-person clinician assessments documented in patients’ electronic health record. Of the 45 patients who completed the text-message prescreening, 31 (62%) were male and 44 (88%) were White, and their median age was 68.

A total of 57.8% of the patients reported ICI toxic effects through the text-messaging prescreening. The instrument had 100% sensitivity with a 0% false-negative rate, 47% specificity, and 100% negative predictive value. The most common barriers limiting patients’ ability to complete the text-messaging prescreening were visual impairments and access to a smartphone.

“We show in this cross-sectional study that a simple text message–based questionnaire can accurately identify patients who are not experiencing symptoms of ICI toxic effects,” the researchers wrote . “This implies that such patients with normal laboratory parameters can likely bypass the usual pretreatment office visit and proceed directly to ICI infusion with minimal risk of missing an immune-related adverse event, which offers the potential to reduce up to 20% of office visits.”

Listen to strategies for educating your patients about reporting toxicities on the Oncology Nursing Podcast , and find other ICI and immunotherapy resources in ONS’s Immuno-Oncology Learning Library .

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Text message program from Truth Initiative helps teens quit e-cigarettes

Teens enrolled in Truth Initiative’s text message-based quit-vaping program were 35% more likely to quit vaping nicotine within seven months compared to those not enrolled in the program, according to research published in the Journal of the American Medical Association . The study, which surveyed 1,503 e-cigarette users ages 13-17, also found the program is effective for teens with high levels of nicotine dependence and mental health concerns.

The research represents the first randomized clinical trial to evaluate a quit-vaping program in this age group. It found that 37.8% of teens enrolled in the interactive program reported abstaining from vaping nicotine at the seven-month mark compared to 28% in the control group, a statistically significant difference. Quit rates among teens exceeded those of a similar clinical trial conducted among users ages 18-24 enrolled in the program and were significantly higher than abstinence rates in most teen quit smoking trials .

The quit-vaping program from Truth Initiative and its national truth public education campaign is a first-of-its-kind, free and anonymous text messaging program designed to help young people quit vaping nicotine. The program incorporates messages from other teens who have attempted to or successfully quit e-cigarettes. The text message intervention tested in this study is called This is Quitting, now part of the EX Program from Truth Initiative. Since This is Quitting launched as a text message program in 2019, over 750,000 young people have enrolled in the program.

Teens and young adults can text DITCHVAPE to 88709 to receive free quit vaping support from the program.

By texting DITCHVAPE to 88709, you consent to recurring messages from Truth Initiative to help you quit vaping, and agree to the Terms & Conditions and Privacy Policy . Text STOP to opt-out. Text HELP for info. Msg & Data Rates May Apply. 

Effectiveness among highly addicted e-cigarette users

All participants of the clinical trial, which took place between October 2021 and October 2023, received incentivized monthly text messages about e-cigarette use to encourage them to complete the study. The intervention group was also enrolled in the program, while control participants did not receive additional support. As a double-blind study, researchers randomly assigned participants to groups and participants did not know which intervention they were receiving.

The study found that This is Quitting was effective among teens with high levels of nicotine dependence and mental health issues. Most teens in the study were highly addicted to nicotine. More than three-quarters (76.2%) used e-cigarettes within 30 minutes of waking – a common way to measure addiction – and 93.6% reported feeling somewhat or very addicted to vaping nicotine. Most (87.3%) had tried to quit in the past year, and more than half (53.4%) had previously made three or more quit attempts. Teens also shared problems with depression, sleep, anxiety, trauma, and substance use, as well as high rates of using multiple substances.

“The significant treatment effect observed in this study against this backdrop of risk factors underscores the power of a digital behavior change intervention to drive clinically meaningful outcomes,” the researchers write.

Young people want to quit, citing concerns about mental health

E-cigarettes are the most popular nicotine product with young people today. In 2023, 10% of high school students used e-cigarettes with more than one in four vaping daily,  according to the National Youth Tobacco Survey . Interest in quitting vaping also remains high: 67% of 15- to 24-year-old e-cigarette users said they were considering quitting as a New Year’s resolution , according to a December 2023 Truth Initiative survey. A separate study that analyzed reasons for quitting among young people enrolled in the program found that health, mental health, and social influence were among the top reasons for quitting vaping nicotine.

Studies show that mental health symptoms improve after quitting nicotine . Quitting smoking is linked with lower levels of anxiety, depression, and stress, according to a 2014 meta-analysis of 26 studies published in the British Medical Journal. And while evidence of a link between quitting vaping and improvements in mental health symptoms is emerging, Truth Initiative survey data show support for this connection: 90% of e-cigarette users who quit said they felt less stressed, anxious, or depressed.

Mounting evidence to support tailored, interactive text message interventions for quitting vaping

This study builds on previous research demonstrating the effectiveness of This is Quitting in young people. A previous randomized clinical trial found  that young adults ages 18-24 who used This is Quitting had nearly 40% higher odds of quitting compared to a control group. A second clinical trial proved the program was not only successful in helping young people quit vaping, but also in  ensuring they don’t later use combustible tobacco products  in place of e-cigarettes.

Combined with the results of the most recent study, this research indicates that a tailored, interactive text message intervention can effectively deliver vaping cessation treatment and encourage youth and young adults to quit vaping.

“Text messaging is a scalable and cost-efficient approach to delivering vaping cessation treatment on a population basis,” researchers write. “These results begin to fill an important gap in understanding how to help adolescent e-cigarette users quit vaping nicotine.”

More in quitting smoking / vaping

Quitting vaping in 2024: Top tips and resources

Vaping prevention and quit resources: top tips for parents and educators

Young people quitting nicotine get help from truth®

Text Message Alerts

Text message alerts are becoming the mainstay to improve research participant/patient engagement and contribute critically to the success of studies., traditionally, text message alerts have only been a one-way, push communication channel used in mobile marketing. mosio was one of the first mobile messaging companies to embrace the power of efficient, two-way text messaging software, giving alerts and notifications a new level of usefulness in healthcare and clinical trials., our text alerts module enables you to send personalized messages with text, links, or emojis. these messages can be replied back to by participants in a two-way textchat. if you don’t want participants to be able to textchat, we’ll set up autoresponders with a different call to action (calling, emailing, etc)..

Key Feature: Storyline Alerts

Used in 90% of our clinical studies, mosio’s storyline alerts ™ feature offers the flexibility to send several different types of messages (text-based messages, urls or surveys), each catered to an individual participant’s enrollment start date., client example:, a client came to mosio wanting to run a study for diabetes with rolling enrollment. they wanted to send the intervention group a text message alert every day with tips for living with diabetes for 6 days, then on day 7 they sent a ten question survey. they also wanted participants to reply to the alerts they received and engage in a two-way conversation via text message with staff if they needed support during the week. the control group received only the survey every 7 days. storyline alerts™ enabled the client to pre-schedule the tips and surveys over the period of their study, then start each patient as they enrolled them, regardless of the time or day of the week., as a result, the client received a significant amount of data, which allowed them to finalize the study without enrolling additional patients., storyline alerts™ can be used for medication adherence, delivery of educational information, gift codes, forms or text-based gamification elements as a way to motivate participants over longer term studies., deliver actionable information in real-time, text message alerts are proven to empower participants by keeping them informed on study activities and requirements., mosio understands that informed patients are better suited to actively participate and remain engaged in studies., by fostering this type of involvement, mosio puts researchers in the better position to achieve exceptional research outcomes..

Send Timely News and Updates

Patient newsletters and updates sent via text message alerts are another benefit of mosio’s award-winning text messaging alert platform., patients can receive timely, scheduled links to newsletters and continuously stay up-to-date on their clinical trial participation., improve recruitment efforts, new study text message alerts provide a quick and cost-effective way to cast a wide net for potential new trial participants. mosio  has proven that providing captivating and timely opportunities for trial recruitment has resulted in improved enrollment outcomes ., with patient privacy and compliance in mind, mosio enables research teams to recruit potential trial participants through convenient and private mobile text message calls to action, eliminating the need for participants to make a phone call to a research site in a public place..

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Mosio is a two-way text messaging company specializing in mobile solutions for research. Our award winning Patient Engagement Platform enables researchers to engage and retain study participants through text message alerts, reminders, surveys and interactive TextChat features. Read more about us .

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Text Message Notification for Web Surveys

Sending texts to survey panel members shortens response time.

By Kyley McGeeney and H. Yanna Yan

Text messaging has grown in popularity in recent years, leading survey researchers to explore ways texts might be used as tools in the public opinion research process. In the U.S., at least, researchers must obtain consent from respondents before they are permitted to send an automated text. This means that text messaging can’t be used in standard one-off surveys of the public – surveys where pollsters reach out to a randomly sampled list of telephone numbers. Texting also presents measurement challenges in terms of offering only limited space for writing questions and requiring respondents to type rather than click. While these factors limit the utility of texting for interviewing itself, texting has been explored as a means of alerting people to complete a survey, such as by sending them a link to a web survey. 1

A new study by Pew Research Center found that sending notifications via text to consenting survey panel members improves response time (people take the survey sooner, on average) and boosts the share of respondents completing the survey on a mobile device. It does not, however, increase the ultimate response rate over a longer field period compared with sending notifications by email only.

These results come from two experiments conducted by Pew Research Center using its American Trends Panel (ATP), a probability-based, nationally representative group of people who have agreed to take multiple surveys and receive text messages about them. The first experiment examined the effect of sending a text as a first notification to take a survey. The second experiment examined using text messages to remind people to take a survey. These messages were sent several days after the initial notification.

In the first experiment, web panelists who had previously consented to receiving text messages (2,109 out of 3,634 web panelists in total) were randomized into one of two groups: one group received survey invitations via email and the other received them via both text message and email. 2

On average, panelists in the email and text group completed the survey earlier than those in the email-only group. This difference was most dramatic at the beginning of the survey field period. By the end of the first full day, half (50%) of the email and text group had completed the survey, compared with 37% of the email-only group.

In the second experiment, all web panelists who had consented to text messages were sent survey invitations via email and text message. Those who hadn’t responded after three days were then randomized into one of two groups: One group only received reminders via email and the other received reminders via email and text 3 .

Again, on average, panelists in the text and email reminder group responded earlier than panelists in the email-only reminder group. By the 10th day, the text and email reminder group had a wave-level response rate of 48% vs. 39% in the email-only reminder group. However, there was no significant difference in the final wave-level response rate by the end of the field period.

This report examines the response patterns and demographic composition of respondents in each group for the two experiments. It also looks more broadly at who in the panel consented to receiving this type of survey text message.

Text messages produce earlier responses but no difference in final response rate

When panelists received invitations via text message and email, they completed the survey earlier in the field period than those who received only email. In fact, in the first 30 minutes after the survey invitations were sent, 15% of the text message and email group had responded to the survey vs. only 6% of the email-only group. This has important implications for survey researchers who need to collect data in a short amount of time.

By the end of the first full day in the field, half of the panelists (50%) in the text and email group had responded vs. only 37% of the email-only group. By the end of the third day, 59% of the text and email group had responded vs. 49% of the email-only group. The higher wave-level response rate in the text and email group continued through the 10th day in the field.

However, given enough time in the field, the email-only group’s response rate eventually catches up with that of the email and text group. By the end of the 20-day field period, there was no difference between the two groups in terms of the percent who opened the survey or the percent who responded.

In total, 84% of the email and text group opened the survey vs. 82% of the email-only group, which led to an 82% and 81% response rate, respectively. The 84% of text and email panelists who opened the survey consisted of 54% who opened the survey from the email link and 30% who opened using the link in the text message, as they had the option to use either link.

It’s important to note that had the field period been shorter, as is typical in other web surveys, the final response rate would have been higher for the text and email group. For instance, 10 days into the field period, 78% of the text and email group had responded compared with only 74% of the email group. After 10 days the difference between the two groups narrowed to just 1 percentage point.

Text messages lead to more interviews completed on a smartphone

Not surprisingly, sending invitations via text message encourages respondents to complete the survey on a smartphone.

Within the email and text group, about half (51%) of respondents completed the survey on a smartphone, compared with only a third (33%) of respondents in the email-only group, despite similar rates of smartphone ownership in the two groups. 4

Taken together with tablets, 57% of respondents in the text and email group completed the survey using a mobile device, compared with only 42% of the email-only group. For survey researchers who want to leverage features of smartphones in their studies, such as capturing GPS (with appropriate consent) or asking respondents to take pictures, this could be quite helpful.

On the other hand, certain types of surveys are better suited for completion on a desktop or laptop computer, such as very long surveys or those using software that is not optimized for smartphones. For these types of surveys, encouraging completion on a mobile device could lead to data quality issues or higher break-off rates.

Text message invitations did not distort respondent demographic composition

Demographically, the respondents in the text message and email group were virtually indistinguishable from respondents in the email-only group. There were no differences between the two groups in terms of sex, age, race/ethnicity, education, income, party affiliation or urbanicity. The only difference found was that the email-only group was somewhat more likely to be religiously unaffiliated (26%) than the text message and email group (21%). Even limiting the analysis to respondents from the first 10 days still produces no demographic difference between the two groups apart from religious affiliation.

This lack of demographic difference across the two sets of respondents is encouraging, as there is evidence that texting is more popular among certain demographic groups than others, such as among younger adults or those with higher education. The experiment suggests that these differences in who texts did not result in differences in who responded to the panel survey when text invitations were used. This may be due in part to the fact that in both experiments all respondents received email invitations. If, by contrast, respondents were only allowed to access the survey via the link from the text, then the effect on the demographic profile of the responding sample may have been more noticeable.

Not all panelists consent to text messages; those who do are demographically distinct

[According to the Centers for Disease Control and Prevention’s National Health Interview Survey , 91% of adults own cellphones. When last measured by Pew Research Center in 2013, 81% of cellphone owners used text messaging. Taken together, at least 74% of U.S. adults use text messaging. Given the rise in text messaging over time , this is likely an underestimate.]

Under federal law, researchers need prior consent in order to send automated text messages to potential respondents. Text messaging was possible in this panel study because consent was obtained from panelists prior to this study being conducted.

Those who consented to receiving survey text messages tend to be younger and higher income than those who didn’t consent. Consenters are more likely to live in urban areas and to be Democrats. They are less likely to be white or to be Protestant. However, there is no difference between the consenter and nonconsenters in sex or education.

Additionally, 5% of panelists consented to receiving text messages but could not receive Pew Research Center text messages because ATP texts are sent using short codes, which the panelists had blocked. Short codes are five- to six-digit phone numbers that companies use to, among other things, send automated text messages to a large set of mobile telephone numbers more quickly than if using a traditional 10-digit phone number (long code). Some cellphone carriers, device manufacturers and/or individuals choose to block text messages sent from short codes.

All in all, only 49% of web panelists could receive survey text messages because they owned a cellphone, consented to receiving text messages and did not have short codes blocked. 5  Pew Research Center uses short codes due to the volume of texts being sent and the speed efficiencies, but using a long code would allow researchers to reach these additional panelists.

Reminder texts result in earlier responses, but not higher overall wave-level response rate

In the second experiment, all consenting respondents received text message and email invitations to their surveys. Those who had not responded by the third day were randomized into either the treatment group, which received text and email reminders, or the control group, which received only email reminders. Reminders were sent on days 4, 9, and 15 of the field period.

The text message reminders resulted in earlier responses, although by day 11 the control group had caught up and was no longer statistically significantly lower than the treatment group. By the end of the 20-day field period there was no statistically significant difference in the final open or response rates between the treatment and control group. That said, the 20-day field period used in the ATP is longer than that of most public opinion surveys. If the field period had been 10 days, for example, the text message reminders would have resulted in a significantly higher final wave-level response rate.

Reminder text messages skewed responding sample slightly older

The respondents who received only email reminders but still answered the survey were younger than the respondents who received both text and email reminders. Of the email-only group, one quarter (25%) were ages 18 to 29 versus only 15% of the text and email group. This was unexpected because of the popularity of texting among this age group. One possible explanation is that younger people use text messaging more than older adults, so the text message reminders may have been less novel. There were no other differences in demographics between the two groups of respondents.

Text messages are now standard American Trends Panel protocol

Based on the results of these experiments, consensual text message invitations and reminders are now standard protocol for the American Trends Panel. The next step is to explore using consensual text messages to collect the survey responses themselves, rather than just using texts to send links to web surveys.

• See Crawford, S., C. McClain, S. O’Brien and T. Nelson. 2013. “Examining the Feasibility of SMS as a Contact Mode for a College Student Survey.” Paper presented at the annual meeting of the American Association for Public Opinion Research, Boston; De Bruijne, M., and A. Wijnant. 2014. “Improving Response Rates and Questionnaire Design for Mobile Web Surveys.” Public Opinion Quarterly, 78 (4): 951-962; Mavletova, A. and M. Couper. 2014. “Mobile Web Survey Design: Scrolling Versus Paging, SMS Versus E-mail Invitations.” Journal of Survey Statistics and Methodology, 2(4): 498-518. ↩
• In this first experiment all panelists received reminders via email and all web panelists with mailing addresses on file (96% of web panelists) also received a pre-notification postcard. In order to isolate the effect of the text messages, the analysis of this experiment was limited to web panelists who had consented and also receive an advance postcard. This excluded 130 web panelists who had consented to receiving text messages but did not have an address on file. ↩
• In the second experiment there was no exclusion based on whether or not the panelist received the advance postcard. ↩
• All panelists in the email and text and email-only groups have cellphones, but not all have smartphones. The rate of smartphone ownership was nearly identical for the two groups: 92% of the text and email group vs. 90% of the email-only group own smartphones. ↩
• The panel vendor made an effort to help panelists unblock short codes. Of the 273 panelists who originally had short codes blocked, 44 had telephone carriers that prohibited them from being unblocked even if the panelist wanted to allow it. The other 229 panelists had one of the top five carriers that would allow short codes to be unblocked. An email was sent to these panelists with instructions on how to unblock short codes. After this effort, 160 remained blocked in addition to the original 44 whose carriers prohibited unblocking. ↩

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